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Bile AS, Ali-Salad MA, Mahmoud AJ, Singh NS, Abdelmagid N, Sabahelzain MM, Checchi F, Mounier-Jack S, Nor B. Assessing Vaccination Delivery Strategies for Zero-Dose and Under-Immunized Children in the Fragile Context of Somalia. Vaccines (Basel) 2024; 12:154. [PMID: 38400137 PMCID: PMC10892412 DOI: 10.3390/vaccines12020154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
Somalia is one of 20 countries in the world with the highest numbers of zero-dose children. This study aims to identify who and where zero-dose and under-vaccinated children are and what the existing vaccine delivery strategies to reach zero-dose children in Somalia are. This qualitative study was conducted in three geographically diverse regions of Somalia (rural/remote, nomadic/pastoralists, IDPs, and urban poor population), with government officials and NGO staff (n = 17), and with vaccinators and community members (n = 52). The data were analyzed using the GAVI Vaccine Alliance IRMMA framework. Nomadic populations, internally displaced persons, and populations living in remote and Al-shabaab-controlled areas are three vulnerable and neglected populations with a high proportion of zero-dose children. Despite the contextual heterogeneity of these population groups, the lack of targeted, population-specific strategies and meaningful engagement of local communities in the planning and implementation of immunization services is problematic in effectively reaching zero-dose children. This is, to our knowledge, the first study that examines vaccination strategies for zero-dose and under-vaccinated populations in the fragile context of Somalia. Evidence on populations at risk of vaccine-preventable diseases and barriers to vital vaccination services remain critical and urgent, especially in a country like Somalia with complex health system challenges.
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Affiliation(s)
- Ahmed Said Bile
- Somali Institute for Development Research and Analysis (SIDRA), Garowe, Puntland State, Somalia; (M.A.A.-S.); (A.J.M.)
| | - Mohamed A. Ali-Salad
- Somali Institute for Development Research and Analysis (SIDRA), Garowe, Puntland State, Somalia; (M.A.A.-S.); (A.J.M.)
| | - Amina J. Mahmoud
- Somali Institute for Development Research and Analysis (SIDRA), Garowe, Puntland State, Somalia; (M.A.A.-S.); (A.J.M.)
- Department of Women’s and Children’s Health, Uppsala University, 753 10 Uppsala, Sweden;
| | - Neha S. Singh
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (N.S.S.); (N.A.); (F.C.)
- Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Nada Abdelmagid
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (N.S.S.); (N.A.); (F.C.)
- Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Majdi M. Sabahelzain
- School of Health Sciences, Ahfad University for Women (AUW), Omdurman P.O. Box 167, Sudan;
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Francesco Checchi
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (N.S.S.); (N.A.); (F.C.)
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Sandra Mounier-Jack
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Barni Nor
- Department of Women’s and Children’s Health, Uppsala University, 753 10 Uppsala, Sweden;
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Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Santiago B, Caminero JA, Barros C, García de Viedma D, Martín C, Bouza E. Tuberculosis in Spain: An opinion paper. Rev Esp Quimioter 2023; 36:562-583. [PMID: 37922367 DOI: 10.37201/req/115.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
This document is the result of the deliberations of the Committee on Emerging Pathogens and COVID-19 of the Illustrious Official College of Physicians of Madrid (ICOMEM) regarding the current situation of tuberculosis, particularly in Spain. We have reviewed aspects such as the evolution of its incidence, the populations currently most exposed and the health care circuits for the care of these patients in Spain. We have also discussed latent tuberculosis, the reality of extrapulmonary disease in the XXI century and the means available in daily practice for the diagnosis of both latent and active forms. The contribution of molecular biology, which has changed the perspective of this disease, was another topic of discussion. The paper tries to put into perspective both the classical drugs and their resistance figures and the availability and indications of the new ones. In addition, the reality of direct observation in the administration of antituberculosis drugs has been discussed. All this revolution is making it possible to shorten the treatment time for tuberculosis, a subject that has also been reviewed. If everything is done well, the risk of relapse of tuberculosis is small but it exists. On the other hand, many special situations have been discussed in this paper, such as tuberculosis in pediatric age and tuberculosis as a cause for concern in surgery and intensive care. The status of the BCG vaccine and its present indications as well as the future of new vaccines to achieve the old dream of eradicating this disease have been discussed. Finally, the ethical and medicolegal implications of this disease are not a minor issue and our situation in this regard has been reviewed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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Jackson EB, Simmons CE, Chia SK. Current Challenges and Disparities in the Delivery of Equitable Breast Cancer Care in Canada. Curr Oncol 2023; 30:7263-7274. [PMID: 37623008 PMCID: PMC10453522 DOI: 10.3390/curroncol30080527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Recent exciting advances in the diagnosis and management of breast cancer have improved outcomes for Canadians diagnosed and living with breast cancer. However, the reach of this progress has been uneven; disparities in accessing care across Canada are increasingly being recognized and are at risk of broadening. Members of racial minority groups, economically disadvantaged individuals, or those who live in rural or remote communities have consistently been shown to experience greater challenges in accessing 'state of the art' cancer care. The Canadian context also presents unique challenges-vast geography and provincial jurisdiction of the delivery of cancer care and drug funding create significant interprovincial differences in the patient experience. In this commentary, we review the core concepts of health equity, barriers to equitable delivery of breast cancer care, populations at risk, and recommendations for the advancement of health equity in the Canadian cancer system.
