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Sexuality Research & Social Policy :... Mar 2022Thirty-seven states require minors seeking abortion to involve a parent, either through notification or consent. Little research has examined how implementation of these...
INTRODUCTION
Thirty-seven states require minors seeking abortion to involve a parent, either through notification or consent. Little research has examined how implementation of these laws affect service delivery and quality of care for those who involve a parent.
METHODS
Between May 2018 and September 2019, in-depth interviews were conducted with 34 staff members involved in scheduling, counseling, and administration at abortion facilities in three Southeastern states. Interviews explored procedures for documenting parental involvement, minors' and parents' reactions to requirements, and challenges with implementation and compliance. Both inductive and deductive codes, informed by the healthcare quality framework, were used in the thematic analysis.
RESULTS
Parental involvement laws adversely affected four quality care domains: efficiency, patient-centeredness, timeliness, and equity. Administrative inefficiencies stemmed from the extensive documentation needed to prove an adult's relationship to a minor, increasing the time and effort needed to comply with state reporting requirements. If parents were not supportive of their minor's decision, participants felt they had a duty to intervene to ensure the minor's decision and needs remained centered. Staff further noted that delays to timely care accumulated as minors navigated parental involvement and other state mandates, pushing some beyond gestational age limits. Lower income families and those with complex familial arrangements had greater difficulty meeting state requirements.
CONCLUSIONS
Parental involvement mandates undermine health service delivery and quality for minors seeking abortion services in the Southeast.
POLICY IMPLICATIONS
Removing parental involvement requirements would protect minors' reproductive autonomy and support the provision of equitable, patient-centered healthcare.
PubMed: 38736735
DOI: 10.1007/s13178-021-00539-0 -
Frontiers in Pharmacology 2021Drugs are regulated in the United States (US) by the Controlled Substances Act (CSA) if assessment of their abuse potential, including public health risks, show such... (Review)
Review
Drugs are regulated in the United States (US) by the Controlled Substances Act (CSA) if assessment of their abuse potential, including public health risks, show such control is warranted. An evaluation via the 8 factors of the CSA provides the comprehensive assessment required for permanent listing of new chemical entities and previously uncontrolled substances. Such an assessment was published for two kratom alkaloids in 2018 that the Food and Drug Administration (FDA) have identified as candidates for CSA listing: mitragynine (MG) and 7-hydroxymitragynine (7-OH-MG) (Henningfield et al., 2018a). That assessment concluded the abuse potential of MG was within the range of many other uncontrolled substances, that there was not evidence of an imminent risk to public health, and that a Schedule I listing (the only option for substances that are not FDA approved for therapeutic use such as kratom) carried public health risks including drug overdoses by people using kratom to abstain from opioids. The purpose of this review is to provide an updated abuse potential assessment reviewing greater than 100 studies published since January 1, 2018. These include studies of abuse potential and physical dependence/withdrawal in animals; receptor binding; assessments of potential efficacy treating pain and substance use disorders; pharmacokinetic/pharmacodynamic studies with safety-related findings; clinical studies of long-term users with various physiological endpoints; and surveys of patterns and reasons for use and associated effects including dependence and withdrawal. Findings from these studies suggest that public health is better served by assuring continued access to kratom products by consumers and researchers. Currently, Kratom alkaloids and derivatives are in development as safer and/or more effective medicines for treating pain, substances use disorders, and mood disorders. Placing kratom in the CSA via scheduling would criminalize consumers and possession, seriously impede research, and can be predicted to have serious adverse public health consequences, including potentially thousands of drug overdose deaths. Therefore, CSA listing is not recommended. Regulation to minimize risks of contaminated, adulterated, and inappropriately marketed products is recommended.
PubMed: 35197848
DOI: 10.3389/fphar.2021.775073 -
Nature Communications Feb 2022While studies suggest that light and feeding patterns can reset circadian rhythms in various metabolites, whether these shifts follow a predictable pattern is unknown....
