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British Journal of Haematology Jul 2024While the coronavirus disease-2019 (COVID-19) might have increased acute episodes in people living with sickle cell disease (SCD), it may also have changed their...
While the coronavirus disease-2019 (COVID-19) might have increased acute episodes in people living with sickle cell disease (SCD), it may also have changed their reliance on emergency department (ED) services. We assessed the impact of the COVID-19 pandemic and lockdowns on ED visits in adult SCD people followed in five French reference centres, with a special focus on 'high users' (≥10 visits in 2019). We analysed the rate of ED visits from 1 January 2015 to 31 December 2021, using a self-controlled case series. Among 1530 people (17 829 ED visits), we observed a significant reduction in ED visits during and after lockdowns, but the effect vanished over time. Compared to pre-pandemic, incidence rate ratios for ED visits were 0.59 [95% CI 0.52-0.67] for the first lockdown, 0.66 [95% CI 0.58-0.75] for the second and 0.85 [95% CI 0.73-0.99] for the third. High users (4% of people but 33.7% of visits) mainly drove the reductions after the first lockdown. COVID-19 lockdowns were associated with reduced ED visits. While most people returned to their baseline utilization by April 2021, high users had a lasting decrease in ED visits. Understanding the factors driving the drop in ED utilization among high users might inform clinical practice and health policy.
PubMed: 38960400
DOI: 10.1111/bjh.19556 -
American Journal of Preventive Medicine Jul 2024Dental care is a critical component of healthy aging; however, emerging evidence suggests that having been previously incarcerated is a risk factor for not using dental...
INTRODUCTION
Dental care is a critical component of healthy aging; however, emerging evidence suggests that having been previously incarcerated is a risk factor for not using dental care services. This study investigates the relationship between prior incarceration and dental care among older adults and assesses whether wealth and dental insurance explain this relationship.
METHODS
Data are from the Health and Retirement Study, a nationally representative sample of community-dwelling older adults in the United States, collected in 2012 and 2014. Multivariable logistic regression is used to assess the relationship between a history of incarceration and dental care. Mediation analyses were conducted using the Karlson-Holm-Breen method of indirect effects in non-linear models. Statistical analyses were conducted from February to April 2024.
RESULTS
Adjusting for potential confounding variables, a respondent's prior incarceration is associated with a 25% lower odds of dental care use (adjusted odds ratio [aOR] = .748, 95% CI = .624, .896). The relationship between incarceration and dental care use is fully mediated-over 90% is explained by-wealth and having dental care insurance. Prior incarceration decreased the likelihood of dental care only among non-Hispanic White respondents.
CONCLUSIONS
The findings offer new evidence that prior incarceration is a risk factor for lacking the ability to utilize dental care among older adults and suggest that broader consequences of incarceration for wealth accumulation and access to dental insurance underpin this relationship. These results suggest the urgent need to expand access to affordable dental care services for older adults with a history of incarceration.
PubMed: 38960292
DOI: 10.1016/j.amepre.2024.06.023 -
Journal of Substance Use and Addiction... Jul 2024Government agencies have identified evidence-based practice (EBP) dissemination as a pathway to high-quality behavioral health care for youth. However, gaps remain about...
INTRODUCTION
Government agencies have identified evidence-based practice (EBP) dissemination as a pathway to high-quality behavioral health care for youth. However, gaps remain about how to best sustain EBPs in treatment organizations in the U.S., especially in resource-constrained settings like publicly-funded youth substance use services. One important, but understudied, determinant of EBP sustainment is alignment: the extent to which multi-level factors that influence sustainment processes and outcomes are congruent, consistent, and/or coordinated. This study examined the role of alignment in U.S. states' efforts to sustain the Adolescent Community Reinforcement Approach (A-CRA), an EBP for youth substance use disorders, during the COVID-19 pandemic.
METHODS
In this mixed methods study, the qualitative investigation preceded and informed the quantitative investigation. We interviewed state administrators and providers (i.e., supervisors and clinicians) from 15 states that had completed a federal A-CRA implementation grant; providers also completed surveys. The sample included 50 providers from 35 treatment organizations that reported sustaining A-CRA when the COVID-19 pandemic began, and 20 state administrators. In qualitative thematic analyses, we applied the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to characterize alignment processes that interviewees described as influential on sustainment. We then used survey items to quantitatively explore the associations described in qualitative themes, using bivariate linear regressions.
RESULTS
At the time of interview, staff from 80 % of the treatment organizations (n = 28), reported sustaining A-CRA. Providers from both sustainer and non-sustainer organizations, as well as state administrators, described major sources of misalignment when state agencies ceased technical assistance post-grant, and because limited staff capacity conflicted with A-CRA's training model, which was perceived as time-intensive. Participants described the pandemic as exacerbating preexisting challenges, including capacity issues. Sustainer organizations reported seeking new funding to help sustain A-CRA. Quantitative associations between self-rated extent of sustainment and other survey items largely followed the pattern predicted from the qualitative findings.
