articles+ search results

Birth control, California legislation, Contraception, Electronic medical record, Extended supply, Prescription, birth control, contraception, electronic medical record, extended supply, prescription, Obstetrics & Reproductive Medicine, Clinical Sciences, Paediatrics and Reproductive Medicine, and Public Health and Health Services

ObjectiveTo evaluate the proportion of 12-month contraceptive pill, patch, and ring prescriptions before and after an institution-wide change of default electronic medical record facility orders to dispensing 12-month supply.Study designThis retrospective pre-post study compares outpatient contraception prescriptions from August 10, 2019 through April 9, 2020 obtained from our institutional electronic medical record prescription database. On December 10, 2019, we facilitated a change in the default orders for dispensing self-administered hormonal contraceptives from one-month to 12-months. We evaluated the primary outcome of 12-month supply prescriptions during the four months before and after the change. We also compared 12-month supply prescriptions for pills, patch, and ring by prescriber specialty and location.ResultsThe dataset included 4897 distinct evaluable prescriptions for the pill, patch, or ring, with an overall increase in 12-month prescriptions from 260/2437 (10.7%) to 669/2460 (27.2%) after the order change (p

Humans, HIV Infections, Mass Screening, Public Health, Minority Groups, Health Policy, Vulnerable Populations, United States, Pandemics, Epidemiological Monitoring, Social Determinants of Health, COVID-19, Clinical Sciences, Public Health and Health Services, and Virology

BACKGROUND:The novel coronavirus, SARS-CoV-2, which was first recognized in December 2019, is responsible for the COVID-19 pandemic that is having a devastating impact on human health, society and the global economy. METHODS:We summarize lessons learned from the HIV epidemic that offer insights about how the response to COVID-19 can be improved, especially in the United States which has incurred one quarter of world's infections to date. RESULTS:Lessons learned include: the need to develop and deploy valid tests for point-of-care diagnosis and surveillance; the importance of considering HIV and COVID-19 in the context of syndemics; the potential role of structural interventions that address drivers of disparities; how existing research infrastructure can be leveraged to accelerate development of therapeutics and vaccines; and how modeling that is tailored to regional epidemics can inform policy. CONCLUSIONS:The window of opportunity to prevent a widespread COVID-19 epidemic in the United States has already closed, but it is not too late to implement a mitigation strategy that can save thousands of lives. Decisive leadership that develops policies grounded in scientific evidence is key to charting a path forward. The question is whether the United States is prepared to learn from its past successes and mistakes with the HIV epidemic to develop a nation-wide plan that puts politics aside and prioritizes saving lives.

Fertility, Gravidity, Intrauterine device, Intrauterine system, Liletta, fertility, gravidity, intrauterine device, intrauterine system, Clinical Sciences, Paediatrics and Reproductive Medicine, Public Health and Health Services, and Obstetrics & Reproductive Medicine

ObjectiveEvaluate reproductive function in nulligravid and gravid women after levonorgestrel 52 mg intrauterine system (IUS) discontinuation based on time to pregnancy.Study designWe evaluated women participating in the ACCESS IUS multicenter, Phase 3, open-label clinical trial of the Liletta(®) levonorgestrel 52 mg IUS who discontinued the IUS within 60 months of use and desired pregnancy. Study staff contacted participants every three months after IUS discontinuation for up to 12 months to determine whether pregnancy occurred. We excluded women who opted to stop attempting to conceive before 12 months. We evaluated 12-month conception rates in participants 16-35 years at IUS placement, comparing dichotomous outcomes using Fisher's exact test. We performed a multivariable analysis to assess the association of baseline characteristics, age at discontinuation, duration of IUS use, and positive sexually transmitted infection testing during IUS use with conception.ResultsAmong 165 women who attempted to conceive, 142 (86.1%) did so within 12 months with a median time to conception of 92 days. The 12-month conception rates did not differ between nulligravid (66/76 [86.8%]) and gravid (76/89 [85.4%]) women (p = 0.83) and nulliparous (78/90 [86.7%]) and parous (64/75 [85.3%]) women (p = 0.83). In multivariable analysis, only obesity (aOR 0.3 [95% CI 0.1-0.8]) was associated with ability to conceive.ConclusionsAfter levonorgestrel 52 mg IUS discontinuation, women have rapid return of fertility in the year post-removal. Fertility rates after IUS removal do not vary based on gravidity, parity, age at discontinuation, or duration of IUS use.ImplicationsThis contemporary IUS study included a large population of nulligravid and nulliparous women. IUS use over many years does not effect spontaneous fertility after IUS discontinuation, regardless of gravidity or parity. Providers and patients should have no concern about the impact of IUS use on future fertility.