While studies suggest that light and feeding patterns can reset circadian rhythms in various metabolites, whether these shifts follow a predictable pattern is unknown. We describe the first phase response curves (PRC) for lipids and hepatic proteins in response to combined light and food stimuli. The timing of plasma rhythms was assessed by constant routine before and after exposure to a combined 6.5-hour blue light exposure and standard meal schedule, which was systematically varied by ~20° between in0000dividuals. We find that the rhythms shift according to a PRC, with generally greater shifts for lipids and liver proteins than for melatonin. PRC timing varies relative to the stimulus, with albumin and triglyceride PRCs peaking at a time similar to melatonin whereas the cholesterol and high-density lipoprotein PRCs are offset by ~12 h. These data have important implications for treating circadian misalignment in shiftworkers who consume meals and are exposed to light around the clock.
Topics: Adult; Albumins; Algorithms; Cholesterol; Cholesterol, HDL; Cholesterol, LDL; Circadian Rhythm; Female; Globulins; Humans; Lipids; Liver; Male; Melatonin; Models, Theoretical; Proteome; Time Factors; Triglycerides; Young Adult
PubMed: 35115537
DOI: 10.1038/s41467-022-28308-6 -
Global Health, Science and Practice Dec 2021Eleven anti-TB drugs were included in the Government of India's Schedule H1 drug regulations in 2014. The National Strategic Plan for TB Elimination in India 2017-2025...
INTRODUCTION
Eleven anti-TB drugs were included in the Government of India's Schedule H1 drug regulations in 2014. The National Strategic Plan for TB Elimination in India 2017-2025 recognized the opportunity to strengthen the TB surveillance system and improve the quality of TB care by implementing the Schedule H1 regulation. However, there were no documented systematic large-scale efforts to use Schedule H1 regulation to support TB surveillance or improve the quality of care. We aimed to document the process of implementation of the Schedule H1 regulation to enhance the quality of TB care and strengthen the TB surveillance system in Kerala, India.
METHODS
We conducted 33 in-depth interviews of the drugs control department enforcement officers, chemist shop owners, private-sector doctors, leaders of professional medical associations, and program managers and key staff of the TB Elimination Program in Kerala. Major themes identified were the process of implementation of Schedule H1 and how the National TB Elimination Program used the information. Findings from the qualitative interviews were corroborated with the quantitative information from the annual program performance reports and anti-TB drug sales data.
RESULTS
The TB Elimination Program of Kerala used the information from the Schedule H1 drug register to identify the missing TB cases and strengthen TB notification, identify providers for engagement and extend support to them for ensuring standards of TB care, and provide feedback to providers regarding prescription practices. Stakeholders felt that implementation of Schedule H1 surveillance has helped to improve TB patient notifications from the private sector, build better public-private partnerships, and improve the quality of TB diagnosis and treatment in Kerala.
CONCLUSION
Pharmacy-based drug sales data collected either through regulatory or non-regulatory methods have immense potential to support TB elimination programs.
Topics: Humans; India; Pharmacies; Pharmacy; Private Sector; Public-Private Sector Partnerships; Tuberculosis
PubMed: 34933980
DOI: 10.9745/GHSP-D-21-00346 -
Orthopaedic Journal of Sports Medicine Nov 2021Rehabilitation is an important component of care in postsurgical knee patients, especially as it pertains to return to preinjury activity level. Despite the established...
BACKGROUND
Rehabilitation is an important component of care in postsurgical knee patients, especially as it pertains to return to preinjury activity level. Despite the established significance of rehabilitation in improving outcomes after certain surgical procedures, there is a lack of investigation into compliance rates and factors that affect compliance in pediatric patients.
PURPOSE/HYPOTHESIS
The purpose of this study was to evaluate sociodemographic factors associated with noncompliance in pediatric patients after knee surgery to characterize health disparities in this population. Our hypothesis was that certain sociodemographic factors would be associated with decreased compliance.
STUDY DESIGN
Cross-sectional study; Level of evidence, 3.
METHODS
A retrospective review of medical records was used to gather data on compliance rate, demographics, and socioeconomic factors for pediatric patients undergoing rehabilitation after knee surgery. Compliance rate was determined by counting the total scheduled appointments, cancellations, and no-shows (defined as visits for which patients did not show up and did not provide notification of cancellation). Various types of knee injuries were included in this study. Data were evaluated using bivariate analyses in addition to hierarchical linear and binary logistic regression to assess for associations between sociodemographic factors and compliance rate.