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Affiliation(s)
- Emily B. Jackson
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Christine E. Simmons
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Stephen K. Chia
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Lucindo Zucoloto M, Meneghini AC, Zangiacomi Martinez E. Panorama of COVID-19, risk perception and vaccine confidence in São Paulo State population, Southeast Brazil. Health Soc Care Community 2022; 30:e4662-e4672. [PMID: 35689448 PMCID: PMC9349625 DOI: 10.1111/hsc.13872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 04/25/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
In 2021, the COVID-19 pandemic remained uncontrolled in Brazil, with more than 17.6 million cases diagnosed and more than a half a million deaths in total. It is known that an accurate risk perception by populations and a consequent adherence to preventive measures can increase the effectiveness of policies to contain the transmission of infectious diseases. The objective of this study was to draw a panorama of COVID-19 in São Paulo State and investigate the population's risk perception about the new coronavirus, attitudes regarding preventive measures and vaccine confidence through an open web survey. A total of 1111 individuals participated (71.6% females). Of those, 15% declared themselves unemployed, almost 6% lost their jobs during the pandemic, and more than 30% suffered a decrease in their monthly income. As for the COVID-19, almost 32% of the participants were tested sometime in 2020, and 11.3% reported a confirmed diagnosis for a level of hospitalisation of 5%. As for the risk perception, it was observed that situations with crowds of people were more frequently considered as of high risk and cause of greater concern with contamination of family members than with themselves. Almost 23% of the participants questioned whether they would take the vaccine when available and do not know if the COVID-19 vaccine will be safe for the population. Almost 70% disagreed with the statement that the actions of the country's health authorities are effective in combating COVID-19. Considering the Cramer's V coefficient, these variables were not associated with gender or educational level.
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Lamster IB, Malloy KP, DiMura PM, Cheng B, Wagner VL, Matson J, Proj A, Xi Y, Abel SN, Alfano MC. Dental Services and Health Outcomes in the New York State Medicaid Program. J Dent Res 2021; 100:928-934. [PMID: 33880960 PMCID: PMC8293758 DOI: 10.1177/00220345211007448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Previous reports suggest that periodontal treatment is associated with improved health care outcomes and reduced costs. Using data from the New York State Medicaid program, rates of emergency department (ED) use and inpatient admissions (IPs), as well as costs for ED, IPs, pharmacy, and total health care, were studied to determine the association of preventive dental care to health care outcomes. Utilization of dental services in the first 2 y (July 2012-June 2014) was compared to health care outcomes in the final year (July 2014-June 2015). Costs and utilization for members who did not receive dental services (No Dental) were compared to those who received any dental care (Any Dental), any preventive dental care (PDC), PDC without an extraction and/or endodontic treatment (PDC without Ext/Endo), PDC with an Ext/Endo (PDC with Ext/Endo), or Ext/Endo without PDC (Ext/Endo without PDC). Propensity scores were used to adjust for potential confounders. After adjustment, ED rate ratios were significantly lower for PDC and PDC without Ext/Endo but higher for the Any Dental and Ext/Endo without PDC. IP ratios were lower for all treatment groups except Ext/Endo without PDC. ED costs differed little compared to the No Dental group except for Ext/Endo without PDC. For IPs, costs per member were significantly lower for all groups (-$262.91 [95% confidence interval (CI), -325.40 to -200.42] to -$379.82 [95% CI, -451.27 to -308.37]) except for Ext/Endo without PDC. For total health care costs, Ext/Endo without PDC had a significantly greater total health care cost ($530.50 [95% CI, 156.99-904.01]). Each additional PDC visit was associated with a 3% reduction in the relative risk for ED and 9% reduction for IPs. Costs also decreased for total health care (-$235.64 [95% CI, -299.95 to -171.33]) and IP (-$181.39 [95% CI, -208.73 to -154.05]). In conclusion, an association between PDC and improved health care outcomes was observed, with the opposite association for Ext/Endo without PDC.
