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Frontiers in Psychiatry 2024In times of war, mental health professionals are at an increased risk of developing psychological problems, including posttraumatic stress disorder (PTSD). The effects...
BACKGROUND
In times of war, mental health professionals are at an increased risk of developing psychological problems, including posttraumatic stress disorder (PTSD). The effects of conflicts or wars on mental health professionals in Palestine and their coping methods of dealing with these challenges remain unknown. This study aimed to assess the prevalence of PTSD symptoms and strategies for coping among mental health professionals in Palestine, in light of the ongoing Gaza war and political violence.
METHODS
The study utilized a cross-sectional research design. Self-reported questionnaires, including the PCL-5 and Brief COPE scales, were used to gather data. The relationship between the research variables and PTSD symptoms was investigated using frequencies, percentages, bivariate analysis, Pearson correlation, and Pearson's chi-square test.
RESULTS
A total of 514 participants were recruited, with an estimated prevalence of PTSD of 38.7%. Furthermore, the multivariate analysis revealed that having a prior history of trauma and feeling disabled or unable to deal with your patients during the current Gaza war and Israeli-Palestinian political violence increases the likelihood of developing PTSD symptoms. In addition, using venting, self-blame, and behavioral disengagement as coping strategies increases the likelihood of developing symptoms of PTSD. Moreover, using acceptance and substance use as coping strategies reduces the risk of developing PTSD symptoms.
CONCLUSION
The findings revealed a high prevalence of PTSD symptoms among mental health professionals during wartime and political violence. As a result, mental health professionals need immediate assistance in enhancing their mental wellbeing through supervision, psychotherapy, and comprehensive and continuous training.
PubMed: 38911708
DOI: 10.3389/fpsyt.2024.1396228 -
Access to insurance navigation support through the State Health Insurance Assistance Program (SHIP).Health Affairs Scholar Jun 2024Medicare enrollment is complex, particularly for low-income individuals who are dually eligible for Medicare and Medicaid, and the wrong plan choice can adversely impact...
Medicare enrollment is complex, particularly for low-income individuals who are dually eligible for Medicare and Medicaid, and the wrong plan choice can adversely impact beneficiaries' out-of-pocket costs and access to providers and medications. The State Health Insurance Assistance Program (SHIP) is a federal program that provides counseling on Medicare coverage, but the degree to which SHIP services are accessible to low-income beneficiaries is unknown. We interviewed SHIP counselors and coordinators to characterize factors affecting access to and quality of SHIP services for low-income beneficiaries. Availability of volunteers was cited as the primary barrier to SHIP services. Topics related to dual eligibility for Medicare and Medicaid were frequently covered in counseling sessions, and staff expressed a desire for more training related to Medicaid and integrated-care programs. Our results suggest that additional counselors and increased training on topics relevant to dually eligible individuals may improve SHIP's ability to provide health insurance-related information to low-income Medicare beneficiaries.
PubMed: 38911681
DOI: 10.1093/haschl/qxae072 -
Journal of Environmental Science and... 2024Cardiovascular diseases are a significant cause of mortality worldwide, and their prevalence can be amplified by a range of environmental factors. This review article...
Cardiovascular diseases are a significant cause of mortality worldwide, and their prevalence can be amplified by a range of environmental factors. This review article critically evaluated the published information on the epidemiology and pathophysiological mechanisms of various environmental factors such as air indoor and outdoor air pollution, water pollution, climate change, and soil pollution. Preventative measures to mitigate these effects including public health responses are discussed with gaps in our knowledge for future studies.
PubMed: 38911615
DOI: 10.26502/jesph.96120206 -
Inquiry : a Journal of Medical Care... 2024Several states are considering competitive procurement to help shape Medicaid managed care markets. In New York state, the focus of our study, regulators propose...
Several states are considering competitive procurement to help shape Medicaid managed care markets. In New York state, the focus of our study, regulators propose contracts that reward quality improvement and simplify state administration by rewarding plans that operate across several of the state's 62 counties. This case analysis uses novel regulatory data from New York state, obtained via public records request, to examine incentives underlying Medicaid markets and help inform contracting design. The data report plan enrollment by county and plan spending across administrative activities for all 16 Medicaid plans in New York state for 2018. We examine the counties in which plans operate, profitability, and administrative resource allocation. We compare outcomes by tertile of plan profitability, measured as net income per member-month. Plan profitability ranged widely, with the most profitable plan realizing nearly $30 per member-month while the least profitable 5 plans realized net negative earnings. Operational differences across plan profitability emerged most clearly in administrative spending. The most profitable plans reported greater spending on salaries overall and for executive management, and taxes, while the least profitable plans spent more on operational functions including utilization management/ quality improvement, claims processing, and informational systems. We observe modest differences in county rurality and little in geographic breadth. Procurement design that rewards capacity-building in key administrative functions might impact market evolution, given that on average, highly profitable firms spent less on these activities in New York's Medicaid managed care market in 2018.
