Chicago Center Research Articles

403. Strain Epidemiology of Clostridioides difficile across Three Geographically Distinct Medical Centers in Chicago

Abstract Background Clostridioides difficile infections (CDI) are caused by a large and diverse group of strains with differences in prevalence and associated morbidity. Over the past 20 years the C. difficile (CD) molecular epidemiology has changed as the prevalence of the epidemic strain recognized as restriction endonuclease analysis (REA) group BI or PCR-Ribotype group (RT) 027 has decreased. The objective of this study was to determine the current epidemiology of CD in the city of Chicago. Methods Baseline characteristics and symptoms were compared for 81 patients who tested positive for CD by PCR (tcdB) between 9/1/2021 and 10/7/2021 at 3 hospitals in the city of Chicago. Patients were classified as having healthcare-associated CDI (HA-CDI) if symptoms began >72 hours after hospital admission, community-associated CDI (CA-CDI) if symptoms began ≤72 hours prior to admission, and community-onset healthcare-associated CDI (COHA-CDI) if they had been hospitalized ≤4 weeks prior to CDI diagnosis. Available stools were cultured and recovered CD isolates underwent REA typing. Determination of CD colonization was made by review of symptoms including chronicity of symptoms, stool frequency, and response to treatment. Results Among all patients, 33% (27/81) were CA-CDI, 28% (23/81) COHA-CDI, 11% (9/81) HA-CDI, and 27% (22/81) were classified as colonized. Primary CDI accounted for 66% (39/59) of the infections. Among patients with a primary CDI, 46% (18/39) of patients were classified as CA-CDI whereas COHA-CDI and HA-CDI accounted for 54% (21/39) of infections. REA group Y was the most common group strain accounting for 29% (22/75) of isolates. (Figure 1) REA group Y accounted for 26% (7/27) of CA-CDI compared to 0 REA group BI [p=0.06], and REA group Y accounted for 35% (7/20) of all colonized patients. (Figure 2) Figure 1Figure 2 Conclusion There has been a marked change in the CD epidemiology within the city of Chicago since 2009 when REA group BI accounted for 61% of CDI (Black et al ICHE 2011; 32:897-902). REA group Y (typically identified as RT 014/020) is now the most common group strain in Chicago supplanting REA group BI (RT027). REA group Y appears to be associated primarily with CA-CDI and CD colonization. A detailed genomic analysis of REA group Y is required to determine potential reservoirs of REA group Y. Disclosures Mary K. Hayden, MD, Sanofi: Member, clinical adjudication panel Nicholas M. Moore, PhD, D(ABMM), Abbott Molecular: Grant/Research Support|Cepheid: Grant/Research Support Amanda Harrington, PhD, Beckman Coulter, Inc.: Clinical trial data collection funded by Beckman Coulter, Inc.|bioMeriuex/BioFire: Grant/Research Support Dale N. Gerding, MD, Destiny Pharma plc.: Advisor/Consultant Stuart Johnson, M.D., Ferring Pharmaceuticals: Membership on Ferring Publication Steering Committee|Ferring Pharmaceuticals: Employee|Summit Plc: Advisor/Consultant.

Machine Learning Techniques to Explore Clinical Presentations of COVID-19 Severity and to Test the Association With Unhealthy Opioid Use: Retrospective Cross-sectional Cohort Study.