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Affiliation(s)
- I B Lamster
- School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.,Columbia University College of Dental Medicine, New York, NY, USA
| | - K P Malloy
- Bureau of Chronic Disease Evaluation and Research, CSP Data Unit, Office of Public Health, New York State Department of Health (NYSDOH), Albany, NY, USA
| | - P M DiMura
- Bureau of Research and Analysis, Division of Performance Improvement and Patient Safety, Office of Quality and Patient Safety, NYSDOH, New York, NY, USA
| | - B Cheng
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - V L Wagner
- Bureau of Research and Analysis, Division of Performance Improvement and Patient Safety, Office of Quality and Patient Safety, NYSDOH, New York, NY, USA
| | - J Matson
- Division of Performance Improvement and Patient Safety, Office of Quality and Patient Safety, NYSDOH, Albany, NY, USA
| | - A Proj
- Bureau of Chronic Disease Evaluation and Research, CSP Data Unit, Office of Public Health, New York State Department of Health (NYSDOH), Albany, NY, USA
| | - Y Xi
- Bureau of Environmental and Occupational Epidemiology, NYSDOH, New York, NY, USA
| | - S N Abel
- Department of Periodontics and Endodontics, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - M C Alfano
- College of Dentistry, New York University, New York, NY, USA
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Abstract
An association between malaria and risk for death among patients with Ebola virus disease has suggested within-host interactions between Plasmodium falciparum parasites and Ebola virus. To determine whether such an interaction might also influence the probability of acquiring either infection, we used a large snapshot surveillance study from rural Gabon to test if past exposure to Ebola virus is associated with current infection with Plasmodium spp. during nonepidemic conditions. We found a strong positive association, on population and individual levels, between seropositivity for antibodies against Ebola virus and the presence of Plasmodium parasites in the blood. According to a multiple regression model accounting for other key variables, antibodies against Ebola virus emerged as the strongest individual-level risk factor for acquiring malaria. Our results suggest that within-host interactions between malaria parasites and Ebola virus may underlie epidemiologic associations.
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Teatero S, McGeer A, Tyrrell GJ, Hoang L, Smadi H, Domingo MC, Levett PN, Finkelstein M, Dewar K, Plevneshi A, Athey TBT, Gubbay JB, Mulvey MR, Martin I, Demczuk W, Fittipaldi N. Canada-Wide Epidemic of emm74 Group A Streptococcus Invasive Disease. Open Forum Infect Dis 2018; 5:ofy085. [PMID: 29780850 DOI: 10.1093/ofid/ofy085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/17/2018] [Indexed: 11/14/2022] Open
Abstract
Background The number of invasive group A Streptococcus (iGAS) infections due to hitherto extremely rare type emm74 strains has increased in several Canadian provinces since late 2015. We hypothesized that the cases recorded in the different provinces are linked and caused by strains of an emm74 clone that recently emerged and expanded explosively. Methods We analyzed both active and passive surveillance data for iGAS infections and used whole-genome sequencing to investigate the phylogenetic relationships of the emm74 strains responsible for these invasive infections country-wide. Results Genome analysis showed that highly clonal emm74 strains, genetically different from emm74 organisms previously circulating in Canada, were responsible for a country-wide epidemic of >160 invasive disease cases. The emerging clone belonged to multilocus sequence typing ST120. The analysis also revealed dissemination patterns of emm74 subclonal lineages across Canadian provinces. Clinical data analysis indicated that the emm74 epidemic disproportionally affected middle-aged or older male individuals. Homelessness, alcohol abuse, and intravenous drug usage were significantly associated with invasive emm74 infections. Conclusions In a period of 20 months, an emm74 GAS clone emerged and rapidly spread across several Canadian provinces located more than 4500 km apart, causing invasive infections primarily among disadvantaged persons.