RESULTS
Our total sample size was 186 patients. When compared with patients from non-single-parent households, patients from single-parent households were found to have a lower rate of physical therapy compliance (72.2% vs 80.1%; < .001), were less likely to reach the 85% compliance threshold (9.1% vs 42.4%; < .001), and had an increased amount of cancellations and no-shows (16.7 vs 11.7 visits; = .02). Although a small sample size, Hispanic/Latino patients were shown to have a lower achievement of the 85% compliance threshold compared with non-Hispanic/Latino patients (0% vs 38.2%; = .04). Increased distance from the rehabilitation clinic was associated with lower achievement of the 85% compliance threshold ( = .033).
CONCLUSION
Overall, there were several significant demographic and socioeconomic variables associated with rehabilitation compliance, specifically single-parent status, distance to rehabilitation clinic, and ethnicity. These results suggest potential predictors of decreased compliance that warrant prospective investigation.
PubMed: 34790832
DOI: 10.1177/23259671211052021 -
Journal of Medical Internet Research Nov 2021Universal access to assessment and treatment of mental health and learning disorders remains a significant and unmet need. There are many people without access to care...
BACKGROUND
Universal access to assessment and treatment of mental health and learning disorders remains a significant and unmet need. There are many people without access to care because of economic, geographic, and cultural barriers, as well as the limited availability of clinical experts who could help advance our understanding and treatment of mental health.
OBJECTIVE
This study aims to create an open, configurable software platform to build clinical measures, mobile assessments, tasks, and interventions without programming expertise. Specifically, our primary requirements include an administrator interface for creating and scheduling recurring and customized questionnaires where end users receive and respond to scheduled notifications via an iOS or Android app on a mobile device. Such a platform would help relieve overwhelmed health systems and empower remote and disadvantaged subgroups in need of accurate and effective information, assessment, and care. This platform has the potential to advance scientific research by supporting the collection of data with instruments tailored to specific scientific questions from large, distributed, and diverse populations.
METHODS
We searched for products that satisfy these requirements. We designed and developed a new software platform called MindLogger, which exceeds the requirements. To demonstrate the platform's configurability, we built multiple applets (collections of activities) within the MindLogger mobile app and deployed several of them, including a comprehensive set of assessments underway in a large-scale, longitudinal mental health study.
RESULTS
Of the hundreds of products we researched, we found 10 that met our primary requirements with 4 that support end-to-end encryption, 2 that enable restricted access to individual users' data, 1 that provides open-source software, and none that satisfy all three. We compared features related to information presentation and data capture capabilities; privacy and security; and access to the product, code, and data. We successfully built MindLogger mobile and web applications, as well as web browser-based tools for building and editing new applets and for administering them to end users. MindLogger has end-to-end encryption, enables restricted access, is open source, and supports a variety of data collection features. One applet is currently collecting data from children and adolescents in our mental health study, and other applets are in different stages of testing and deployment for use in clinical and research settings.
CONCLUSIONS
We demonstrated the flexibility and applicability of the MindLogger platform through its deployment in a large-scale, longitudinal, mobile mental health study and by building a variety of other mental health-related applets. With this release, we encourage a broad range of users to apply the MindLogger platform to create and test applets to advance health care and scientific research. We hope that increasing the availability of applets designed to assess and administer interventions will facilitate access to health care in the general population.
Topics: Adolescent; Humans; Mental Health; Mobile Applications; Psychiatry; Surveys and Questionnaires; Telemedicine
PubMed: 34762054
DOI: 10.2196/22369 -
JMIR Aging Nov 2021Czech older adults have lower rates of physical activity than the average population and lag behind in the use of digital technologies, compared with their peers from...
BACKGROUND
Czech older adults have lower rates of physical activity than the average population and lag behind in the use of digital technologies, compared with their peers from other European countries.
OBJECTIVE
This study aims to assess the feasibility of intensive behavior monitoring through technology in Czech adults aged ≥50 years.
METHODS
Participants (N=30; mean age 61.2 years, SD 6.8 years, range 50-74 years; 16/30, 53% male; 7/30, 23% retired) were monitored for 12 weeks while wearing a Fitbit Charge 2 monitor and completed three 8-day bursts of intensive data collection through surveys presented on a custom-made mobile app. Web-based surveys were also completed before and at the end of the 12-week period (along with poststudy focus groups) to evaluate participants' perceptions of their experience in the study.