Topics: Managed Care Programs; New York; Medicaid; United States; Humans; Motivation
PubMed: 38910529
DOI: 10.1177/00469580241258653 -
BMJ Open Jun 2024What are the Canadian public's understanding of and views toward medical assistance in dying (MAID) in persons refusing recommended treatment or lacking access to...
OBJECTIVES
What are the Canadian public's understanding of and views toward medical assistance in dying (MAID) in persons refusing recommended treatment or lacking access to standard treatment or resources?
DESIGN/SETTING
An online survey assessed knowledge of and support for Canadian MAID law, and views about four specific scenarios in a two (medical or psychiatric) by two (treatment refusal or lack of access) design.
PARTICIPANTS
A quota sample (N=2140) matched to the 2021 Canadian census by age, gender, income, education and province.
MAIN OUTCOMES
Participants' level of support for MAID in general and in the four specific scenarios.
RESULTS
Only 12.1% correctly answered ≥4 of 5 knowledge questions about the MAID law; only 19.2% knew terminal illness is not required and 20.2% knew treatment refusal is compatible with eligibility. 73.3% of participants expressed support for the MAID law in general, matching a nationally representative poll that used the same question. 40.4% of respondents supported MAID for mental illnesses. Support for MAID in the scenarios depicting refusal or lack of access to treatment ranged from 23.2% (lack of access in medical condition) to 32.0% (treatment refusal in medical illness). Older age, more education, higher income, lower religious attendance or being white was associated with greater support for MAID in general but was either negatively associated or not associated with support for MAID in the four refusal or lack of access scenarios.
CONCLUSIONS
Most Canadians support the current MAID law but appear unaware that MAID cases they do not support are compatible with that law. The lower support for MAID in the four scenarios cuts across sociodemographics. The gap between current policy and public opinion warrants further study. For jurisdictions debating MAID, opinion surveys may need to go beyond assessing general attitudes, and target knowledge and views regarding implications of legalisation.
Topics: Humans; Canada; Male; Female; Middle Aged; Adult; Suicide, Assisted; Aged; Surveys and Questionnaires; Public Opinion; Young Adult; Adolescent; Treatment Refusal; Health Knowledge, Attitudes, Practice; Health Services Accessibility
PubMed: 38910003
DOI: 10.1136/bmjopen-2024-087736 -
Nature Communications Jun 2024Given limited institutional resources, low-income populations often rely on social networks to improve their socioeconomic outcomes. However, it remains in question...
Given limited institutional resources, low-income populations often rely on social networks to improve their socioeconomic outcomes. However, it remains in question whether small-scale social interactions could affect large-scale economic inequalities in under-resourced contexts. Here, we leverage population-level data from one of the poorest South African settings to construct a large-scale, geographically defined, inter-household social network. Using a multilevel network model, we show that having social ties in close geographic proximity is associated with stable household asset conditions, while geographically distant ties correlate to changes in asset allocation. Notably, we find that localised network interactions are associated with an increase in wealth inequality at the regional level, demonstrating how macro-level inequality may arise from micro-level social processes. Our findings highlight the importance of understanding complex social connections underpinning inter-household resource dynamics, and raise the potential of large-scale social assistance programs to reduce disparities in resource-ownership by accounting for local social constraints.
Topics: Humans; South Africa; Socioeconomic Factors; Social Networking; Poverty; Family Characteristics; Income; Male; Female; Social Support; Social Interaction
PubMed: 38909070
DOI: 10.1038/s41467-024-49607-0 -
International Journal of Retina and... Jun 2024Macular holes (MHs), including atraumatic idiopathic and refractory MHs, affect central vision acuity due to full-thickness defects in the retinal tissue. The existing... (Review)
Review
Macular holes (MHs), including atraumatic idiopathic and refractory MHs, affect central vision acuity due to full-thickness defects in the retinal tissue. The existing controversy regarding the pathophysiology and management of MHs has significantly improved with the implementation of internal limiting membrane (ILM) surgical techniques and improved MH closure rates. Thus, to determine the effect of ILM techniques on large idiopathic and refractory MH management, the present study systematically reviewed 5910 original research articles extracted from online literature databases, including PubMed, Cochrane, Google Scholar, and Embase, following the PRISMA guidelines. The primary outcome measures were MH closure rate and postoperative visual acuity. A total of 23 randomized controlled trials (RCTs) with adequate patient information and information on the effect of ILM peeling, inverted ILM flaps, autologous retinal transplantation (ART), and ILM insertion techniques on large idiopathic and refractory MH patients were retrieved and analyzed using RevMan software (version 5.3) provided by the Cochrane Collaboration. Statistical risk of bias analysis was also conducted on the selected sources using RoB2, which showed a low risk of bias in the included studies. A meta-analysis indicated that the inverted ILM flap technique had a significantly greater MH closure rate for primary MH than the other treatment methods (OR = 3. 22, 95% CI 1.34-7.43; p = 0.01). Furthermore, the findings showed that the inverted ILM flap group had significantly better postoperative visual acuity than did the other treatment options for patients with idiopathic MH (WMD = - 0.13; 95% CI = 0.22-0.09; p = 0.0002). The ILM peeling technique had the second highest statistical significance for MH closure rates in patients with idiopathic MH (OR = 2. 72, 95% CI: 1.26-6.32; p = 0.016). In refractory MHs, autologous retinal transplant (ART) and multilayer ILM plug (MIP) techniques improve the closure rate and visual function; human amniotic membrane grafting (hAMG) provides a high degree of anatomical outcomes but disappointing visual results. This study demonstrated the reliability and effectiveness of ILM techniques in improving the functional and anatomical outcomes of large idiopathic and refractory MH surgery. These findings will help clinicians choose the appropriate treatment technique for patients with idiopathic and refractory MH.
