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BMC Pediatrics Jan 2018By 2020, the child population is projected to have more racial and ethnic minorities make up the majority of the populations and health care organizations will need to...
BACKGROUND
By 2020, the child population is projected to have more racial and ethnic minorities make up the majority of the populations and health care organizations will need to have a system in place that collects accurate and reliable demographic data in order to monitor disparities. The goals of this group were to establish sample practices, approaches and lessons learned with regard to race, ethnicity, language, and other demographic data collection in pediatric care setting.
METHODS
A panel of 16 research and clinical professional experts working in 10 pediatric care delivery systems in the US and Canada convened twice in person for 3-day consensus development meetings and met multiple times via conference calls over a two year period. Current evidence on adult demographic data collection was systematically reviewed and unique aspects of data collection in the pediatric setting were outlined. Human centered design methods were utilized to facilitate theme development, facilitate constructive and innovative discussion, and generate consensus.
RESULTS
Group consensus determined six final data collection domains: 1) caregivers, 2) race and ethnicity, 3) language, 4) sexual orientation and gender identity, 5) disability, and 6) social determinants of health. For each domain, the group defined the domain, established a rational for collection, identified the unique challenges for data collection in a pediatric setting, and developed sample practices which are based on the experience of the members as a starting point to allow for customization unique to each health care organization. Several unique challenges in the pediatric setting across all domains include: data collection on caregivers, determining an age at which it is appropriate to collect data from the patient, collecting and updating data at multiple points across the lifespan, the limits of the electronic health record, and determining the purpose of the data collection before implementation.
CONCLUSIONS
There is no single approach that will work for all organizations when collecting race, ethnicity, language and other social determinants of health data. Each organization will need to tailor their data collection based on the population they serve, the financial resources available, and the capacity of the electronic health record.
Topics: Canada; Data Collection; Disability Evaluation; Electronic Health Records; Ethnicity; Gender Identity; Health Equity; Healthcare Disparities; Humans; Language; Minority Groups; Pediatrics; Racial Groups; Sexual Behavior; Social Determinants of Health; United States
PubMed: 29385988
DOI: 10.1186/s12887-018-0993-2 -
Harm Reduction Journal Apr 2021Methadone and buprenorphine are the most prevalent types of opioid maintenance programs in Andalusia. The main objective is comparing the functional status of patients...
BACKGROUND
Methadone and buprenorphine are the most prevalent types of opioid maintenance programs in Andalusia. The main objective is comparing the functional status of patients with pharmacological opioid maintenance treatments according to different socio-demographic characteristic, health and disabilities domains and sexual difficulties.
METHODS
A total of 593 patients from the Andalusia community, 329 were undergoing methadone treatment and 264 were undergoing buprenorphine treatment. The patients were interviewed by socio-demographic and opioid-related variables, assessed by functioning, disability and health domains (WHODAS 2.0.) and for sexual problems (PRSexDQ-SALSEX).
RESULTS
We found significant differences in the socio-demographic and the opioid-related variables as the onset of opioid use, being on previous maintenance programs, opioid intravenous use, the length of previous maintenance programs, polydrug use and elevated seroprevalence rates (HCV and HIV) between the methadone group and the buprenorphine group. Regarding health and disability domains there were differences in the Understanding and communication domain, Getting around domain, Participation in society domain and in the WHODAS 2.0. simple and complex score, favoring buprenorphine-treated patients. The methadone group referred elevated sexual impairments compared with the buprenorphine group. Opioid-related variables as seroprevalence rates, other previous lifetime maintenance program, the daily opioid dosage and the daily alcohol use are the most discriminative variables between both groups. Participation in society variables and sexual problems were the most important clinical variables in distinguishing the methadone group from the buprenorphine group regarding their functional status.
CONCLUSIONS
The methadone group showed higher prevalence in opioid dependence-related variables, elevated disabilities in participation in society activities and sexual problems compared with the buprenorphine group. This study shows the importance of carry out a functional evaluation in the healthcare follow-up, especially in those areas related with social activity and with sexual problems.
