-
Annals of Palliative Medicine Mar 2024The issue of racial and ethnic disparities in healthcare has been a significant concern for many years. It encompasses various aspects, including disease prevention,... (Review)
Review
BACKGROUND AND OBJECTIVE
The issue of racial and ethnic disparities in healthcare has been a significant concern for many years. It encompasses various aspects, including disease prevention, diagnosis, management, and end-of-life (EOL) care. Research has found that timely intervention with palliative care can result in better EOL care and reduced healthcare costs. This review aims to detail the role of healthcare disparities impacting palliative care, hospice enrollment, and EOL care in patients with serious illnesses who are facing EOL. It addresses the factors that play a role in creating these disparities and describes specific interventions that may reduce disparities in the provision of EOL care.
METHODS
Authors searched, PubMed Central, Medline, and PubMed databases using Racial Disparity and End-of-Life/Palliative Care combinations. A total of 57 studies were identified. All articles were reviewed, and the available evidence was synthesized and to identify key domains in EOL care impacted by racial disparities and the factors contributing to them.
KEY CONTENT AND FINDINGS
Several patient, provider, and institutional level factors may be responsible for disparities seen in EOL care, including health literacy, access to care, mistrust of the healthcare system, social determinants of health (SDH), medical racism, cultural and religious customs, and communication at EOL. Disparities in EOL care experienced by minority patients is an extension of the systemic and institutionalized racism rampant in the healthcare system. Providers must work on multiple fronts to address this inequity and injustice, the first of which is recognition and conversation regarding disparities in EOL care.
CONCLUSIONS
Disparities in communication, palliative and hospice care utilization, and symptom management must be eradicated. Palliative care and hospice should be made accessible for all patients and families experiencing severe illness regardless of their racial or ethnic background.
Topics: Humans; Hospice Care; Ethnic and Racial Minorities; Terminal Care; Healthcare Disparities; Death
PubMed: 38462936
DOI: 10.21037/apm-23-459 -
PloS One 2023Value-Based Healthcare (VBHC) focuses on the value of patient outcomes and is achieved by ensuring resources already available are managed to realise the best possible... (Review)
Review
BACKGROUND
Value-Based Healthcare (VBHC) focuses on the value of patient outcomes and is achieved by ensuring resources already available are managed to realise the best possible individual and population health outcomes. Patient reported outcome measures (PROMs) measure the impact of illnesses from the patient perspective. We conducted a scoping review to understand how PROMs were implemented and used, and their impact in the context of VBHC.
METHODS
Arksey and O'Malley's overarching framework supplemented by principles from mixed-methods Framework Synthesis were used. CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, Web of Science, Google Scholar and reference lists were searched. An a priori data extraction framework was created using the review question and objectives as key domains against which to extract data. Mixed-methods data were organised, integrated and preserved in original format and reported for each domain.
RESULTS
Forty-three studies were included with 60,200 participants. Few studies reported a well-developed programme theory and we found little robust evidence of effect. PROMs were universally considered to have the potential to increase patient satisfaction with treatment and services, enhance patient awareness of symptoms and self-management, and improve health outcomes such as quality of life and global health status. Evidence is currently limited on how PROMs work and how best to optimally implement PROMs to achieve the target outcome. Implementation challenges commonly prevented the realisation of optimal outcomes and patients generally needed better and clearer communication about why PROMs were being given and how they could optimally be used to support their own self-management.
CONCLUSION
PROMSs have yet to demonstrate their full potential in a VBHC context. Optimal PROMs implementation is poorly understood by clinicians and patients. Future studies should explore different models of PROM implementation and use within VBHC programmes to understand what works best and why for each specific context, condition, and population.
Topics: Humans; Quality of Life; Value-Based Health Care; Health Facilities; Patient Satisfaction; Patient Reported Outcome Measures
PubMed: 38055759
DOI: 10.1371/journal.pone.0290976 -
Stress and Health : Journal of the... Sep 2023The objectives of this article are to introduce a conceptual framework for physical resilience in the context of ageing and to discuss key elements and challenges in the...
The objectives of this article are to introduce a conceptual framework for physical resilience in the context of ageing and to discuss key elements and challenges in the design of studies of physical resilience after health stressors. Advancing age is associated with increasing exposure to multiple stressors and declining capacity to respond to health stressors. Resilience is defined broadly as the ability to resist or recover well from the adverse effects of a health stressor. In ageing-related study designs of physical resilience after a health stressor, this dynamic resilience response can be observed as changes in repeated measures of function or health status in various domains important to older adults. Methodologic issues in selecting the study population, defining the stressor, covariates, outcomes, and analytic strategies are highlighted in the context of an ongoing prospective cohort study of physical resilience after total knee replacement surgery. The article concludes with approaches to intervention development to optimize resilience.