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Affiliation(s)
- Sarah Teatero
- Public Health Ontario Laboratory, Toronto, ON, Canada
| | - Allison McGeer
- Sinai Health System, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gregory J Tyrrell
- Alberta Provincial Laboratory for Public Health, and Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada
| | - Hanan Smadi
- New Brunswick Department of Health, Communicable Disease and Control, Fredericton, NB, Canada
| | - Marc-Christian Domingo
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Ste-Anne de Bellevue, QC, Canada
| | - Paul N Levett
- Saskatchewan Disease Control Laboratory, Regina, SK, Canada
| | | | - Ken Dewar
- Genome Québec Innovation Centre, and McGill University, Montreal, QC, Canada
| | | | | | - Jonathan B Gubbay
- Public Health Ontario Laboratory, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Nahuel Fittipaldi
- Public Health Ontario Laboratory, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Wilcox HC, Fullerton JM, Glowinski AL, Benke K, Kamali M, Hulvershorn LA, Stapp EK, Edenberg HJ, Roberts GMP, Ghaziuddin N, Fisher C, Brucksch C, Frankland A, Toma C, Shaw AD, Kastelic E, Miller L, McInnis MG, Mitchell PB, Nurnberger JI. Traumatic Stress Interacts With Bipolar Disorder Genetic Risk to Increase Risk for Suicide Attempts. J Am Acad Child Adolesc Psychiatry 2017; 56:1073-1080. [PMID: 29173741 PMCID: PMC5797709 DOI: 10.1016/j.jaac.2017.09.428] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/08/2017] [Accepted: 09/29/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) is one of the most heritable psychiatric conditions and is associated with high suicide risk. To explore the reasons for this link, this study examined the interaction between traumatic stress and BD polygenic risk score in relation to suicidal ideation, suicide attempt, and nonsuicidal self-injury (NSSI) in adolescent and young adult offspring and relatives of persons with BD (BD-relatives) compared with adolescent and young adult offspring of individuals without psychiatric disorders (controls). METHOD Data were collected from 4 sites in the United States and 1 site in Australia from 2006 through 2012. Generalized estimating equation models were used to compare rates of ideation, attempts, and NSSI between BD-relatives (n = 307) and controls (n = 166) and to determine the contribution of demographic factors, traumatic stress exposure, lifetime mood or substance (alcohol/drug) use disorders, and BD polygenic risk score. RESULTS After adjusting for demographic characteristics and mood and substance use disorders, BD-relatives were at increased risk for suicidal ideation and attempts but not for NSSI. Independent of BD-relative versus control status, demographic factors, or mood and substance use disorders, exposure to trauma within the past year (including bullying, sexual abuse, and domestic violence) was associated with suicide attempts (p = .014), and BD polygenic risk score was marginally associated with attempts (p = .061). Importantly, the interaction between BD polygenic risk score and traumatic event exposures was significantly associated with attempts, independent of demographics, relative versus control status, and mood and substance use disorders (p = .041). CONCLUSION BD-relatives are at increased risk for suicide attempts and ideation, especially if they are exposed to trauma and have evidence of increased genetic vulnerability.
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Affiliation(s)
| | - Janice M Fullerton
- Neuroscience Research Australia, Sydney, New South Wales (NSW), Australia; University of New South Wales, Sydney
| | | | | | - Masoud Kamali
- Massachusetts General Hospital and Harvard University, Boston
| | | | | | | | | | | | | | | | - Andrew Frankland
- University of New South Wales, Sydney; Black Dog Institute, Sydney
| | - Claudio Toma
- Neuroscience Research Australia, Sydney, New South Wales (NSW), Australia; University of New South Wales, Sydney
| | - Alex D Shaw
- Neuroscience Research Australia, Sydney, New South Wales (NSW), Australia; University of New South Wales, Sydney
| | | | | | | | | | - John I Nurnberger
- Indiana University School of Medicine, Indianapolis; Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis
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Dury S, De Roeck E, Duppen D, Fret B, Hoeyberghs L, Lambotte D, Van der Elst M, van der Vorst A, Schols J, Kempen G, Rixt Zijlstra GA, De Lepeleire J, Schoenmakers B, Kardol T, De Witte N, Verté D, De Donder L, De Deyn PP, Engelborghs S, Smetcoren AS, Dierckx E. Identifying frailty risk profiles of home-dwelling older people: focus on sociodemographic and socioeconomic characteristics. Aging Ment Health 2017; 21:1031-1039. [PMID: 27267783 DOI: 10.1080/13607863.2016.1193120] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This paper investigates risk profiles of frailty among older people, as these are essential for detecting those individuals at risk for adverse outcomes and to undertake specific preventive actions. Frailty is not only a physical problem, but also refers to emotional, social, and environmental hazards. METHODS Using data generated from the Belgian Ageing Studies, a cross-sectional study (n = 28,049), we tested a multivariate regression model that included sociodemographic and socioeconomic indicators as well as four dimensions of frailty, for men and women separately. RESULTS The findings indicated that for both men and women, increased age, having no partner, having moved house in the previous 10 years, having a lower educational level and having a lower household income are risk characteristics for frailty. Moreover, when looking at the different frailty domains, different risk profiles arose, and gender-specific risk characteristics were detected. DISCUSSION This paper elaborates on practical implications, and formulates a number of future research recommendations to tackle frailty in an aging society. The conclusion demonstrates the necessity for a thorough knowledge of risk profiles of frailty, as this will save both time and money and permit preventive actions to be more individually tailored.