The COVID-19 pandemic has exacerbated health inequities in the United States. People with unhealthy opioid use (UOU) may face disproportionate challenges with COVID-19 precautions, and the pandemic has disrupted access to opioids and UOU treatments. UOU impairs the immunological, cardiovascular, pulmonary, renal, and neurological systems and may increase severity of outcomes for COVID-19. We applied machine learning techniques to explore clinical presentations of hospitalized patients with UOU and COVID-19 and to test the association between UOU and COVID-19 disease severity. This retrospective, cross-sectional cohort study was conducted based on data from 4110 electronic health record patient encounters at an academic health center in Chicago between January 1, 2020, and December 31, 2020. The inclusion criterion was an unplanned admission of a patient aged ≥18 years; encounters were counted as COVID-19-positive if there was a positive test for COVID-19 or 2 COVID-19 International Classification of Disease, Tenth Revision codes. Using a predefined cutoff with optimal sensitivity and specificity to identify UOU, we ran a machine learning UOU classifier on the data for patients with COVID-19 to estimate the subcohort of patients with UOU. Topic modeling was used to explore and compare the clinical presentations documented for 2 subgroups: encounters with UOU and COVID-19 and those with no UOU and COVID-19. Mixed effects logistic regression accounted for multiple encounters for some patients and tested the association between UOU and COVID-19 outcome severity. Severity was measured with 3 utilization metrics: low-severity unplanned admission, medium-severity unplanned admission and receiving mechanical ventilation, and high-severity unplanned admission with in-hospital death. All models controlled for age, sex, race/ethnicity, insurance status, and BMI. Topic modeling yielded 10 topics per subgroup and highlighted unique comorbidities associated with UOU and COVID-19 (eg, HIV) and no UOU and COVID-19 (eg, diabetes). In the regression analysis, each incremental increase in the classifier's predicted probability of UOU was associated with 1.16 higher odds of COVID-19 outcome severity (odds ratio 1.16, 95% CI 1.04-1.29; P=.009). Among patients hospitalized with COVID-19, UOU is an independent risk factor associated with greater outcome severity, including in-hospital death. Social determinants of health and opioid-related overdose are unique comorbidities in the clinical presentation of the UOU patient subgroup. Additional research is needed on the role of COVID-19 therapeutics and inpatient management of acute COVID-19 pneumonia for patients with UOU. Further research is needed to test associations between expanded evidence-based harm reduction strategies for UOU and vaccination rates, hospitalizations, and risks for overdose and death among people with UOU and COVID-19. Machine learning techniques may offer more exhaustive means for cohort discovery and a novel mixed methods approach to population health.

Tecovirimat Use in Ambulatory and Hospitalized Patients With Monkeypox Virus Infection.

In this case series of 20 ambulatory and hospitalized adult patients treated for monkeypox virus at a large academic medical center in Chicago, Illinois, tecovirimat use was reserved for those with or at high risk of severe disease, delayed because of logistical and clinical factors, but well tolerated.

Assessing widening disparities in HbA1c and systolic blood pressure retesting during the COVID-19 pandemic in an LGBTQ+-focused federally qualified health center in Chicago: a retrospective cohort study using electronic health records

IntroductionTo assess disparities in retesting for glycated hemoglobin (HbA1c) and systolic blood pressure (SBP) among people with diabetes mellitus (DM) and hypertension (HTN), respectively, we analyzed medical records from a...

CHEC-UP: A Digital Intervention to Reduce Disparities in Well-Child and Immunization Completion in Community Health

Objective
 Well-child visits and immunizations among children in the U.S. declined at the pandemic’s onset and vulnerable populations have been disproportionately affected. This pilot projects tested an innovative mechanism to use chatbots to engage caregivers in evidence-based preventive care for children. 
 Design 
 We used artificial intelligence (AI)-enabled chatbots to personalize messages and facilitate appointment scheduling over a five-month period. Chatbots introduced a novel way to connect vulnerable populations to care and challenged traditional convention of provider-patient engagement.
 Setting
 The pilot study was conducted at a Community Health Center in Chicago, Illinois that serves roughly 10,500 children, and 82% of patients are racial and/or ethnic minorities. 
 Participants 
 We targeted outreach to 200 English and Spanish-speaking families with children 0-17 years of age for proactive outreach using chatbots promoting well-child visit completion and up-to-date immunization status; moreover, a special emphasis was placed on the 0-2 age group as the first two years represent a critical time for primary prevention of vaccine-preventable diseases.
 InterventionsThe intervention focused on pre-visit engagement by launching an AI-enabled chatbot to deliver personalized messages and facilitate appointment scheduling via mobile devices. CHEC-UP also provided evidence-based anticipatory guidance prior to an appointment. Coaching in preparation for the visit with trusted information has the potential to educate, improve confidence and promote shared decisions between the parent and provider. Patient experience was measured via surveys deployed via the chatbot.
 Main Outcome Measures & Results
 Chatbots facilitated a relative increase in well-child visits and immunizations by 27% in the intervention group. Well-child visits and immunizations in the intervention group increased 13% compared to the control group. Survey results and patient interviews indicated a high level of patient satisfaction using the chatbot. In addition to a favorable perception of the chatbots, patients also identified future use cases for chatbots.
 Conclusions Engaging patients with chatbots improved vaccination and well-child uptake. Patients were highly satisfied with chatbot engagement. By engaging patients and caregivers, chatbots present the potential to proactively engage patients in care and optimize vaccination uptake and realize one of societies’ greatest public health achievements: decreasing the spread of communicable diseases.