Topics: Humans; Aged; Resilience, Psychological; Prospective Studies; Aging; Longitudinal Studies; Health Status
PubMed: 36879359
DOI: 10.1002/smi.3241 -
BMC Medical Education Sep 2023Medical residency is a part of postgraduate medical education and involves clinical training in a selected specialty. It is a challenging step in a physician's... (Observational Study)
Observational Study
BACKGROUND
Medical residency is a part of postgraduate medical education and involves clinical training in a selected specialty. It is a challenging step in a physician's professional development. This study aims to estimate the impact of the residency training program and demographic factors on the trainee's state of well-being (SOW).
METHODS
This was an observational cross-sectional study carried out in the year 2019-2020, which aimed to measure the SOW of residents undergoing clinical training in Riyadh, Saudi Arabia. A total of 260 residents participated in the study. A self-administered validated online the World Health Organization, Quality of Life Scale questionnaire- BREF was distributed to collect the data. The collected information on four different domains was analysed and compared across the baseline characteristics and different specialties. When appropriate, the independent sample t-test, bivariate correlation analysis, and ANOVA tests were used.
RESULTS
A total of 260 resident responses were included in the final analysis The results revealed a significant difference in physical health scores (p = 0.006), social relationship scores (p = 0.038), and environmental scores (p < 0.001) while no significant difference was found in psychological health scores among the physicians' specialties (p = 0.053). Post hoc comparison found statistically significant variations in the physical health domain between the medical and emergency specialties (p = 0.007), as well as surgical and emergency specialties (p = 0.024). There was also a significant difference between medical and emergency specialties (p = 0.008) in the social relationship domain. In the environment domain, significant variation was reported between medical specialties and emergency specialties (p = 0.001), as well asbetween surgical specialties and emergency specialties (p = 0.045). Female residents reported significantly lower quality of life in the physical (p = 0.020) and psychological (p = 0.032) domains.
CONCLUSIONS
A significant relationship was found between physical, social, and environmental domains according to residents' specialties. The factors that affected one or more domains included age, female gender, marital status, disease status, the number of on-calls received, and workload. We emphasize the importance of implementing policies to regulate working hours and on-call schedules as well as prioritizing mental health support.
Topics: Female; Animals; Saudi Arabia; Cross-Sectional Studies; Quality of Life; Medicine; Correlation of Data
PubMed: 37684578
DOI: 10.1186/s12909-023-04596-4 -
Annals of Agricultural and... Sep 2023Diabetes is commonly classified as a chronic disease of affluence due to the frequency of its incidence and the rate of its spreading. The aim of the study was to...
INTRODUCTION AND OBJECTIVE
Diabetes is commonly classified as a chronic disease of affluence due to the frequency of its incidence and the rate of its spreading. The aim of the study was to evaluate the quality of life of geriatric patients with type 2 diabetes.
MATERIAL AND METHODS
294 seniors diagnosed with type 2 diabetes living in the Lower Silesian Province in south-western Poland took part in the study. The study used a self-developed questionnaire collecting clinical and socio-demographic data, the WHOQOL-Bref questionnaire, Acceptance of Illness Scale (AIS), Self-Care of Diabetes Inventory (SCODI) and the Geriatric Depression Scale (GDS).
RESULTS
Significant relationships of QoL with BMI, level of education and place of residence, were observed. BMI was significantly negatively correlated with the psychological domain of functioning and the environmental functioning, the level of education was correlated with physical health, psychological and environmental functioning, while the place of residence was correlated with the perception of the QoL and environmental functioning. Acceptance of illness was positively correlated with the perception of QoL and one's physical health. The results of regression analyses in predicting QoL in all domains showed that all models were a good fit for the data (p < 0.001), and the single predictor was maintenance of self-care. The level of depression was negatively correlated to a statistically significant degree with the perception of QoL and one's health condition.
CONCLUSIONS
BMI, level of education and place of residence had the highest impact on the quality of life of the participants. The quality of life of the participants improved with the increase in the acceptance of their illness. The higher the level of depression exhibited by the participants, the poorer they evaluated their quality of life.