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Affiliation(s)
- Sarah Dury
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Ellen De Roeck
- b Laboratory of Neurochemistry and Behavior , University of Antwerp , Antwerp , Belgium.,c Department of Clinical and Lifespan Psychology , Vrije Universiteit Brussel , Brussels , Belgium
| | - Daan Duppen
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Bram Fret
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Lieve Hoeyberghs
- d Faculty of Education, Health and Social Work , University College Ghent , Gent , Belgium
| | - Deborah Lambotte
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Michaël Van der Elst
- e Department of General Practice , Catholic University of Leuven , Leuven , Belgium
| | - Anne van der Vorst
- f Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - Jos Schols
- f Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands.,g Department of General Practice, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - Gertrudis Kempen
- f Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - G A Rixt Zijlstra
- f Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - Jan De Lepeleire
- h Department of Public Health and Primary Care , University of Leuven , Leuven , Belgium
| | - Birgitte Schoenmakers
- h Department of Public Health and Primary Care , University of Leuven , Leuven , Belgium
| | - Tinie Kardol
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Nico De Witte
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium.,d Faculty of Education, Health and Social Work , University College Ghent , Gent , Belgium
| | - Dominique Verté
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Liesbeth De Donder
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Peter Paul De Deyn
- b Laboratory of Neurochemistry and Behavior , University of Antwerp , Antwerp , Belgium
| | | | - An-Sofie Smetcoren
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Eva Dierckx
- c Department of Clinical and Lifespan Psychology , Vrije Universiteit Brussel , Brussels , Belgium
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Krueger H, Koot J, Andres E. The economic benefits of fruit and vegetable consumption in Canada. Can J Public Health 2017; 108:e152-e161. [PMID: 28621651 PMCID: PMC6972418 DOI: 10.17269/cjph.108.5721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 03/20/2017] [Accepted: 01/15/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The objectives of this study were to determine the proportion of the population that meets or exceeds Canada's Food Guide (CFG) recommendations regarding the number of daily servings of fruits and vegetables (F/V), to assess trends in this proportion between 2000 and 2013, to estimate the annual economic burden attributable to inadequate F/V consumption within the context of other important risk factors, and to estimate the short- and long-term costs that could be avoided if modest improvements were made to F/V consumption in Canada. METHODS We used a previously developed methodology based on population-attributable fractions and a prevalence-based cost-of-illness approach to estimate the economic burden associated with low F/V consumption. RESULTS Over three quarters of Canadians are not meeting CFG recommendations regarding the number of daily servings of F/V, leading to an annual economic burden of $4.39 billion. If a 1% relative increase in F/V consumption occurred annually between 2013 and 2036, the cumulative reduction in economic burden over the 23-year period would reach $8.4 billion. Consumption levels of F/V, and the resulting economic burden, varied by sex, age and province. CONCLUSION A significant majority of Canadians are not consuming the recommended daily servings of F/V, with important consequences to their health and the Canadian economy. Programs and policies are required to encourage F/V consumption in Canada.
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Affiliation(s)
- Hans Krueger
- School of Population and Public Health, University of British Columbia, Vancouver, BC; H. Krueger & Associates Inc., Delta, BC.
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Teatero S, Coleman BL, Beres SB, Olsen RJ, Kandel C, Reynolds O, Athey TBT, Musser JM, McGeer A, Fittipaldi N. Rapid Emergence of a New Clone Impacts the Population at Risk and Increases the Incidence of Type emm89 Group A Streptococcus Invasive Disease. Open Forum Infect Dis 2017; 4:ofx042. [PMID: 28470020 PMCID: PMC5407211 DOI: 10.1093/ofid/ofx042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/02/2017] [Indexed: 12/02/2022] Open
Abstract
Background Invasive group A Streptococcus (iGAS) disease caused by type emm89 strains has been increasing worldwide, driven by the emergence of an epidemic clonal variant (clade 3 emm89). The clinical characteristics of patients with emm89 iGAS disease, and in particular with clade 3 emm89 iGAS disease, are poorly described. Methods We used population-based iGAS surveillance data collected in metropolitan Toronto, Ontario, Canada during the period 2000–2014. We sequenced the genomes of 105 emm89 isolates representing all emm89 iGAS disease cases in the area during the period and 138 temporally matched emm89 iGAS isolates collected elsewhere in Ontario. Results Clades 1 and 2 and clade O, a newly discovered emm89 genetic variant, caused most cases of emm89 iGAS disease in metropolitan Toronto before 2008. After rapid emergence of new clade 3, previously circulating clades were purged from the population and the incidence of emm89 iGAS disease significantly increased from 0.14 per 100000 in 2000–2007 to 0.22 per 100000 in 2008–2014. Overall, emm89 organisms caused significantly more arthritis but less necrotizing fasciitis than strains of the more common type emm1. Other clinical presentations were soft tissue and severe respiratory tract infections. Clinical outcomes did not differ significantly between emm89 clades overall. However, clade 3 emm89 iGAS disease was more common in youth and middle-aged individuals. Conclusions The rapid shift in emm89 iGAS strain genetics in metropolitan Toronto has resulted in a significant increase in the incidence of emm89 iGAS disease, with noticeably higher rates of clade 3 disease in younger patients.