PubMed: 38907361
DOI: 10.1186/s40942-024-00564-2 -
Cell Jun 2024The gut microbiota influences the clinical responses of cancer patients to immunecheckpoint inhibitors (ICIs). However, there is no consensus definition of detrimental...
The gut microbiota influences the clinical responses of cancer patients to immunecheckpoint inhibitors (ICIs). However, there is no consensus definition of detrimental dysbiosis. Based on metagenomics (MG) sequencing of 245 non-small cell lung cancer (NSCLC) patient feces, we constructed species-level co-abundance networks that were clustered into species-interacting groups (SIGs) correlating with overall survival. Thirty-seven and forty-five MG species (MGSs) were associated with resistance (SIG1) and response (SIG2) to ICIs, respectively. When combined with the quantification of Akkermansia species, this procedure allowed a person-based calculation of a topological score (TOPOSCORE) that was validated in an additional 254 NSCLC patients and in 216 genitourinary cancer patients. Finally, this TOPOSCORE was translated into a 21-bacterial probe set-based qPCR scoring that was validated in a prospective cohort of NSCLC patients as well as in colorectal and melanoma patients. This approach could represent a dynamic diagnosis tool for intestinal dysbiosis to guide personalized microbiota-centered interventions.
Topics: Humans; Gastrointestinal Microbiome; Immunotherapy; Carcinoma, Non-Small-Cell Lung; Female; Lung Neoplasms; Male; Dysbiosis; Feces; Middle Aged; Metagenomics; Immune Checkpoint Inhibitors; Treatment Outcome; Aged; Melanoma; Akkermansia; Colorectal Neoplasms; Neoplasms
PubMed: 38906102
DOI: 10.1016/j.cell.2024.05.029 -
Journal of Nutrition Education and... Jun 2024This paper describes the 30-year evolution of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) to provide evidence to support our perspective that SNAP-Ed...
This paper describes the 30-year evolution of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) to provide evidence to support our perspective that SNAP-Ed has earned its position as a pillar of the public health infrastructure in the US. Legislatively designated as a nutrition education and obesity prevention program, its focus is the nearly 90 million Americans with limited income. This audience experiences ongoing health disparities and is disproportionately affected by public health crises. The SNAP-Ed program works to reduce nutrition-related health disparities at all levels of the Social-Ecological Model, follows a robust evaluation framework, and leverages strong partnerships between state-based practitioners, state agencies, and the US Department of Agriculture. The expansion of SNAP-Ed would enable the program to reach more Americans so that our nation can end hunger and reduce diet-related health disparities.
PubMed: 38904598
DOI: 10.1016/j.jneb.2024.03.011 -
BMJ Quality & Safety Jun 2024Proximal femoral fractures in older adults affect prognosis, quality of life and medical expenses. Therefore, identifying patients with an elevated risk for proximal...
BACKGROUND
Proximal femoral fractures in older adults affect prognosis, quality of life and medical expenses. Therefore, identifying patients with an elevated risk for proximal femoral fractures and implementing preventive measures to mitigate their occurrence are crucial.
OBJECTIVE
This study aimed to develop an accurate in-hospital fracture prediction model that considers patients' daily conditions and medical procedure status. Additionally, it investigated the changes in their conditions associated with fractures during hospital stays.
DESIGN
A retrospective observational study.
SETTINGS
Acute care hospitals in Japan.
PARTICIPANTS
Participants were 8 514 551 patients from 1321 medical facilities who had been discharged between April 2018 and March 2021 with hip and proximal femoral fractures.
METHODS
Logistic regression analysis determined the association between patients' changes in their ability to transfer at admission and the day before fracture, and proximal femoral fracture during hospital stays.
RESULTS
Patients were classified into fracture and non-fracture groups. The mean ages were 77.4 (SD: 7.7) and 82.6 (SD: 7.8), and the percentages of women were 42.7% and 65.3% in the non-fracture and fracture groups (p<0.01), respectively. Model 4 showed that even if a patient required partial assistance with transfer on the day before the fracture, the fracture risk increased in each category of change in ability to transfer in the following order: 'declined', 'improved' and 'no change'.
CONCLUSIONS
Patients showing improved ability to transfer during their hospitalisation are at a higher risk for fractures. Monitoring patients' daily conditions and tracking changes can help prevent fractures during their hospital stays.
PubMed: 38902020
DOI: 10.1136/bmjqs-2023-016865