RESULTS
All 30 participants completed the study. Across the three 8-day bursts, participants completed 1454 out of 1744 (83% compliance rate) surveys administered 3 times per day on a pseudorandom schedule, 451 out of 559 (81% compliance rate) end-of-day surveys, and 736 episodes of self-reported planned physical activity (with 29/736, 3.9% of the reports initiated but returned without data). The overall rating of using the mobile app and Fitbit was above average (74.5 out of 100 on the System Usability Scale). The majority reported that the Fitbit (27/30, 90%) and mobile app (25/30, 83%) were easy to use and rated their experience positively (25/30, 83%). Focus groups revealed that some surveys were missed owing to notifications not being noticed or that participants needed a longer time window for survey completion. Some found wearing the monitor in hot weather or at night uncomfortable, but overall, participants were highly motivated to complete the surveys and be compliant with the study procedures.
CONCLUSIONS
The use of a mobile survey app coupled with a wearable device appears feasible for use among Czech older adults. Participants in this study tolerated the intensive assessment schedule well, but lower compliance may be expected in studies of more diverse groups of older adults. Some difficulties were noted with the pairing and synchronization of devices on some types of smartphones, posing challenges for large-scale studies.
PubMed: 34757317
DOI: 10.2196/15220 -
Journal of Medical Internet Research Nov 2021Secure patient portals are widely available, and patients use them to view their electronic health records, including their clinical notes. We conducted experiments...
BACKGROUND
Secure patient portals are widely available, and patients use them to view their electronic health records, including their clinical notes. We conducted experiments asking them to cogenerate notes with their clinicians, an intervention called OurNotes.
OBJECTIVE
This study aims to assess patient and provider experiences and attitudes after 12 months of a pilot intervention.
METHODS
Before scheduled primary care visits, patients were asked to submit a word-constrained, unstructured interval history and an agenda for what they would like to discuss at the visit. Using site-specific methods, their providers were invited to incorporate the submissions into notes documenting the visits. Sites served urban, suburban, and rural patients in primary care practices in 4 academic health centers in Boston (Massachusetts), Lebanon (New Hampshire), Denver (Colorado), and Seattle (Washington). Each practice offered electronic access to visit notes (open notes) to its patients for several years. A mixed methods evaluation used tracking data and electronic survey responses from patients and clinicians. Participants were 174 providers and 1962 patients who submitted at least 1 previsit form. We asked providers about the usefulness of the submissions, effects on workflow, and ideas for the future. We asked patients about difficulties and benefits of providing the requested information and ideas for future improvements.
RESULTS
Forms were submitted before 9.15% (5365/58,652) eligible visits, and 43.7% (76/174) providers and 26.76% (525/1962) patients responded to the postintervention evaluation surveys; 74 providers and 321 patients remembered receiving and completing the forms and answered the survey questions. Most clinicians thought interim patient histories (69/74, 93%) and patient agendas (72/74, 97%) as good ideas, 70% (52/74) usually or always incorporated them into visit notes, 54% (40/74) reported no change in visit length, and 35% (26/74) thought they saved time. Their most common suggestions related to improving notifications when patient forms were received, making it easier to find the form and insert it into the note, and educating patients about how best to prepare their submissions. Patient respondents were generally well educated, most found the history (259/321, 80.7%) and agenda (286/321, 89.1%) questions not difficult to answer; more than 92.2% (296/321) thought sending answers before the visit a good idea; 68.8% (221/321) thought the questions helped them prepare for the visit. Common suggestions by patients included learning to write better answers and wanting to know that their submissions were read by their clinicians. At the end of the pilot, all participating providers chose to continue the OurNotes previsit form, and sites considered expanding the intervention to more clinicians and adapting it for telemedicine visits.
CONCLUSIONS
OurNotes interests patients, and providers experience it as a positive intervention. Participation by patients, care partners, clinicians, and electronic health record experts will facilitate further development.
Topics: Electronic Health Records; Humans; Patient Portals; Primary Health Care; Surveys and Questionnaires; Telemedicine
PubMed: 34747710
DOI: 10.2196/29951 -
PloS One 2021Distance learning in response to the COVID-19 pandemic presented tremendous challenges for many families. Parents were expected to support children's learning, often...
Parents' perspectives on a smartwatch intervention for children with ADHD: Rapid deployment and feasibility evaluation of a pilot intervention to support distance learning during COVID-19.