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Affiliation(s)
| | - Brenda L Coleman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada.,Mount Sinai Hospital, Toronto, Canada; and
| | - Stephen B Beres
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Texas
| | - Randall J Olsen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Texas
| | - Christopher Kandel
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada.,Mount Sinai Hospital, Toronto, Canada; and
| | | | | | - James M Musser
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Texas
| | - Allison McGeer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada.,Mount Sinai Hospital, Toronto, Canada; and
| | - Nahuel Fittipaldi
- Public Health Ontario, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada
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12
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Krueger H, Koot JM, Rasali DP, Gustin SE, Pennock M. Regional variations in the economic burden attributable to excess weight, physical inactivity and tobacco smoking across British Columbia. Health Promot Chronic Dis Prev Can 2017; 36:76-86. [PMID: 27077793 DOI: 10.24095/hpcdp.36.4.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Prevalence rates of excess weight, tobacco smoking and physical inactivity vary substantially by geographical region within British Columbia (B.C.). The purpose of this study is to determine the potential reduction in economic burden in B.C. if all regions in the province achieved prevalence rates of these three risk factors equivalent to those of the region with the lowest rates. METHODS We used a previously developed approach based on population-attributable fractions to estimate the economic burden associated with the various risk factors. Sex-specific relative risk and age/sex-specific prevalence data was used in the modelling. RESULTS The annual economic burden attributable to the three risk factors in B.C. was about $5.6 billion in 2013, with a higher proportion of this total attributable to excess weight ($2.6 billion) than to tobacco smoking ($2.0 billion). While B.C. has lower prevalence rates of the risk factors than any other Canadian province, there is significant variation within the province. If each region in the province were to achieve the best prevalence rates for the three risk factors, then $1.4 billion (24% of the $5.6 billion) in economic burden could be avoided annually. CONCLUSION There are notable disparities in the prevalence of each risk factor across health regions within B.C., which were mirrored in each region's attributable economic burden. A variety of social, environmental and economic factors likely drive some of this geographical variation and these underlying factors should be considered when developing prevention programs.
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Affiliation(s)
- H Krueger
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,H. Krueger & Associates Inc., Delta, British Columbia, Canada
| | - J M Koot
- H. Krueger & Associates Inc., Delta, British Columbia, Canada
| | - D P Rasali
- Population and Public Health, British Columbia Provincial Health Services Authority (PHSA), Vancouver, British Columbia, Canada.,Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - S E Gustin
- Population and Public Health, British Columbia Provincial Health Services Authority (PHSA), Vancouver, British Columbia, Canada
| | - M Pennock
- Population Health Surveillance and Public Health Planning, British Columbia Ministry of Health, Vancouver, British Columbia, Canada
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13
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Glaser JB, El-Haddad H. Exploring Novel Medicare Readmission Risk Variables in Chronic Obstructive Pulmonary Disease Patients at High Risk of Readmission within 30 Days of Hospital Discharge. Ann Am Thorac Soc 2015; 12:1288-93. [PMID: 26348091 DOI: 10.1513/AnnalsATS.201504-228OC] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE New risk factors for readmission within 30 days of hospital discharge for patients with chronic obstructive pulmonary disease (COPD) need to be identified in view of the lack of efficacy of current interventions for preventing readmission. OBJECTIVES To identify novel risk predictors for 30-day readmission among COPD index admissions at high risk of readmission. METHODS For this analysis, we used the fiscal year 2015 hospital-specific Medicare Hospital Readmissions Reduction Program workbook for Staten Island University Hospital (Staten Island, NY). We analyzed 41 variables, each with a risk-variable score. A predicted probability of readmission was calculated for each case by using the risk-variable regression coefficient and a hospital-specific effect. A predicted probability greater than 0.4 was used to identify patients with COPD with a high risk of readmission in both the readmitted and nonreadmitted groups. A percent ratio of the readmission percentage divided by the nonreadmission percentage was generated for each risk variable for patients with a predicted probability of readmission greater than 0.4. A percent ratio greater than 3 was used to identify high-risk variables predictive of readmission. A risk index was defined as the number of high-risk variables present for each index admission. MEASUREMENTS AND MAIN RESULTS Nine high-risk variables were identified. A risk index greater than 3 for all index admissions identified 54 (22.7%) of 238 readmitted patients versus 41 (6.5%) of 630 nonreadmitted patients (P < 0.0001; positive predictive value, 0.56; specificity, 0.93). A risk index greater than 2 for multiple-admission patients identified 56 (65.1%) of 86 readmitted patients versus 135 (40.7%) of 332 nonreadmitted patients (P < 0.0001; positive predictive value, 0.65; specificity, 0.86). Over 30% of readmitted patients meeting the risk index criteria were discharged to home without organized home care. Sleep apnea, vertebral fractures, and electrolyte and acid-base disorders were newly identified predictors of readmission. CONCLUSIONS This study developed a risk index based upon the 2015 Hospital Readmissions Reduction Program worksheet for one hospital to explore risk variables predictive of 30-day readmissions for patients with COPD at high risk of readmission (>0.4). Because most currently used interventions lack efficacy in preventing 30-day readmission, interventions based upon the newly identified variables should be validated with larger validation cohorts.