Statistics, Public Health and Health Services, and Epidemiology

Background: Women can be exposed to a multitude of hardships before and during pregnancy that may affect fetal growth, but previous approaches have not analyzed them jointly as social exposure mixtures.Methods: We evaluated the independent, mutually adjusted, and pairwise joint associations between self-reported hardships and birthweight for gestational age z-scores in the Chemicals in Our Bodies-2 prospective birth cohort (N = 510) using G-computation. We examined financial hardship, food insecurity, job strain, poor neighborhood environment, low community standing, caregiving, high burden of stressful life events, and unplanned pregnancy collected via questionnaire administered in the second trimester of pregnancy. We used propensity scores to ensure our analyses had sufficient data support and estimated absolute differences in outcomes.Results: Food insecurity was most strongly associated with reduced birthweight for gestational age z-scores individually, with an absolute difference of -0.16, 95% confidence interval (CI) -0.45, 0.14. We observed an unexpected increase in z-scores associated with poor perceived neighborhood environment (0.18, 95% CI -0.04, 0.41). Accounting for coexposures resulted in similar findings. The pairwise joint effects were strongest for food insecurity in combination with unplanned pregnancy (-0.45, 95% CI -0.93, 0.02) and stressful life events (-0.42, 95% CI -0.90, 0.05). Poor neighborhood environment in combination with caregiving was associated with an increase in z-scores (0.47, 95% CI -0.01, 0.95).Conclusions: Our results are consistent with the hypothesis that experiencing food insecurity during pregnancy, alone and in combination with stressful life events and unplanned pregnancy, may affect fetal growth.

epidemiology, health informatics, public health, Clinical Sciences, Public Health and Health Services, and Other Medical and Health Sciences

ObjectivesRapid detection and surveillance of COVID-19 is essential to reducing spread of the virus. Inadequate screening capacity has hampered COVID-19 detection, while traditional infectious disease response has been delayed due to significant demands for healthcare resources, time and personnel. This study investigated whether an online health decision-support tool could supplement COVID-19 surveillance and detection in China and the USA.SettingDaily website traffic to Thermia was collected from China and the USA, and cross-correlation analyses were used to assess the designated lag time between the daily time series of Thermia sessions and COVID-19 case counts from 22 January to 23 April 2020.ParticipantsThermia is a validated health decision-support tool that was modified to include content aimed at educating users about Centers for Disease Control and Prevention recommendations on COVID-19 symptoms. An advertising campaign was released on Microsoft Advertising to refer searches for COVID-19 symptoms to Thermia.ResultsThe lead times observed for Thermia sessions to COVID-19 case reports was 3 days in China and 19 days in the USA. We found negative cross-correlation between the number of Thermia sessions and rates of influenza A and B, possibly due to the decreasing prevalence of influenza and the lack of specificity of the system for identification of COVID-19.ConclusionThis study suggests that early deployment of an online campaign and modified health decision-support tool may support identification of emerging infectious diseases like COVID-19. Researchers and public health officials should deploy web campaigns as early as possible in an epidemic to detect, identify and engage those potentially at risk to help prevent transmission of the disease.

HIV/AIDS, behavior modification, mHealth, medication adherence, short message service, Clinical Sciences, and Public Health and Health Services