Topics: Humans; Aged; Quality of Life; Diabetes Mellitus, Type 2; Chronic Disease; Educational Status; Surveys and Questionnaires
PubMed: 37772527
DOI: 10.26444/aaem/168415 -
Cardiovascular Research Sep 2023Cognitive impairment has been associated with kidney function and chronic kidney disease. Whether this association is due to accelerated cardiovascular disease (CVD) or...
The association between kidney function, cognitive function, and structural brain abnormalities in community-dwelling individuals aged 50+ is mediated by age and biomarkers of cardiovascular disease.
AIMS
Cognitive impairment has been associated with kidney function and chronic kidney disease. Whether this association is due to accelerated cardiovascular disease (CVD) or an independent specific kidney function effect related to toxins is unclear. We investigated the impact of an array of clinical factors, inflammatory biomarkers, and cardiovascular biomarkers on the association between kidney function, cognitive function, and structural brain abnormalities.
METHODS AND RESULTS
We used data from the first and third waves of the TILDA Study, a population-representative prospective cohort of Irish adults aged 50 years and over, based on stratified random sampling (n = 3774). The MRI sub-study included participants who consented to MRI brain imaging in addition to the health assessment. Multivariable linear and mixed-effect longitudinal regression models were fitted separately for each kidney marker/estimated glomerular filtration rate (eGFR) equation after adjusting for baseline age and demographics, clinical vascular risk factors, and biomarkers. Unadjusted analyses showed an association between low eGFR, cognitive dysfunction, and cognitive decline (P < 0.001 for all kidney markers). Kidney function markers were also associated with white matter disease [OR = 3.32 (95% CI: 1.11, 9.98)], total grey matter volume (β = -0.17, 95% CI -0.27 to -0.07), and regional grey matter volumes within areas particularly susceptible to hypoxia (P < 0.001 for all). All the associations decreased after adjusting for age and were also diminished after adjusting for CVD biomarkers. Age and CVD-biomarker score were significant mediators of the adjusted associations between eGFR and cognitive status. These results remained consistent for cross-sectional and longitudinal outcomes and specific cognitive domains.
CONCLUSION
Decreased kidney function was associated with cerebrovascular disease. The association appeared to be mediated predominantly by age and the combination of CVD markers [namely N-terminal pro-B-type natriuretic peptide (NT-proBNP) and Growth Differentiation Factor 15 (GDF15)], supporting the idea that shared biological pathways underline both diseases. Further mechanistic studies of the specific molecular mechanisms that lead to both kidney and cognitive decline are warranted.
Topics: Humans; Middle Aged; Aged; Cardiovascular Diseases; Prospective Studies; Independent Living; Cross-Sectional Studies; Cognition; Biomarkers; Kidney; Brain
PubMed: 37052588
DOI: 10.1093/cvr/cvad060 -
JAMA Network Open May 2024Many health care systems are investing resources in identifying social determinants of health (SDoH) needs and facilitating interventions among the populations they...
IMPORTANCE
Many health care systems are investing resources in identifying social determinants of health (SDoH) needs and facilitating interventions among the populations they serve. Because self-reported SDoH information is lacking, area-level measures are often used to estimate needs and direct resources.
OBJECTIVE
To describe the large-scale deployment of SDoH assessments by a health system and determine the extent to which self-reported SDoH needs identified therein are associated with census tract-level social vulnerability measured using the Social Vulnerability Index (SVI).
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study assessed SDoH needs between January 1, 2020, and April 30, 2023, in both payer and clinical care settings. Modalities included telephonic outreach, face-to-face clinical interactions, self-entry into a tablet or kiosk, and web-based survey tools. Participants included individuals who responded to the assessment and had sufficient information for census tract identification. Respondents included both Highmark Health Plan members and nonmembers. Health plan members responded to the assessment through health plan programs or platforms, and both members and nonmembers responded to assessments during inpatient or outpatient encounters with the affiliated health system.
MAIN OUTCOMES AND MEASURES
Overall and domain-specific SDoH needs self-reported through assessments, and severity and complexity of needs identified. Residential social vulnerability measures included overall SVI and the 4 conceptual themes comprising overall SVI.