CONCLUSIONS
The COVID-19 pandemic amplified longstanding A-CRA sustainment challenges, but treatment organizations already successfully sustaining A-CRA pre-pandemic largely continued. There are missed opportunities for state-level actors to coordinate with providers on the shared goal of EBP sustainment. A greater focus on alignment processes in research and practice could help states and providers strengthen sustainability planning.
PubMed: 38960147
DOI: 10.1016/j.josat.2024.209445 -
The Canadian Journal of Cardiology Jul 2024
PubMed: 38960125
DOI: 10.1016/j.cjca.2024.06.023 -
Kidney International Jul 2024Patient navigators enable adult patients to circumnavigate complex health systems, improving access to health care and outcomes. Here, we aimed to evaluate the effects...
Patient navigators enable adult patients to circumnavigate complex health systems, improving access to health care and outcomes. Here, we aimed to evaluate the effects of a patient navigation program in children with chronic kidney disease (CKD). In this multi-center, randomized controlled trial, we randomly assigned children (aged 0-16 years) with CKD stages 1-5 (including children on dialysis or with kidney transplants), from low socioeconomic status backgrounds, and/or residing in remote areas, to receive patient navigation at randomization (immediate) or at six months (waitlist). The primary outcome was self-rated health (SRH) of participating children at six months, using intention to treat analysis. Secondary outcomes included caregivers' SRH and satisfaction with health care, children's quality of life, hospitalizations, and missed school days. Repeated measures of the primary outcome from baseline to six months were analyzed using cumulative logit mixed effects models. Semi-structured interviews were thematically evaluated. Of 398 screened children, 162 were randomized (80 immediate and 82 waitlist); mean age (standard deviation) of 8.8 (4.8) years with 64.8% male. SRH was not significantly different between the immediate and wait-listed groups at six months. There were also no differences across all secondary outcomes between the two groups. Caregivers' perspectives were reflected in seven themes: easing mental strain, facilitating care coordination, strengthening capacity to provide care, reinforcing care collaborations, alleviating family tensions, inability to build rapport and unnecessary support. Thus, in children with CKD, self-rated health may not improve in response to a navigator program, but caregivers gained skills related to providing and accessing care.
PubMed: 38959996
DOI: 10.1016/j.kint.2024.05.031 -
Current Opinion in Psychology Jun 2024Machine Learning (ML) affords researchers tools to advance beyond research methods commonly employed in psychology, business, and public policy studies of federal... (Review)
Review
Machine Learning (ML) affords researchers tools to advance beyond research methods commonly employed in psychology, business, and public policy studies of federal nutrition programs and participant food decision-making. It is a sub domain of AI that is applied for feature extraction - a crucial step in decision making. These features are used in context-specific automated decisions resulting in predictive AI models. Whereas many prior studies rely on retrospective, static, "one-shot" decision-making in controlled laboratory environments, ML allows researchers to refine predictions about participation and food behaviors using large-scale datasets. We propose a case study using ML to predict an aspect of participation in a large, publicly funded nutrition education program (The Expanded Food and Nutrition Education Program). Participation has important downstream implications for diet quality, food security, and other important nutrition related decisions. We then suggest a process for validating the ML insights using qualitative research and survey data.
PubMed: 38959778
DOI: 10.1016/j.copsyc.2024.101830 -
Sexual & Reproductive Healthcare :... Jun 2024The term 'vulnerable' is often used to describe women facing psychosocial adversity during pregnancy, implying a heightened risk of experiencing suboptimal pregnancy...
Exploring perceptions of vulnerability among women facing psychosocial adversity before, during and after pregnancy: A qualitative interview-study using thematic analysis.
OBJECTIVE
The term 'vulnerable' is often used to describe women facing psychosocial adversity during pregnancy, implying a heightened risk of experiencing suboptimal pregnancy outcomes. While this label might facilitate the pathway to appropriate care, it can be perceived as stigmatizing by the women it intends to help, which could deter their interaction with healthcare services. This study explores how women facing psychosocial adversity before, during and after pregnancy perceive the concept of vulnerability and experience being labeled as such.
METHODS
We conducted a thematic analysis of semi-structured, in-depth interviews. Through purposive sampling targeting maximum variation, ten women of diverse backgrounds were included.