Distance learning in response to the COVID-19 pandemic presented tremendous challenges for many families. Parents were expected to support children's learning, often while also working from home. Students with Attention Deficit Hyperactivity Disorder (ADHD) are at particularly high risk for setbacks due to difficulties with organization and increased risk of not participating in scheduled online learning. This paper explores how smartwatch technology, including timing notifications, can support children with ADHD during distance learning due to COVID-19. We implemented a 6-week pilot study of a Digital Health Intervention (DHI) with ten families. The DHI included a smartwatch and a smartphone. Google calendars were synchronized across devices to guide children through daily schedules. After the sixth week, we conducted parent interviews to understand the use of smartwatches and the impact on children's functioning, and we collected physiological data directly from the smartwatch. Our results demonstrated that children successfully adopted the use of the smartwatch, and parents believed the intervention was helpful, especially in supporting the development of organizational skills in their children. Overall, we illustrate how even simple DHIs, such as using smartwatches to promote daily organization and task completion, have the potential to support children and families, particularly during periods of distance learning. We include practical suggestions to help professionals teach children with ADHD to use smartwatches to improve organization and task completion, especially as it applies to supporting remote instruction.
Topics: Attention Deficit Disorder with Hyperactivity; COVID-19; Child; Education, Distance; Humans; Male; Pandemics; Parents; Pilot Projects
PubMed: 34705845
DOI: 10.1371/journal.pone.0258959 -
Journal of the American Academy of... Mar 2022Ecological momentary assessment (EMA) often places high physical and mental burden on research participants compared with retrospective self-reports. The high burden... (Observational Study)
Observational Study
BACKGROUND
Ecological momentary assessment (EMA) often places high physical and mental burden on research participants compared with retrospective self-reports. The high burden could result in noncompliance with the EMA sampling scheme protocol. It has been a concern that certain types of participants could be more likely to have low compliance, such as those who have severe hearing loss and poor speech recognition performance, are employed, are not familiar with technologies used to implement EMA (e.g., smartphones), and have poorer cognitive abilities. Noncompliance dependent on personal characteristics could negatively impact the generalizability of EMA research.
PURPOSE
This article aims to determine personal characteristics associated with EMA compliance in a group of adult cochlear implant (CI) candidates and users.
RESEARCH DESIGN
An observational study.
STUDY SAMPLE
Fifty-eight adults who were either scheduled to received CIs or were experienced CI users completed the study.
DATA COLLECTION AND ANALYSIS
Participants conducted smartphone-based EMA designed to assess an individual's daily auditory ecology for 1 week. EMA compliance was quantified using two metrics: the number of completed surveys and the response rate to the notification delivered by the EMA app. Personal characteristics (i.e., predictors) included age, gender, CI status (candidate or user), employment status (employed or not employed), smartphone ownership, speech recognition performance, social network size, level of depressive symptoms, and neurocognitive abilities. A word recognition test, questionnaires, and a test battery of neurocognitive assessments were used to measure the predictors. We used negative binomial regression and logistic mixed models to determine the factors associated with the number of completed surveys and the response rate, respectively. We hypothesized that, for example, employed participants with poorer speech recognition performance would have lower compliance.
RESULTS
Contrary to the hypothesis, word recognition score was negatively associated with the number of completed surveys ( = 0.022). Holding all other variables constant, a 10-point (i.e., 10%) word recognition score decrease was associated with an 11% increase in the number of completed surveys. For the response rate, employment status was the only significant predictor ( < 0.0001). Consistent with our hypothesis, the odds of responding to EMA notifications for those who are not employed are 82% higher than the odds for those who are employed. No other studied personal characteristic was associated with compliance.
CONCLUSION
For CI candidates and users, EMA compliance could be affected by personal characteristics such as speech recognition performance and employment status. Because (1) participants with poorer speech recognition performance do not necessarily have lower compliance and (2) most personal characteristics investigated in the present study (e.g., age, gender, smartphone ownership, and neurocognitive abilities) do not predict compliance, a wide range of participants could successfully conduct smartphone-based EMA.
Topics: Adult; Cochlear Implantation; Cochlear Implants; Ecological Momentary Assessment; Humans; Retrospective Studies; Surveys and Questionnaires
PubMed: 34670290
DOI: 10.1055/a-1674-0060