Patient Portal Perceptions in an Urban Community Health Center Setting: Insights for Telehealth

Introduction
 Patient portals are the “front door” to telehealth - online scheduling, video visit links, and digital after visit summaries are often conveyed via the patient portal. Patient portal tools often require similar patient skills and attitudes as telehealth adoption. Analyzing patients’ perceptions and beliefs around this digital patient engagement tool may lead to insights regarding telehealth, particularly in historically underrepresented patient populations.
 
 Methods
 Participants from a Federally Qualified Health Center (FQHC) in Chicago, IL were surveyed on general technology use, healthcare-specific technology use, and barriers and facilitators to patient portal use.
 
 Results
 The 149 respondents (81% response rate) represented a unique population base with 96% African American, 74% with educational attainment of some college or less, and 48% with at least one chronic medical condition. Technology access and use were high with 78% computer ownership, 98% mobile phone ownership (with 75% smartphone ownership). In terms of patient portal perception, 75% rated Perceived Usefulness (U) as high. Perceived Ease of Use (E) domains similarly had 70% or higher agreement from patients, and potential barriers and facilitators in the Attitudes Toward Use (A) section included a preference to calling their doctor, and minority of patients viewing the portal as unsafe way to communication, too complicated to use, or taking too much time. Additional stratification analysis by demographic variables (age, gender, educational attainment, and number of chronic conditions) revealed differences in portal perception across the Usefulness, Ease of Use, and Attitudes domains.
 
 Discussion
 Insights from barriers, attitudes, and capacity to use patient portal tools deliver important insight into overall adoption of other digital health modalities, including telehealth. In an urban historically underserved patient population, technology access and use is quite high, and mobile phones access was nearly ubiquitous with a large majority using the internet function on their mobile device. Different age groups, genders, levels of educational attainment, or degree of multi-morbidity have different values and needs. Therefore, each subpopulation needs targeted messaging of different portal benefits.
 
 Conclusion
 Our research provides initial insights into patient-level factors influencing patient portal attitudes, with implications toward telehealth adoption. Demographic differences have a significant impact on attitudes toward technology adoption. Equitable uptake of portal and telehealth services will require tailored messaging, training, and multiple modes of communication, including web-based and mobile.

In Memoriam: Anil K. Bidani, MD.

In Memoriam: Anil K. Bidani, MD.

Genomic Investigation to Identify Sources of Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Healthcare Personnel in an Acute Care Hospital.

Identifying the source of healthcare personnel (HCP) coronavirus disease 2019 (COVID-19) is important to guide occupational safety efforts. We used a combined whole genome sequencing (WGS) and epidemiologic approach to investigate the source of HCP COVID-19 at a tertiary-care center early in the COVID-19 pandemic. Remnant nasopharyngeal swab samples from HCP and patients with polymerase chain reaction-proven COVID-19 from a period with complete sample retention (14 March 2020 to 10 April 2020) at Rush University Medical Center in Chicago, Illinois, underwent viral RNA extraction and WGS. Genomes with >90% coverage underwent cluster detection using a 2 single-nucleotide variant genetic distance cutoff. Genomic clusters were evaluated for epidemiologic linkages, with strong linkages defined by evidence of time/location overlap. We analyzed 1031 sequences, identifying 49 clusters that included ≥1 HCP (265 patients, 115 HCP). Most HCP infections were not healthcare associated (88/115 [76.5%]). We did not identify any strong epidemiologic linkages for patient-to-HCP transmission. Thirteen HCP cases (11.3%) were attributed to a potential patient source (weak evidence involving nonclinical staff that lacked location data to prove or disprove contact with patients in same cluster). Fourteen HCP cases (12.2%) were attributed to HCP source (11 with strong evidence). Using genomic and epidemiologic data, we found that most HCP severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections were not healthcare associated. We did not find strong evidence of patient-to-HCP transmission of SARS-CoV-2.