RESULTS
Three central themes emerged: defining vulnerability, embracing vulnerability and the feeling of being stigmatized. Women perceived vulnerability as an inability to adequately care for themselves or their children, necessitating additional support alongside routine antenatal care. Acceptance of the 'vulnerable' label came when it also acknowledged their proactive efforts and strengths to improve their situation. Conversely, if discussions surrounding vulnerability failed to recognize women's agency - specifically, their personal journeys and the courage needed to seek support - the label was perceived as stigmatizing.
CONCLUSIONS
Addressing vulnerability effectively in maternity care requires a nuanced, patient-centered approach, acknowledging both the challenges and strengths of women facing psychosocial adversities. Emphasizing personal narratives and their courage in seeking support can mitigate the stigmatizing effects of the 'vulnerable' label. Integrating these narratives into maternal healthcare practices can foster deeper connections with the women involved, enhancing the overall quality of care.
PubMed: 38959679
DOI: 10.1016/j.srhc.2024.100999 -
JCO Global Oncology Jul 2024Sudan has been under an armed conflict between the Sudanese Armed Forces and the Rapid Support Forces (RSF) militia since April 15, 2023. The conflict has turned the... (Review)
Review
Sudan has been under an armed conflict between the Sudanese Armed Forces and the Rapid Support Forces (RSF) militia since April 15, 2023. The conflict has turned the country into the largest internal displacement humanitarian crisis with 9.05 million internally displaced persons including 2.2 million children younger than 5 years and caused 1.47 million Sudanese to flee the country as refugees. The conflict has had a major destructive impact on the health system, which has incurred targeting with air raids, ground invasion, vandalization, looting of assets and supplies, and killing of doctors, nurses, and other health personnel. Khartoum Oncology Hospital, Sudan's main cancer hub for treatment, diagnostics, and research has become nonfunctional as a result of the conflict. The National Cancer Institute in Wad Medani, the second largest hub, faced a similar fate as the conflict spread to Al-Gezira State. Patients with cancer have been displaced multiple times in Sudan with grave consequences on the continuity of care, worsening of their disease outcomes and palpable negative impacts on children. The oncology workforce in Sudan have themselves been displaced yet are working hard to provide services and care for patients under impossible circumstances. Sudan's doctors in diaspora have rallied to provide support but they face multiple obstacles. As the conflict continues to spread, we call upon the WHO, the United Nations Children's Fund, St Jude Hospital, and all relevant partners to implement an immediate evacuation operation with urgent air lifts of the affected children to continue their cancer care in neighboring countries as was done in Ukraine and Gaza.
Topics: Sudan; Humans; Neoplasms; Armed Conflicts; Refugees; Delivery of Health Care
PubMed: 38959450
DOI: 10.1200/GO.24.00144 -
JCO Clinical Cancer Informatics Jun 2024Primer that helps clarify large-scale clinical data sets and participant demographics for oncologists.
Primer that helps clarify large-scale clinical data sets and participant demographics for oncologists.
Topics: Humans; Neoplasms; Oncologists; Medical Oncology; Datasets as Topic; Databases, Factual
PubMed: 38959448
DOI: 10.1200/CCI.23.00245 -
Alzheimer's & Dementia : the Journal of... Jul 2024Although poor glycemic control is associated with dementia, it is unknown if variability in glycemic control, even in those with optimal glycosylated hemoglobin A (HbA)...
INTRODUCTION
Although poor glycemic control is associated with dementia, it is unknown if variability in glycemic control, even in those with optimal glycosylated hemoglobin A (HbA) levels, increases dementia risk.
METHODS
Among 171,964 people with type 2 diabetes, we evaluated the hazard of dementia association with long-term HbA variability using five operationalizations, including standard deviation (SD), adjusting for demographics and comorbidities.
RESULTS
The mean baseline age was 61 years (48% women). Greater HbA SD was associated with greater dementia hazard (adjusted hazard ratio = 1.15 [95% confidence interval: 1.12, 1.17]). In stratified analyses, higher HbA SD quintiles were associated with greater dementia hazard among those with a mean HbA < 6% (P = 0.0004) or 6% to 8% (P < 0.0001) but not among those with mean HbA ≥ 8% (P = 0.42).
DISCUSSION
Greater HbA variability is associated with greater dementia risk, even among those with HbA concentrations at ideal clinical targets. These findings add to the importance and clinical impact of recommendations to minimize glycemic variability.
HIGHLIGHTS
We observed a cohort of 171,964 people with type 2 diabetes (mean age 61 years). This cohort was based in Northern California between 1996 and 2018. We examined the association between glycosylated hemoglobin A (HbA) variability and dementia risk. Greater HbA variability was associated with greater dementia hazard. This was most evident among those with normal-low mean HbA concentrations.
PubMed: 38959429
DOI: 10.1002/alz.14066