BackgroundAfrican Americans are disproportionally affected by HIV and have poorer rates of antiretroviral therapy (ART) adherence compared to other racial or ethnic groups in the United States. Factors associated with poor HIV disease outcomes are commonly associated with sociostructural barriers that prevent engagement with and retention in HIV care. SMS text messaging interventions to promote ART adherence among predominantly non-Hispanic White persons with HIV (PWH) have been shown to be efficacious; however, limited research has been devoted to culturally tailoring interventions for underrepresented racial/ethnic groups. Considering African Americans show poorer engagement along the HIV care continuum, we developed an individualized and culturally tailored two-way SMS text messaging intervention to improve ART adherence and associated virologic suppression among African American PWH.ObjectiveIn this paper we describe the protocol of a culturally tailored individualized Texting for Adherence Building (iTAB) intervention in a 24- to 48-week, single-arm study.MethodsWe developed a culturally tailored iTAB intervention, which we are implementing in a 24- to 48-week, single-arm study. Participants were recruited from the Family Health Centers of San Diego (FHCSD), a federally qualified health center. Patient inclusion criteria were (1) receiving care at the FHCSD, (2) living with HIV, (3) self-identification as Black, African American, or of African ancestry, (4) English speaking, (5) age 18 or older, (6) currently on ART, and (7) able to provide informed consent. Study enrollment began in November 2017 and closed in July 2019. A total of 90 participants from the FHCSD enrolled in the iTAB intervention, and we anticipate completing data collection in July 2020. Participants were assisted in individualizing and customizing their SMS text message preferences at the baseline study visit. Self-assessment measures are collected at baseline, interim, and final study visits. Problems related to sending/receiving SMS text messages and barriers to ART adherence are assessed at each interim study visit. The FHCSD staff monitors and tracks participants' daily SMS text message responses to ART adherence reminders using a clinical dashboard.ResultsWe hypothesize that the proportion of individuals achieving HIV virologic suppression (viral load

Maternal health, Person-centered care, Quality improvement, Library and Information Studies, Nursing, Public Health and Health Services, and Health Policy & Services

Background: Poor patient experiences during delivery leads to delayed presentation at facilities and contributes to poor maternal health outcomes. Person-centered maternity care (PCMC) is a key component of quality. Improving PCMC requires changing the process of care which can be complex and necessitate significant external input, making replication and scale difficult. This study compares the effectiveness two Quality Improvement (QI) intervention phases, one Intensive, one Light-Touch.Methods: We use a matched case-control design to compare two phases of a QI Intervention targeting PCMC, with three facilities in each. The Intensive phase was introduced into three government facilities where teams were supported to identify, design, and test potential improvements over 12 months. The Light-Touch phase was subsequently introduced in three other government facilities and changes were tracked over six months. We compared the two groups using multivariate linear regression and difference-in-difference models to assess changes in PCMC outcome RESULTS: Both Intensive and Light-Touch arms demonstrated large improvements in PCMC. On a scale from 0 to 100, Intensive facilities increased in PCMC scores from 85.02 to 97.13, while Light-Touch facilities increased from 63.42 to 87.47. For both there was a 'halo' effect, with a similar improvement recorded for the specific improvement activities focused on, as w ell as aspects of PCMC not directly addressed.Conclusions: This study demonstrates that a short, inexpensive, light-touch and directive intervention can change staff practices and significantly improve the experiences of women during childbirth. It also shows that improvements in a few areas of provider-patient interaction have a 'halo' effect, changing many other aspects of patient-provider interaction at the same time.Trial registration: QI Phase 1 - NCT04208867 . Retrospectively registered. December 19th, 2019. QI Phase 2 - NCT04208841 . Retrospectively registered. December 23, 2019.

Pediatric Emergency Research Networks (PERN) Pneumonia Investigators, paediatric A&E and ambulatory care, paediatric infectious disease & immunisation, paediatrics, paediatric A, E and ambulatory care, paediatric infectious disease, immunisation, Clinical Sciences, Public Health and Health Services, and Other Medical and Health Sciences

Introduction: Pneumonia is a frequent and costly cause of emergency department (ED) visits and hospitalisations in children. There are no evidence-based, validated tools to assist physicians in management and disposition decisions for children presenting to the ED with community-acquired pneumonia (CAP). The objective of this study is to develop a clinical prediction model to accurately stratify children with CAP who are at risk for low, moderate and severe disease across a global network of EDs.Methods and analysis: This study is a prospective cohort study enrolling up to 4700 children with CAP at EDs at ~80 member sites of the Pediatric Emergency Research Networks (PERN; https://pern-global.com/). We will include children aged 3 months to

California, Cigarettes, E-cigarettes, Own- and cross-price elasticity, and Public Health and Health Services