An EHR-automated and theory-based population health management intervention for smoking cessation in diverse low-income patients of safety-net health centers: a pilot randomized controlled trial.

This study tested the preliminary effectiveness of an electronic health record (EHR)-automated population health management (PHM) intervention for smoking cessation among adult patients of a federally qualified health center in Chicago. Participants (N = 190; 64.7% women, 82.1% African American/Black, 8.4% Hispanic/Latino) were self-identified as smokers, as documented in the EHR, who completed the baseline survey of a longitudinal "needs assessment of health behaviors to strengthen health programs and services." Four weeks later, participants were randomly assigned to the PHM intervention (N = 97) or enhanced usual care (EUC; N = 93). PHM participants were mailed a single-page self-determination theory (SDT)-informed letter that encouraged smoking cessation or reduction as an initial step. The letter also addressed low health literacy and low income. PHM participants also received automated text messages on days 1, 5, 8, 11, and 20 after the mailed letter. Two weeks after mailing, participants were called by the Illinois Tobacco Quitline. EUC participants were e-referred following a usual practice. Participants reached by the quitline were offered behavioral counseling and nicotine replacement therapy. Outcome assessments were conducted at weeks 6, 14, and 28 after the mailed letter. Primary outcomes were treatment engagement, utilization, and self-reported smoking cessation. In the PHM arm, 25.8% of participants engaged in treatment, 21.6% used treatment, and 16.3% were abstinent at 28 weeks. This contrasts with no quitline engagement among EUC participants, and a 6.4% abstinence rate. A PHM approach that can reach all patients who smoke and address unique barriers for low-income individuals may be a critical supplement to clinic-based care.

OUTCOMES OF COVID-19 IN LUNG TRANSPLANT RECIPIENTS: A SINGLE CENTER REVIEW

SESSION TITLE: Lung Transplantation: New Issues in 2022SESSION TYPE: Rapid Fire Original InvPRESENTED ON: 10/19/2022 11:15 am - 12:15 pmPURPOSE: Currently the sequelae of COVID pneumonia in lung transplant recipients (LTR) is poorly described and the long-term effects are largely unknown. LTRs encompass a unique patient population with anatomic and immunological changes that pose a huge challenge in the management of COVID pneumonia compared to the general population. This project looks to further delineate risk factors, prognostication, and long-term sequelae of COVID pneumonia in LTRs.METHODS: A retrospective analysis was performed in a single large lung transplant center in Chicago from January 2020 to June 2021. Impact of COVID-19 based on patient demographics, management strategies, level of care, mortality, and pre- and post-COVID spirometry changes were analyzed based on follow-up visits after infection in survivors.RESULTS: There was an overall mortality of 21% with 68% requiring hospital admission. Of the patients admitted, there was a 62% mortality risk associated with ICU admission. Pre-existing chronic lung allograft dysfunction (CLAD) was present in 10 patients of which 50% were admitted to the ICU. Baseline FEV1 was 1.95 L with an average post covid FEV1 of 1.89 L (3.7% decline) for survivors. Pre-existing CLAD, lower baseline FEV1, and increased time since transplant were predictors of ICU admission.CONCLUSIONS: COVID-19 continues to remain a dangerous, life-threatening disease, particularly for LTRs. While there were no patients that developed CLAD post infection, there was an overall decrease in lung function. The long term trajectory of graft function post-covid remains unclear, however pre-existing allograft dysfunction appears to provide prognostic value.CLINICAL IMPLICATIONS: Further study needs to be done on COVID-19 and the long-term implications of allograft function in the LTR population.DISCLOSURES: Speaker/Speaker's Bureau relationship with boehringer ingelheim Please note: $5001 - $20000 by Brad Bemiss, value=Travel and payment for lectureNo relevant relationships by Timothy O'ConnorNo relevant relationships by Love Patel SESSION TITLE: Lung Transplantation: New Issues in 2022 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Currently the sequelae of COVID pneumonia in lung transplant recipients (LTR) is poorly described and the long-term effects are largely unknown. LTRs encompass a unique patient population with anatomic and immunological changes that pose a huge challenge in the management of COVID pneumonia compared to the general population. This project looks to further delineate risk factors, prognostication, and long-term sequelae of COVID pneumonia in LTRs. METHODS: A retrospective analysis was performed in a single large lung transplant center in Chicago from January 2020 to June 2021. Impact of COVID-19 based on patient demographics, management strategies, level of care, mortality, and pre- and post-COVID spirometry changes were analyzed based on follow-up visits after infection in survivors. RESULTS: There was an overall mortality of 21% with 68% requiring hospital admission. Of the patients admitted, there was a 62% mortality risk associated with ICU admission. Pre-existing chronic lung allograft dysfunction (CLAD) was present in 10 patients of which 50% were admitted to the ICU. Baseline FEV1 was 1.95 L with an average post covid FEV1 of 1.89 L (3.7% decline) for survivors. Pre-existing CLAD, lower baseline FEV1, and increased time since transplant were predictors of ICU admission. CONCLUSIONS: COVID-19 continues to remain a dangerous, life-threatening disease, particularly for LTRs. While there were no patients that developed CLAD post infection, there was an overall decrease in lung function. The long term trajectory of graft function post-covid remains unclear, however pre-existing allograft dysfunction appears to provide prognostic value. CLINICAL IMPLICATIONS: Further study needs to be done on COVID-19 and the long-term implications of allograft function in the LTR population. DISCLOSURES: Speaker/Speaker's Bureau relationship with boehringer ingelheim Please note: $5001 - $20000 by Brad Bemiss, value=Travel and payment for lecture No relevant relationships by Timothy O'Connor No relevant relationships by Love Patel