Topics: Buprenorphine; Functional Status; Humans; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Seroepidemiologic Studies
PubMed: 33849574
DOI: 10.1186/s12954-021-00488-2 -
The Angle Orthodontist May 2021(1) To assess the effectiveness of the Orthognathic Quality of Life Questionnaire (OQLQ) and the Child Oral Health Impact Profile (COHIP) to detect differences in Oral...
OBJECTIVES
(1) To assess the effectiveness of the Orthognathic Quality of Life Questionnaire (OQLQ) and the Child Oral Health Impact Profile (COHIP) to detect differences in Oral Health-Related Quality of Life (OHRQoL) between pediatric patients with dentofacial deformities and controls. (2) To assess for correlations between scores from the OQLQ and COHIP domains with the type and severity of the skeletal mal-relationship. (3) To assess if the COHIP and OQLQ were identifying unique or overlapping OHRQoL concerns.
MATERIALS AND METHODS
Subjects were under age 18, presented with a dentofacial deformity, and completed both surveys. Matched controls completed the same. Severity for conditions was recorded via overjet, overbite, and ANB values and subjects were classified as skeletal Class I, II, or III.
RESULTS
Enrollment yielded 30 subjects and 31 controls. For the OQLQ, significant differences between subjects and controls were found for the Facial Esthetics domain, Oral Function domain, and total score. For the COHIP, significant differences were found for the Social/Emotional Well-Being and Self-Image domains plus total score. There were no significant correlations between the severity of the condition as measured by overjet and reported OHRQoL for any domains.
CONCLUSIONS
The OQLQ and COHIP are effective at detecting significant OHRQoL differences between pediatric patients with dentofacial deformities and controls. Although there is some overlap in the results, the instruments appear to identify different OHRQoL concerns.
Topics: Adolescent; Child; Humans; Oral Health; Quality of Life; Self Concept; Surveys and Questionnaires
PubMed: 33449101
DOI: 10.2319/051820-448.1 -
PsyCh Journal Apr 2020Schizophrenia, bipolar disorder, and related psychotic illnesses are common, serious mental disorders that are often associated with functional impairments and poor...
Schizophrenia, bipolar disorder, and related psychotic illnesses are common, serious mental disorders that are often associated with functional impairments and poor quality of life, even after clinical recovery. Cognitive dysfunction is a strong predictor of functional impairment; however, findings regarding relative impairments in functioning and cognition across diagnoses have been mixed, as have reports of the contribution of clinical symptoms and other illness features to functioning across diagnostic boundaries. We assessed 211 patients with psychotic disorders and 87 healthy controls using the MATRICS Consensus Cognitive Battery, clinical measures of state mood and psychotic symptoms, and an interview measure of community functioning. Diagnostic groups were compared on MATRICS composite and domain scores, and clinical and functional measures. We then examined cognitive, clinical, and demographic predictors of community functioning using stepwise hierarchical linear regression. All three patient groups exhibited deficits in most cognitive domains relative to controls, and significantly poorer community functioning. While scores on most cognitive domains did not differ by diagnosis, when groups did differ patients with schizophrenia performed worse than patients with bipolar disorder. Cognition was correlated with functioning across the sample. The final regression model included negative symptoms, mania, social cognition, and processing speed, and explained 47% of the variance in community functioning scores across patient groups. Residual negative symptoms, residual mania, and social cognition significantly and independently predicted community functioning. These findings indicate that, while all cognitive domains are associated with community outcomes, when considered together and with clinical symptoms, negative symptoms, mania, and social cognition are the strongest predictors across diagnoses. Development of interventions targeting negative symptoms and social cognition may be effective in improving community functioning for patients across diagnoses.
Topics: Adult; Bipolar Disorder; Cognition Disorders; Female; Humans; Independent Living; Male; Neuropsychological Tests; Psychotic Disorders; Quality of Life; Schizophrenia; Social Behavior; United States
PubMed: 32208557
DOI: 10.1002/pchj.356 -
Journal of Clinical Epidemiology May 2020The Singapore Caregiver Quality of Life Scale (SCQOLS) comprises five domains and 51 items in total. This study aimed to develop and evaluate short forms of SCQOLS. (Review)
Review
OBJECTIVES
The Singapore Caregiver Quality of Life Scale (SCQOLS) comprises five domains and 51 items in total. This study aimed to develop and evaluate short forms of SCQOLS.