Although numerous studies have examined the impact of cigarette prices on cigarette demand, research examining the impact of e-cigarette and cigarette prices on e-cigarette demand is relatively limited. This study estimated the impact of e-cigarette and cigarette prices on e-cigarette and cigarette sales in California. Using the 2012-2017 Nielsen Retail Scanner Data, we constructed e-cigarette prices, cigarette prices, and per capita e-cigarette and cigarette sales by year, quarter, and Nielsen scantrack market in California. E-cigarettes were categorized as disposable or reusable. Separate fixed-effects models estimated the impact of e-cigarette and cigarette prices on per capita disposable e-cigarette, reusable e-cigarette, and cigarette sales controlling for year, quarter, market, and smoke-free air law coverage. Average prices were $5.86 per pack of 20 cigarettes, $9.80 per disposable e-cigarette, and $19.11 per reusable e-cigarette. When prices of disposable e-cigarettes, reusable e-cigarettes, and cigarettes increased by 1%, per capita sales of the products decreased by 0.37%, 0.20%, and 0.21% respectively. Cigarette prices were positively associated with per capita sales of reusable e-cigarettes, indicating reusable e-cigarettes are substitutes for cigarettes. Reusable e-cigarette prices were positively associated with per capita sales of disposable e-cigarettes, indicating disposable e-cigarettes are substitutes for reusable e-cigarettes. No statistically significant association was found between disposable/reusable e-cigarette prices and cigarette sales. Our results suggest that raising prices of disposable e-cigarettes, reusable e-cigarettes, and cigarettes such as via tobacco excise tax increases would result in reduced sales for the products. Policymakers should consider the substitution between e-cigarettes and cigarettes when designing tobacco control policies.

COVID-19, Dexamethasone, Glucocorticoids, Humans, Pandemics, Pragmatic Clinical Trials as Topic, SARS-CoV-2, Clinical Sciences, Public Health and Health Services, and Other Medical and Health Sciences

cs.SI, physics.soc-ph, Endocrinology & Metabolism, Clinical Sciences, Nutrition and Dietetics, and Public Health and Health Services

AbstractThere has been longstanding interest in the evolution of positive and negative relationships among countries. An interdisciplinary field of study, Structural Balance Theory, has developed on the dynamics of such appraisal systems. However, the advancement of research in the field has been impeded by the lack of longitudinal empirical data on large-scale networks. We construct the networks of international amicable and hostile relations occurring in specific time-periods in order to study the global evolution of the network of such international appraisals. Here we present an empirical evidence on the alignment of Structural Balance Theory with the evolution of the structure of this network, and a model of the probabilistic micro-dynamics of the alterations of international appraisals during the period 1995-2018. Also remarkably, we find that the trajectory of the Frobenius norm of sequential transition probabilities, which govern the evolution of international appraisals among nations, dramatically stabilizes.

CRE, ESBL, Infectious disease, MDRO colonization, MRSA, epidemiology, infection control, Clinical Sciences, Nursing, Public Health and Health Services, and Geriatrics

Objective: Determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum beta-lactamase producing organisms (ESBLs), and carbapenem-resistant Enterobacteriaceae (CRE) among residents and in the environment of nursing homes (NHs).Design: Point prevalence sampling of residents and environmental sampling of high-touch objects in resident rooms and common areas.Setting: Twenty-eight NHs in Southern California from 2016 to 2017.Participants: NH participants in Project PROTECT, a cluster-randomized trial of enhanced bathing and decolonization vs routine care.Methods: Fifty residents were randomly sampled per NH. Twenty objects were sampled, including 5 common room objects plus 5 objects in each of 3 rooms (ambulatory, total care, and dementia care residents).Results: A total of 2797 swabs were obtained from 1400 residents in 28 NHs. Median prevalence of multidrug-resistant organism (MDRO) carriage per NH was 50% (range: 24%-70%). Median prevalence of specific MDROs were as follows: MRSA, 36% (range: 20%-54%); ESBL, 16% (range: 2%-34%); VRE, 5% (range: 0%-30%); and CRE, 0% (range: 0%-8%). A median of 45% of residents (range: 24%-67%) harbored an MDRO without a known MDRO history. Environmental MDRO contamination was found in 74% of resident rooms and 93% of common areas.Conclusions and implications: In more than half of the NHs, more than 50% of residents were colonized with MDROs of clinical and public health significance, most commonly MRSA and ESBL. Additionally, the vast majority of resident rooms and common areas were MDRO contaminated. The unknown submerged portion of the iceberg of MDRO carriers in NHs may warrant changes to infection prevention and control practices, particularly high-fidelity adoption of universal strategies such as hand hygiene, environmental cleaning, and decolonization.