Navigating medication-taking after kidney transplant.

Mixed methods are valuable in understanding multifaceted health behaviors like medication adherence. Kidney transplant recipients (KTRs) have complex medication regimens and are more vulnerable to nonadherence relative to other transplant recipients. Yet mixed methods have not been widely applied to examine adherence among KTRs, especially in relation to prescribed medications beyond immunosuppressants. As part of a sequential approach, we used in-depth interviews to better understand findings from a previous quantitative study and to describe additional factors that influence prescription medication-taking among adult KTRs. Semi-structured interviews were conducted with a purposive sample of 14 adult KTRs recruited from a transplant center in Chicago, IL. Deductive and inductive content analysis was used to code transcripts and identify key themes. Across the sample, we identified insurance challenges, disruptions in routine, and poor mental well-being as barriers to adherence at the patient level. For Black and Hispanic KTRs, poor communication between providers and disjointed care transitions posed additional barriers at the health system level. Compared with White KTRs, Black and Hispanic KTRs experienced greater medication burden due to comorbidities, while medication and digital literacy challenges were unique to Hispanic KTRs. KTRs are often motivated to take medications as prescribed, but sometimes lack the capacity or support to do so. Eliciting KTR perspectives is necessary in addressing knowledge and resource gaps at the patient and health system levels to improve adherence. In addition, recognizing the relative burden of taking comorbidity medications compared with immunosuppressants may important, particularly for Black and Hispanic KTRs.

Barriers to participation in supervised exercise therapy reported by people with peripheral artery disease

ObjectiveThis study identified barriers to participation in supervised exercise therapy covered by the Centers for Medicare and Medicaid Services (CMS), reported by people with lower extremity peripheral artery disease (PAD). MethodsPeople with PAD participating in research studies of walking impairment due to PAD in the Chicagoland area were asked to complete a questionnaire between March 15, 2019, and July 12, 2022, assessing their experience and attitudes about supervised exercise therapy. Participants were identified using mailed postcards to people aged 50 and older in Chicagoland, from medical centers in Chicago, and using bus and train advertisements. The questionnaire was developed based on focus group feedback from people with PAD. ResultsOf 516 participants with PAD approached, 489 (94.8%) completed the questionnaire (mean age: 71.0 years [standard deviation: 8.7], mean ankle-brachial index: 0.71 [standard deviation: 0.25]; 204 [41.7%] women and 261 [53.4%] Black). Of the 489 participants, 416 (85.1%) reported that their physician had never prescribed or recommended supervised exercise therapy. Overall, 357 (73.2%) reported willingness to travel three times weekly to the medical center for supervised exercise participation. However, of these, 214 (59.9%) reported that they were unwilling or unable to pay the $11 per exercise session copay required for supervised exercise covered by CMS. Of 51 people with PAD who reported prior participation in supervised exercise, only 5 (9.8%) completed the 12 weeks of supervised exercise therapy covered by CMS and 29 (56.9%) completed 6 or fewer weeks. Of 131 (26.8%) unwilling to travel three times weekly to a center for supervised exercise, the most common reasons for unwillingness to participate were “too time-consuming” (55.0%), “too inconvenient” (45.8%), and “lack of interest in treadmill exercise” (28.2%). ConclusionsApproximately 2 to 4 years after CMS began covering supervised exercise for PAD, most people with PAD in this study from a large urban area had not participated in supervised exercise therapy. Of those who participated, most completed fewer than half of the sessions covered by CMS. The required CMS copayment was a common barrier to supervised exercise participation by people with PAD.