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14
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Brown A, Rice SM, Rickwood DJ, Parker AG. Systematic review of barriers and facilitators to accessing and engaging with mental health care among at-risk young people. Asia Pac Psychiatry 2016; 8:3-22. [PMID: 26238088 DOI: 10.1111/appy.12199] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 06/08/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study aims to review the literature on barriers and facilitators to accessing and engaging with mental health care among young people from potentially disadvantaged groups, including young people identified as Aboriginal or Torres Strait Islander (ATSI); culturally and linguistically diverse (CALD); lesbian, gay, bisexual, transgender, queer, or intersex (LGBTQI); homeless; substance using; and youth residing in rural or remote areas. METHODS Fourteen databases were searched to identify qualitative and quantitative researches that examined barriers and/or facilitators to mental health care among the six groups of potentially disadvantaged young people. RESULTS Out of 62 studies identified, 3 were conducted with ATSI young people, 1 with CALD young people, 4 with LGBTQI young people, 14 with homeless young people, 24 with substance-using young people, and 16 with young people residing in rural or remote areas. Findings generally confirmed barriers already established for all young people, but indicated that some may be heightened for young people in the six identified groups. Findings also pointed to both similarities and differences between these groups, suggesting that ATSI, CALD, LGBTQI, homeless, substance-using, and rural young people have some similar needs with respect to not only mental health care, but also other needs likely to reflect their individual circumstances. DISCUSSION This systematic review highlights that young people from potentially disadvantaged groups have distinct needs that must be recognized to improve their experiences with mental health care. Future research of good methodological quality with young people is needed to increase accessibility of, and engagement with, mental health care.
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Affiliation(s)
- Adrienne Brown
- Headspace Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Simon M Rice
- Headspace Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Debra J Rickwood
- Headspace Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Alexandra G Parker
- Headspace Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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15
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Krueger H, Krueger J, Koot J. Variation across Canada in the economic burden attributable to excess weight, tobacco smoking and physical inactivity. Can J Public Health 2015; 106:e171-7. [PMID: 26285186 DOI: 10.17269/cjph.106.4994] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/05/2015] [Accepted: 04/26/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Tobacco smoking, excess weight and physical inactivity contribute substantially to the preventable disease burden in Canada. The purpose of this paper is to determine the potential reduction in economic burden if all provinces achieved prevalence rates of these three risk factors (RFs) equivalent to those of the province with the lowest rates, and to update and address a limitation noted in our previous model. METHODS We used a previously developed approach based on population attributable fractions to estimate the economic burden associated with these RFs. Sex-specific relative risk and age-/sex-specific prevalence data were used in the modelling. The previous model was updated using the most current data for developing resource allocation weights. RESULTS In 2012, the prevalence of tobacco smoking, excess weight and physical inactivity was the lowest in British Columbia. If age- and sex-specific prevalence rates from BC were applied to populations living in the other provinces, the annual economic burden attributable to these three RFs would be reduced by $5.3 billion. Updating the model resulted in a considerable shift in economic burden from smoking to excess weight, with the estimated annual economic burden attributable to excess weight now 25% higher compared to that of tobacco smoking ($23.3 vs. $18.7 billion). CONCLUSION Achieving RF prevalence rates equivalent to those of the province with the lowest rates would result in a 10% reduction in economic burden attributable to excess weight, smoking and physical inactivity in Canada. This study shows that using current resource use data is important for this type of economic modelling.
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Affiliation(s)
- Hans Krueger
- UBC School of Population and Public Health H. Krueger & Associates Inc..
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16
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Shah JP, Valdes M, Rockey DC. Transferred and delayed care of patients with colorectal cancer in a safety-net hospital system--manifestations of a distressed healthcare system. J Gen Intern Med 2012; 27:1142-9. [PMID: 22528617 PMCID: PMC3514982 DOI: 10.1007/s11606-012-2040-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 01/17/2012] [Accepted: 02/29/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Safety-net hospital systems provide care to a large proportion of United States' under- and uninsured population. We have witnessed delayed colorectal cancer (CRC) care in this population and sought to identify demographic and systemic differences in these patients compared to those in an insured health-care system. DESIGN, PATIENTS, AND APPROACH/MEASUREMENTS: We collected demographic, socioeconomic, and clinical data from 2005-2007 on all patients with CRC seen at Parkland Health and Hospital System (PHHS), a safety-net health system and at Presbyterian Hospital Dallas System (Presbyterian), a community health system, and compared characteristics among the two health-care systems. Variables associated with advanced stage were identified with multivariate logistic regression analysis and odds ratios were calculated. RESULTS Three hundred and eighteen patients at PHHS and 397 patients at Presbyterian with CRC were identified. An overwhelming majority (75 %) of patients seen at the safety-net were diagnosed after being seen in the emergency department or at an outside facility. These patients had a higher percentage of stage 4 disease compared to the community. Patients within the safety-net with Medicare/private insurance had lower rates of advanced disease than uninsured patients (25 % vs. 68 %, p < 0.001). Insurance status and physician encounter resulting in diagnosis were independent predictors of disease stage at diagnosis. CONCLUSIONS A large proportion of patients seen in the safety-net health system were transferred from outside systems after diagnosis, thus leading to delayed care. This delay in care drove advanced stage at diagnosis. The data point to a pervasive and systematic issue in patients with CRC and have fundamental health policy implications for population-based CRC screening.