STUDY DESIGN AND SETTING
Data were collected from 612 family caregivers of patients with advanced cancers in Singapore. Exploratory factor analysis and best subset regression were used to identify candidate items for each domain. The short forms were evaluated for measurement properties.
RESULTS
Inclusion of at least two items per domain in the short form gave correlation coefficients of at least 0.8 with the corresponding domain scores in the full-length version. The short forms and full-length version had similar correlation coefficients with Negative Personal Impact and Positive Personal Impact measures. Two of the five domains of the 10-item version had Cronbach's alpha ≤0.50 and test-retest reliability ≤0.65. A 15-item version of the scale with two to four items per domain performed satisfactorily in all aspects evaluated.
CONCLUSION
A 15-item short form of the SCQOLS (SCQOLS-15) is valid and reliable for the assessment of the overall and domain-specific quality of life of family caregivers. A 10-item short form (SCQOLS-10) may serve as a quick, valid and reliable assessment of the overall level of quality of life.
Topics: Activities of Daily Living; Caregivers; Economics; Family; Health Status; Humans; Mental Health; Neoplasms; Personal Satisfaction; Quality of Life; Reproducibility of Results; Singapore
PubMed: 32097714
DOI: 10.1016/j.jclinepi.2020.02.003 -
Journal of Urban Health : Bulletin of... Oct 2023Compared to previous studies commonly using a single summary score, we aimed to construct a multidomain neighborhood environmental vulnerability index (NEVI) to...
Compared to previous studies commonly using a single summary score, we aimed to construct a multidomain neighborhood environmental vulnerability index (NEVI) to characterize the magnitude and variability of area-level factors with the potential to modify the association between environmental pollutants and health effects. Using the Toxicological Prioritization Index framework and data from the 2015-2019 U.S. Census American Community Survey and the 2020 CDC PLACES Project, we quantified census tract-level vulnerability overall and in 4 primary domains (demographic, economic, residential, and health status), 24 subdomains, and 54 distinct area-level features for New York City (NYC). Overall and domain-specific indices were calculated by summing standardized feature values within the subdomains and then aggregating and weighting based on the number of features within each subdomain within equally-weighted primary domains. In citywide comparisons, NEVI was correlated with multiple existing indices, including the Neighborhood Deprivation Index (r = 0.91) and Social Vulnerability Index (r = 0.87) but provided additional information on features contributing to vulnerability. Vulnerability varied spatially across NYC, and hierarchical cluster analysis using subdomain scores revealed six patterns of vulnerability across domains: 1) low in all, 2) primarily low except residential, 3) medium in all, 4) high demographic, economic, and residential 5) high economic, residential, and health status, and 6) high demographic, economic and health status. Created using methods that offer flexibility for theory-based construction, NEVI provided detailed vulnerability metrics across domains that can inform targeted research and public health interventions aimed at reducing the health impacts from environmental exposures across urban centers.
Topics: Humans; New York City; Environmental Exposure; Health Status; Public Health; Nevus
PubMed: 37594675
DOI: 10.1007/s11524-023-00766-3 -
Journal of Affective Disorders Jan 2019Treatment-resistant depression affects millions of people worldwide and is a leading cause of disability and suicide. Studies of treatment-resistant depression outcomes... (Observational Study)
Observational Study
BACKGROUND
Treatment-resistant depression affects millions of people worldwide and is a leading cause of disability and suicide. Studies of treatment-resistant depression outcomes have traditionally focused on depressive symptoms and functional impairment. Quality of life (QoL) has not been well described. We aimed to measure QoL in individuals with treatment-resistant depression and to determine how QoL was related to traditional measures of symptoms and social functioning.