RESULTS
In total, 841 874 assessments were recorded for 401 697 individuals (55.1% women; median [IQR] age, 55 [41-70] years). Social determinants of health needs were identified in 120 769 assessments (14.3%). Across all SDoH domains, increasing SVI was associated with a higher positivity rate (eg, 11.2% of those residing in the lowest-risk SVI quintile reported a need compared with 22.7% among those residing in the highest-risk quintile). Associations varied by SDoH domain and SVI theme. After adjusting for demographic and screening characteristics, odds of positive screening among those residing in the highest-risk SVI quintile were 1.74 (95% CI, 1.62-1.86) to 3.73 (95% CI, 3.48-4.00) times the odds among those residing in lowest risk quintile.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study, the overall level of SDoH needs generally corresponded to area-level vulnerability. Some SDoH domains appeared far more sensitive to community characteristics than others. Notably, even among individuals from the highest-risk areas, the positive screening rate was roughly 1 in 4. These findings underscore the importance of individual-level SDoH data for service provision planning and health services research.
Topics: Humans; Social Determinants of Health; Cross-Sectional Studies; Self Report; Male; Female; Social Vulnerability; Middle Aged; Adult; Aged; Needs Assessment
PubMed: 38767915
DOI: 10.1001/jamanetworkopen.2024.12109 -
JAMA Network Open Nov 2023People with disabilities face inequitable access to reproductive health (RH) services, yet the national prevalence of barriers to access experienced across disability...
IMPORTANCE
People with disabilities face inequitable access to reproductive health (RH) services, yet the national prevalence of barriers to access experienced across disability types and statuses is unknown.
OBJECTIVE
To assess the national prevalence of barriers to RH access experienced by people with disabilities.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study analyzed results of an online probability-based national survey of RH experiences that was conducted from December 2021 to January 2022. The national sample consisted of English- and Spanish-speaking panel members of a market research firm. Panelists were invited to participate in a survey on their RH experiences and opinions. These participants were aged 15 to 49 years and assigned female at birth (AFAB). Weighted proportions were estimated, and bivariable and multivariable regression analyses were performed to assess associations between disability status and barriers to accessing RH services.
EXPOSURE
Using 5 of the 6 Washington Group Short Set on Functioning items, 8 dichotomous disability indicators were created: (1) vision, (2) hearing, (3) mobility, (4) activities of daily living, (5) communication, (6) overall disability status (a lot or more difficulty functioning in ≥1 domain), (7) some difficulty functioning (below the disability threshold; some or more difficulty functioning in ≥1 domain), and (8) multiple disabilities (a lot or more difficulty functioning in ≥2 domains).
MAIN OUTCOMES AND MEASURES
Number and types of barriers (logistical, access, cost, privacy, and interpersonal relationship) to accessing RH services in the past 3 years.
RESULTS
After exclusion, the final sample included 6956 people AFAB, with a mean (SD) age of 36.0 (8.3) years. Of these participants, 8.5% (95% CI, 7.6%-9.5%) met the disability threshold. Participants with disabilities compared with those without disabilities were disproportionately more likely to be non-Hispanic Black (18.8% [95% CI, 14.4%-24.1%] vs 13.2% [95% CI, 11.9%-14.5%]) or Hispanic or Latinx (completed survey in English: 18.1% [95% CI, 14.0%-23.0%] vs 14.6% [95% CI, 13.3%-16.0%]; completed survey in Spanish: 8.9% [95% CI, 6.2%-12.8%] vs 6.2% [95% CI, 5.4%-7.1%]) individuals, to identify as LGBTQAI (lesbian, gay, bisexual, transgender, queer [or questioning], asexual [or allied], intersex; 16.4% [95% CI, 12.3%-21.6%] vs 11.8% [95% CI, 10.6%-13.1%]), to live below the federal poverty level (27.3% [95% CI, 22.3%-32.8%] vs 10.7% [95% CI, 9.7%-11.9%]), and to ever experienced medical mistreatment (49.6% [95% CI, 43.7%-55.5%] vs 36.5% [95% CI, 34.8%-38.2%]). Among those who had ever tried to access RH services (n = 6027), people with disabilities vs without disabilities were more likely to experience barriers (69.0% [95% CI, 62.9%-74.5%] vs 43.0% [95% CI, 41.2%-44.9%]), which were most often logistical (50.7%; 95% CI, 44.2%-57.2%) and access (49.9%; 95% CI, 43.4%-56.4%) barriers. The disability domains with the highest proportion of people who experienced 3 or more barriers in the past 3 years included activities of daily living (75.3%; 95% CI, 61.1%-85.6%), communication (65.1%; 95% CI, 49.5%-78.1%), and multiple (59.9%; 95% CI, 45.6%-72.7%) disabilities.