Community-Academic Partnerships: Addressing Health Inequities Through Community-Engaged Service Learning.

In Chicago, Black men who have sex with men (MSM) and transgender and gender nonconforming (TGNC) individuals experience higher rates of HIV diagnoses. The Southside of Chicago has a thriving house ball culture powered by MSM and TGNC individuals who are disproportionately impacted by HIV. While this community has a history of facilitating health promotion at their events, gaps exist in community-empowered education specific to this community. Through partnership between nursing students from University of Illinois Chicago (UIC) and leaders from the Southside Health Advocacy Resource Partnership (SHARP) and the University of Chicago Center for HIV Elimination (CCHE), we aimed to reduce health disparities experienced by the Black MSM/TGNC community in Chicago. We promoted COVID-19 vaccinations and obtained funding for a community-led project to reduce HIV-related stigma. Our team consisted of two community leaders, seven students, and two professors. We met weekly during the development stages and detailed notes were maintained by students and updated with next steps. Four months of collaboration demonstrated how nursing coursework can facilitate community-academic partnership and yielded a COVID-19 viral vaccination promotion video, community administration of vaccines, and SHARP's procurement of funding to implement a project to reduce HIV-related stigma. Students learned the importance of community leaders' presence when bringing health care to communities. Community leaders learned to communicate population needs and best utilize students as a resource. Enriching nursing curriculum using an integrated service-learning format offers the opportunity for student development while simultaneously serving the community.

Notes on Contributors

Previous article FreeNotes on ContributorsPDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMoreJacob Collins is associate professor of history at the College of Staten Island, City University of New York, where he teaches courses in modern European history. His first book is The Anthropological Turn: French Political Thought after 1968 (University of Pennsylvania Press, 2020). He is a member of the New Left Review’s editorial board, and his current book project is an intellectual history of autobiography.Inés Escobar González is an anthropologist specializing in social, economic, and political transformation in Mexico and the Americas. She is a Junior Fellow of the Harvard Society of Fellows. Her recent publications include “L’informalité de l’inclusion: Réforme, logement et finances dans les nouvelles périphéries de Mexique, le cas de Guadalajara” (L’Harmattan, 2021). She teaches courses on ethnographic methods, financialization, and the political economy of poverty in Latin America. She is currently writing a book on the afterlives of inclusion in Mexico.Trevor Jackson is assistant professor in the Department of History at George Washington University, where he teaches and researches the history of inequality, capitalism, and financial crisis, mostly but not exclusively in early modern Europe. His first book, Impunity and Capitalism: Afterlives of European Financial Crises, 1690–1830, is forthcoming from Cambridge University Press.Jaewoong Jeon is assistant professor in the Department of East Asian Studies at New York University. His work is centered on the history of capitalism in East Asia and often takes the form of comparative macrohistory.Tad Skotnicki teaches and writes about the politics and culture of capitalism as well as social scientific reason. He is an assistant professor of sociology at the University of North Carolina at Greensboro and published The Sympathetic Consumer: Moral Critique in Capitalist Culture with Stanford University Press in 2021. His current research deals with futurelessness in capitalist societies, on the one hand, and the role of totalities in social scientific explanations, on the other.Matthew Soener is assistant professor of sociology at the University of Illinois Urbana-Champaign, where he teaches courses on social theory and political economy. His research centers on financialization, globalization, and inequality. More recently he has begun focusing on the political economy of climate change and fossil fuels. His work has been published in Socio-Economic Review, Economy and Society, New Political Economy, Sociological Forum, and Sociology Compass. Previous article DetailsFiguresReferencesCited by Critical Historical Studies Volume 9, Number 2Fall 2022 Sponsored by the Chicago Center for Contemporary Theory (3CT) Article DOIhttps://doi.org/10.1086/721839 © 2022 The University of Chicago. All rights reserved.PDF download Crossref reports no articles citing this article.