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Affiliation(s)
- Jessica P. Shah
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8887 USA
| | - Marisa Valdes
- Performance Improvement and Patient Safety, Parkland Health and Hospital System, Dallas, TX USA
| | - Don C. Rockey
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8887 USA
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Abstract
BACKGROUND Many Americans lack health insurance. Despite good evidence that lack of insurance compromises access to care, few prospective studies examine its relationship to health outcomes. OBJECTIVE To determine the relationship between insurance and cardiovascular outcomes and the relationship between insurance and selected process measures. DESIGN AND PARTICIPANTS We used data from 15,792 participants in the Atherosclerosis Risk in Communities Study, a prospective cohort study. Participants were enrolled in 1987-1989 and returned for follow-up visits every 3 years, for a total of 4 visits. MAIN OUTCOME MEASURES We estimated the hazard of myocardial infarction, stroke, and death associated with insurance status using Cox proportional hazard modeling. We used generalized estimating equations to examine the association between insurance status and risk of (1) reporting no routine physical examinations, (2) being unaware of a personal cardiovascular risk condition, and (3) inadequate control of cardiovascular risk conditions. RESULTS Persons without insurance had higher rates of stroke (adjusted hazard ratio, 95% CI 1.22-2.22) and death (adjusted hazard ratio 1.26, 95% CI 1.03-1.53), but not myocardial infarction, than those who were insured. The uninsured were less likely to report routine physical examinations (adjusted risk ratio 1.13, 95% CI 1.08-1.18); more likely to be unaware of hypertension (adjusted risk ratio 1.12, 95% CI 1.00-1.25) and hyperlipidemia (adjusted risk ratio 1.11, 95% CI 1.03-1.19); and more likely to have poor blood pressure control (adjusted risk ratio 1.23, 95% CI 1.08-1.39). CONCLUSIONS Lack of health insurance is associated with increased rates of stroke and death and with less awareness and control of cardiovascular risk conditions. Health insurance may improve cardiovascular risk factor awareness, control and outcomes.
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Affiliation(s)
- Angela Fowler-Brown
- Division of General Medicine and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Newman PA, Duan N, Lee SJ, Rudy ET, Seiden DS, Kakinami L, Cunningham WE. HIV vaccine acceptability among communities at risk: the impact of vaccine characteristics. Vaccine 2006; 24:2094-101. [PMID: 16332402 PMCID: PMC2819665 DOI: 10.1016/j.vaccine.2005.11.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2005] [Revised: 11/02/2005] [Accepted: 11/08/2005] [Indexed: 11/19/2022]
Abstract
HIV vaccines offer the best long-term hope of controlling the AIDS pandemic; yet, the advent of HIV vaccines will not ensure their acceptability. We conducted a cross-sectional survey (n=143), incorporating conjoint analysis, to assess HIV vaccine acceptability among participants recruited using multi-site (n=9), venue-based sampling in Los Angeles. We used a fractional factorial experimental design to construct eight hypothetical HIV vaccines, each with seven dichotomous attributes. The acceptability of each vaccine was assessed individually and then averaged across participants. Next, the impact of each attribute on vaccine acceptability was estimated for each participant using ANOVA and then analyzed across participants. Acceptability of the eight hypothetical HIV vaccines ranged from 33.2 (S.D. 34.9) to 82.2 (S.D. 31.3) on a 0-100 scale; mean=60.0 (S.D. 21.9). Efficacy had the greatest impact on acceptability (22.7; CI: 18.5-27.1; p<0.0001), followed by cross-clade protection (12.5; CI: 8.7-16.3, p<0.0001), side effects (11.5; CI: 7.4-15.5; p<0.0001), and duration of protection (6.1; CI: 3.2-9.0; p<.0001). Route of administration, number of doses and cost were not significant. Low acceptability of "partial efficacy" vaccines may present obstacles to future HIV vaccine dissemination. Educational and social marketing interventions may be necessary to ensure broad HIV vaccine uptake.
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Affiliation(s)
- Peter A Newman
- Centre for Applied Social Research, University of Toronto, Faculty of Social Work, 246 Bloor Street West, Toronto, Ont., Canada M5S 1A1.
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