METHODS
We used a reliable, cross-culturally validated questionnaire, the abbreviated World Health Organization Quality of Life scale (WHOQOL-BREF), to prospectively measure QoL in 79 patients with treatment-resistant depression who were referred for electroconvulsive therapy at a United States tertiary-care medical center. QoL was characterized in four domains: physical, psychological, social, and environmental. QoL domains were examined for association with demographic variables, patient-reported depressive symptoms, functional impairment, and childhood adversity, as well as clinician-rated scales.
RESULTS
Relative to published international norms, mean QoL scores were low in physical (standardized score, z = -2.0), psychological (z = -2.6), and social (z = -1.0) domains, but not in the environmental domain (z = 0.2). After controlling for age and income, patient-rated depressive symptoms correlated with physical (Pearson correlation, r = -0.26) and psychological (r = -0.43) QoL, whereas adverse childhood experiences correlated with environmental QoL (r = -0.33). Patient-rated functional impairment correlated modestly with all domains (r = -0.25 to -0.39). Surprisingly, QoL correlated very weakly with clinician-rated measures. These modest associations of QoL with other clinical scales were confirmed in multiple regression analyses.
LIMITATIONS
We used a single QoL instrument, which did not allow us to directly compare the WHOQOL-BREF scale with other commonly used instruments. Our sample was recruited from a single academic medical center in the Midwest region of the United States and was largely Caucasian. These factors may limit generalizability to other settings and ethnicities.
CONCLUSION
Among individuals with treatment-resistant depression, QoL is lowest in the psychological and physical domains. QoL is only modestly correlated with patient-rated symptoms and functioning, and even more weakly correlated with clinician-rated scales, indicating that measures of symptoms and functioning cannot serve as QoL proxies. QoL should be assessed when caring for patients with treatment-resistant depression. When developing novel biological, psychological, and social interventions for treatment-resistant depression, QoL should be targeted as a distinct clinical outcome.
Topics: Adult; Child; Depressive Disorder, Treatment-Resistant; Female; Humans; Male; Middle Aged; Quality of Life; Regression Analysis; Surveys and Questionnaires
PubMed: 30268955
DOI: 10.1016/j.jad.2018.09.062 -
Computational and Mathematical Methods... 2022UPOINT clinical phenotype system was used to estimate the type III prostatitis patients. Put in the erectile dysfunction (ED) domain and analysis the ED domain's effect...
OBJECTIVE
UPOINT clinical phenotype system was used to estimate the type III prostatitis patients. Put in the erectile dysfunction (ED) domain and analysis the ED domain's effect towards the UPOINT system.
METHODS
A total of 126 patients with type III prostatitis were prospectively collected and classified in each domain of the UPOINT system, including urinary, psychosocial, organ-specific, infection, neurological/systemic, and tenderness. Symptom severity was measured using the national institutes of health chronic prostatitis symptom index (NIH-CPSI) and the international prostate symptom score (IPSS). The erectile function was evaluated using the international index of erectile function (IIEF-5). Mental state was evaluated using the Symptom Checklist 90 (SCL-90). The quality of life of patients was assessed by the Quality of Life scale (QoL).
RESULTS
The percentage of patients positive for each domain was 60.32%, 43.65%, 53.17%, 11.11%, 42.06%, and 33.33% for the urinary, psychosocial, organ-specific, infection, neurological/systemic, and tenderness, respectively. There were significant correlations between the number of positive UPOINT domains and total NIH-CPSI ( = 0.630, < 0.001) and IPSS ( = 0.429, < 0.001). Symptom duration was associated with a number of positive domains ( = 0.194, < 0.05). After adding an ED domain to establish a modified UPOINT system, the correlation between the number of positive domains and symptom severity was not improved (0.630 to 0.590, < 0.001). The percentage of the patients who suffered psychosocial problems was 43.65%.
CONCLUSIONS
In our cohort, the number of positive domains was correlated with symptom severity. Inclusion of the ED phenotype in the UPOINT phenotype classification system did not significantly enhance the association of positive presentation with symptom severity. Our findings presented do not support the utility of using ED as a stand-alone item in the UPOINT domain. Psychological problems should be considered when treating type III prostatitis patients.