CONCLUSIONS AND RELEVANCE
This cross-sectional study found large disparities in access to RH services among people AFAB with disabilities. Findings indicated a need to alleviate barriers to RH care, including improving the transportation infrastructure and reinforcing patient-centered approaches that engender inclusivity in health care settings.
Topics: Female; Humans; Activities of Daily Living; Cross-Sectional Studies; Sexual and Gender Minorities; Health Services Accessibility; Reproductive Health Services; Adolescent; Young Adult; Adult; Middle Aged; Disabled Persons; Healthcare Disparities
PubMed: 38019515
DOI: 10.1001/jamanetworkopen.2023.44877 -
Medical Decision Making : An... 2023The Dental Caries Utility Index (DCUI) is a new oral health-specific health state classification system for adolescents, consisting of 5 domains: pain/discomfort,...
INTRODUCTION
The Dental Caries Utility Index (DCUI) is a new oral health-specific health state classification system for adolescents, consisting of 5 domains: pain/discomfort, difficulty eating food/drinking, worried, ability to participate in activities, and appearance. Each domain has 4 response levels. This study aims to generate an Australian-specific utility algorithm for the DCUI.
METHODS
An online survey was conducted using a representative sample of the adult Australian general population. The discrete choice experiment (DCE) was used to elicit the preferences on 5 domains. Then, the latent utilities were anchored onto the full health-dead scale using the visual analogue scale (VAS). DCE data were modeled using conditional logit, and 2 anchoring procedures were considered: anchor based on the worst health state and a mapping approach. The optimal anchoring procedure was selected based on the model parsimony and the mean absolute error (MAE).
RESULTS
A total of 995 adults from the Australian general population completed the survey. The conditional logit estimates on 5 dimensions and levels were monotonic and statistically significant, except for the second level of the "worried" and "appearance" domains. The mapping approach was selected based on a smaller MAE between the 2 anchoring procedures. The Australian-specific tariff of DCUI ranges from 0.1681 to 1.
CONCLUSION
This study developed a utility algorithm for the DCUI. This value set will facilitate utility value calculations from the participants' responses for DCUI in economic evaluations of dental caries interventions targeted for adolescents.
HIGHLIGHTS
Preference-based quality-of-life measures (PBMs), which consist of a health state classification system and a set of utility values (a scoring algorithm), are used to generate utility weights for economic evaluations.This study is the first to develop an Australian utility value set for the Dental Caries Utility Index (DCUI), a new oral health-specific classification system for adolescents.The availability of a utility value set will enable using DCUI in economic evaluations of oral health interventions targeted for adolescents and may ultimately lead to more effective and efficient planning of oral health care services.
Topics: Adult; Adolescent; Humans; Health Status; Australia; Dental Caries; Quality-Adjusted Life Years; Quality of Life; Surveys and Questionnaires
PubMed: 37724663
DOI: 10.1177/0272989X231197149 -
Biosensors Dec 2023Technological progress has led to the development of analytical tools that promise a huge socio-economic impact on our daily lives and an improved quality of life for... (Review)
Review
Technological progress has led to the development of analytical tools that promise a huge socio-economic impact on our daily lives and an improved quality of life for all. The use of plant extract synthesized nanoparticles in the development and fabrication of optical or electrochemical (bio)sensors presents major advantages. Besides their low-cost fabrication and scalability, these nanoparticles may have a dual role, serving as a transducer component and as a recognition element, the latter requiring their functionalization with specific components. Different approaches, such as surface modification techniques to facilitate precise biomolecule attachment, thereby augmenting recognition capabilities, or fine tuning functional groups on nanoparticle surfaces are preferred for ensuring stable biomolecule conjugation while preserving bioactivity. Size optimization, maximizing surface area, and tailored nanoparticle shapes increase the potential for robust interactions and enhance the transduction. This article specifically aims to illustrate the adaptability and effectiveness of these biosensing platforms in identifying precise biological targets along with their far-reaching implications across various domains, spanning healthcare diagnostics, environmental monitoring, and diverse bioanalytical fields. By exploring these applications, the article highlights the significance of prioritizing the use of natural resources for nanoparticle synthesis. This emphasis aligns with the worldwide goal of envisioning sustainable and customized biosensing solutions, emphasizing heightened sensitivity and selectivity.
Topics: Oxides; Quality of Life; Biosensing Techniques; Metal Nanoparticles; Technology; Electrochemical Techniques
PubMed: 38131791
DOI: 10.3390/bios13121031