Humans, Pneumonia, Viral, Coronavirus Infections, HIV Infections, Developing Countries, Pandemics, Betacoronavirus, COVID-19, HIV, High income countries, Prevention, Public health, Pneumonia, Viral, Public Health and Health Services, Social Work, and Public Health

High income countries (HIC) have set the initial global policy responses to COVID-19. Yet, low and middle income countries (LIMIC) face very different challenges than HIC. In LMIC, there is a far greater emphasis on community solutions; families live in far more dense communities, making shelter-in-place mandates questionable; and strengthening existing health systems is more important than novel services. LMIC have far fewer economic resources. Most distressing, the successful economic commitments that HIC made to help stop HIV in LMIC have not yet been imitated, or even initiated-this support is needed now to fight COVID-19.

Adult mortality, Developing countries, Education, Longevity, Middle-income countries, Schooling, and Public Health and Health Services

Background:There are large differences in adult mortality across schooling groups in many high-income countries (HICs). An important open question is whether there are similar gradients in adult mortality in middle-income countries (MICs), where schooling and healthcare quality tends to be lower and health-related behaviors are often not strongly patterned by schooling. Methods:We present one of the first international-comparative studies on schooling differences in adult mortality across MICs using harmonizedlongitudinal data on adults ages 50+ from China, Costa Rica, Indonesia, Mexico, South Africa, and South Korea. We use Cox proportional hazards models to estimate differences in the hazard of mortality across schooling groups overall and separately by sex and broad age groups. We also estimate schooling gradients in smoking and body mass index to determine whether risk factor gradients potentially explain mortality patterns. Results:Only adults with tertiary schooling have a consistent adult mortality advantage compared to those with no schooling. We do not find evidence that individuals with primary schooling have a lower hazard of mortality compared to individuals with no schooling in five of the six countries. The mortality advantage for individuals with secondary schooling is mixed, with evidence of lower mortality relative to those with no schooling in Mexico, South Africa, and South Korea. Gradients in BMI and smoking are inconsistent across countries and unlikely to explain mortality differences. Conclusions:We find that adult mortality and risk factor gradients in MICs can be much different than the established patterns seen in modern HICs. Our results highlight that adult mortality gradients are not an inevitability and are not found in all populations. Understanding what factors give rise to inequalities in adult mortality and what can be done to minimize gradients while still ensuring continued mortality improvements in MICs is a crucial focus for research and policy.

Geriatrics, Clinical Sciences, Public Health and Health Services, and Cognitive Sciences

Instrumental variables analysis, Peer effects, Smoking cessation, Social networks, Tobacco control, Workplace intervention, and Public Health and Health Services

While smoking is widely acknowledged to be a social activity, limited evidence exists on the extent to which friends influence each other during worksite-based tobacco cessation interventions. Drawing on data from adult smokers (N = 1823) in a large, cluster randomized controlled trial in worksites in Thailand, this study examines the presence of social spillovers in the decision to abstain from smoking. We leverage a unique aspect of social network structure in these data-the existence of non-overlapping friendship networks-to address the challenge of isolating the effects of peers on smoking behavior from the confounding effects of endogenous friend selection and bidirectional peer influence. We find that individuals with workplace friends who have abstained from smoking during the trial are significantly more likely to abstain themselves. Instrumental variables estimates suggest that abstinence after 3 and 12 months increases 26 and 32 percentage points, respectively, for each additional workplace friend who abstains. These findings highlight the potential for workplace interventions to use existing social networks to magnify the effect of individual-level behavior change, particularly in low- and middle-income countries where tobacco cessation support tends to be limited.