Topics: China; Chronic Disease; Erectile Dysfunction; Humans; Male; Pelvic Pain; Prostatitis; Quality of Life; Severity of Illness Index
PubMed: 35547566
DOI: 10.1155/2022/9227032 -
International Journal of Circumpolar... Dec 2021Social, environmental, and behavioural factors impact human health. Integrating these social determinants of health (SDOH) into electronic health records (EHR) may... (Review)
Review
Social, environmental, and behavioural factors impact human health. Integrating these social determinants of health (SDOH) into electronic health records (EHR) may improve individual and population health. But how these data are collectedand their use in clinical settings remain unclear. We reviewed efforts to integrate SDOH into EHR in the U.S. and Canada, especially how this implementation serves Indigenous peoples. We followed an established scoping review process, performing iterative keyword searches in subject-appropriate databases, reviewing identified works' bibliographies, and soliciting recommendations from subject-matter experts. We reviewed 20 articles from an initial set of 2,459. Most discussed multiple SDOH indicator standards, with the National Academy of Medicine's (NAM) the most frequently cited (n = 10). Common SDOH domains were demographics, economics, education, environment, housing, psychosocial factors, and health behaviours. Twelve articles discussed project acceptability and feasibility; eight mentioned stakeholder engagement (none specifically discussed engaging ethnic or social minorities); and six adapted SDOH measures to local cultures . Linking SDOH data to EHR as related to Indigenous communities warrants further exploration, especially how to best align cultural strengths and community expectations with clinical priorities. Integrating SDOH data into EHR appears feasible and acceptable may improve patient care, patient-provider relationships, and health outcomes.
Topics: Educational Status; Electronic Health Records; Housing; Humans; Population Groups; Social Determinants of Health
PubMed: 34252016
DOI: 10.1080/22423982.2021.1943983 -
BMC Medical Education Apr 2023To determine physician assistant/associate (PA) perceptions of the value of certification and explore how they vary across demographic and practice characteristics.
BACKGROUND
To determine physician assistant/associate (PA) perceptions of the value of certification and explore how they vary across demographic and practice characteristics.
METHODS
We conducted a cross-sectional online survey between March and April 2020 with PAs participating in the longitudinal pilot program for recertification administered by the National Commission on Certification of Physician Assistants (NCCPA). The survey was distributed to 18,147 PAs, of which 10,965 participated (60.4% response rate). In addition to descriptive statistics, chi-square tests were conducted on demographics and specialty to examine if perceptions of value of certification (1 global and 10 items measuring specific domains) were associated with a particular PA profile. A series of fully adjusted multivariate logistic regressions were performed, exploring the relationship between PA characteristics and the value of certification items.
RESULTS
Most PAs strongly agreed/agreed that certification helps with fulfilling licensure requirements (9,578/10,893; 87.9%), helps with updating medical knowledge (9,372/10,897; 86.0%), and provides objective evidence of continued competence (8,875/10,902; 81.4%). The items receiving the lowest percentage of responses for strongly agreeing/agreeing were for certification providing no value (1,925/10,887; 17.7%), helping with professional liability insurance (5,076/10,889; 46.6%), and competing with other providers for clinical positions (5,661/10,905; 51.9%). Age 55 and older and practicing in dermatology and psychiatry were among the strongest predictors of less favorable views. PAs from underrepresented in medicine (URiM) backgrounds had more positive perceptions.
CONCLUSIONS
Overall, the findings indicate that PAs value certification; however, perceptions varied by demographics and specialties. PAs who were younger, from URiM backgrounds, and practicing in primary care specialties had among the most favorable perspectives. Continued feedback monitoring is critical in ensuring certification is relevant and meaningful in supporting PAs across demographics and specialties. Measuring PA perceptions of the value of certification is essential to understanding how to support the PA profession's current and future credentialing needs and those who license and hire PAs.
Topics: Humans; Middle Aged; Cross-Sectional Studies; Certification; Physician Assistants; Psychiatry; Demography
PubMed: 37041511
DOI: 10.1186/s12909-023-04215-2