Pediatrics, Paediatrics and Reproductive Medicine, and Public Health and Health Services

Nigeria, Primary health care facilities, factor analysis, health facility management, performance-based financing, scorecard, and Public Health and Health Services

BACKGROUND:In low- and middle-income countries, there is scarcity of validated and reliable measurement tools for health facility management, and many interventions to improve primary health care (PHC) facilities are designed without adequate evidence base on what management practices are critical. OBJECTIVE:This article developed and validated a scorecard to measure management practices at primary health care facilities under the performance-based financing (PBF) scheme in Nigeria. METHODS:Relevant management practice domains and indicators for PHC facilities were determined based on literature review and a prior qualitative study conducted in Nigeria. The domains and indicators were tested for face validity via experts review and organized into an interviewer-administered scorecard. A stratified random sampling of PHC facilities in three States in Nigeria was conducted to assess the reliability and construct validity of the scorecard. Inter-rater reliability using inter-class correlation (ICC) (1, k) was assessed with one-way ANOVA. Exploratory factor analysis (EFA) was conducted to assess the construct validity, and an updated factor structure were developed. RESULTS:32 indicators and 6 management practice domains were initially described. Ordinal responses were derived for each indicator. Data on the scorecard were obtained from 111 PHC facilities. The ICC of mean ratings for each team of judges was 0.94. The EFA identified 6 domains (Stakeholder engagement and communication; Community-level activities; Update of plan and target; Performance management; Staff attention to planning, target, and performance; and Drugs and financial management) and reduced the number of indicators to 17. The average communality of selected items was 0.45, and item per factor ratio was 17:6. CONCLUSIONS:Despite a few areas for further refinement, this paper presents a reliable and valid scorecard for measuring management practices in PHC facilities. The scorecard can be applied for routine supervisory visits to PHC facilities, and can help accumulate knowledge on facility management, how it affects performance, and how it may be strengthened.

Humans, Social Identification, Social Values, Learning, Curriculum, Professional Competence, Students, Medical, Writing, Health Personnel, Patient panels, pre-clerkship education, professional identity formation, professionalism, reflective practice, Public Health and Health Services, and Specialist Studies in Education

BackgroundWhile there are several curricula using patients as educators, little has been published on how they affect student learning and professional development.ObjectiveTo explore what 1st year medical students learn about professional values from a patient-led educational experience and how it affects their professional development.DesignWe piloted a pediatric patient and family-led educational session during the molecular medicine course, with the goal of sharing the experience of caring for a child with a chronic illness. Following the session, students were required to submit a written reflection on what they learned and the impact the session had on them. All reflections from one academic year were qualitatively analyzed by two investigators and organized using HyperRESEARCH software. A content analysis approach was used to generate codes and emergent themes. Two theoretical lenses guided the analyses: Arnold's framework on professional values and the lens of professional identity formation, described as a process by which health care professionals "think, act and feel like a physician.ResultsStudents gained an appreciation of professional values, especially humanism and excellence, and how clinician role models reinforce these values. Reflective writings demonstrated recognition among learners that their identity involved being active participants in health care delivery and not just as passive classroom learners. Students were motivated to study diligently and be patient advocates; some questioned their skills in dealing with ambiguity and with the health-care system, resulting in a sense of helplessness.ConclusionStudents learn the importance of professional attributes and of clinician role models through a pediatric family teaching experience. They are motivated, displaying glimpses of their future role as caregivers and patient advocates; however, some also express fear and doubt their own abilities. Based on this, a debriefing session has been introduced to prevent a negative effect on learner self-efficacy.

Acculturation, Asian americans, HIV, Patient-healthcare provider relationships, Stigma, Public Health, and Public Health and Health Services

Acculturation may limit HIV-positive Asian Americans' active interactions with patient-healthcare providers (HCP) and utilization of HIV healthcare services; however, the specific mediation effect of acculturation still unknown. A bias-corrected factor score path analysis was performed to examine the proposed model of relations among acculturation, stigma, stress, and patient-HCP relationships. A convenience sample of 69 HIV-positive Asian Americans in San Francisco, Los Angeles, and New York City were recruited and collect data were collected on demographics, HIV-related stigma, stress, and patient-HCP relationships. HIV stigma and stress had a direct, negative effect on patient-HCP relationships. Acculturation had a positive total effect on patient-HCP relationships, and was mediated by HIV stigma and stress. A acculturation also had a direct impact on stigma and stress. Acculturation, HIV-related stigma, and stress are key elements to achieving good patient-HCP relationships, and provide insights on the design of culturally sensitive interventions to improve patient-HCP relationships.