HIV testing in a high prevalence urban area in the US: Identifying missed opportunities two ways.

Routine opt-out HIV testing in healthcare settings is often not implemented to its fullest extent. We assessed factors contributing to missed HIV testing opportunities at an academic medical center in Chicago, Illinois, with a routine HIV screening program. Retrospective analysis of HIV testing in clinical encounters was performed using multivariate regession models. Missed opportunities were defined as 1) an encounter during which an HIV test was not conducted on a patient later diagnosed with HIV, or 2) an encounter in which a bacterial STI test was performed without HIV testing. Of 122 people newly diagnosed with HIV from 2011-2018, 98 patients had 1215 prior encounters, of which 82.8% were missed opportunities. Female gender, persons not known to be men who have sex with men, and encounter location other than inpatient had higher odds of a missed opportunity. Nearly half (48.4%) of 104,678 bacterial STI testing encounters were missed opportunities. Female gender, older age, lack of syphilis testing, and location outside the emergency department had higher odds of a missed opportunity. We found a high number of missed HIV testing opportunities, which could be reduced by strengthening routine screening and increasing targeted testing concurrent with STI screening.

Impact of Individualized Patient Education Material on Patients' Cancer Care Experiences

Background Patient education materials (PEMs) empower patients to have an understanding of their health and treatment options. PEMs that currently exist in Radiation Oncology are available primarily as text heavy resources, or multiple-click web-based Internet resources, exceeding the national readability recommendation of a 6th grade reading level. A health literacy level appropriate PEM that simplifies the complexity of a cancer diagnosis and treatment options may be a reasonable option to facilitate patient-provider communication in Oncology. Methods We are developing a multidisciplinary, health literacy appropriate thoracic oncology PEM at Rush University Medical Center (RUMC) in Chicago, IL, which serves a diverse patient population with varying health literacy levels. This new PEM, part of an ongoing study, aims to address the knowledge translation gap. The primary outcome is to assess the mean difference in patient satisfaction between control and study groups. The secondary outcome is to assess an interaction effect between health literacy and the overall effect of the PEM on patient satisfaction. Results This prospective randomized control trial with IRB approval is ongoing. The PEM was developed collaboration with media designers and the RUMC Patient Education Committee. Readability of the PEM was assessed with ten common readability assessment scales, represented through a mean score. All English or Spanish speaking adults scheduled for a new patient consult during Comprehensive Lung Clinic will be included. The control group will receive the standard of care (physician encounter without the PEM), while the intervention group will receive standard of care and the PEM. All patients will complete an anonymized validated survey that measures health literacy levels, sociodemographic factors, and satisfaction of the encounter. A cumulative anonymized health-care provider survey will gather descriptive data about health-care providers' experiences using the PEM. Descriptive statistics will characterize the control and study group. Patient satisfaction will be measured on a 5-point scale. A two-sample t-test with a one-sided alternative will measure the difference of mean score of patient satisfaction between the control and study group. We will apply interaction tests to determine the differential impact of health literacy on the correlation of the PEM and patient satisfaction. Multiple linear regression modeling will be done to determine the correlation of the PEM and patient satisfaction after adjusting for other socio-demographic variables. Discussion If received well, we will explore expanding this study to other treatment sites, with the overall goal of improving health literacy appropriate PEMs in Radiation Oncology. Patient education materials (PEMs) empower patients to have an understanding of their health and treatment options. PEMs that currently exist in Radiation Oncology are available primarily as text heavy resources, or multiple-click web-based Internet resources, exceeding the national readability recommendation of a 6th grade reading level. A health literacy level appropriate PEM that simplifies the complexity of a cancer diagnosis and treatment options may be a reasonable option to facilitate patient-provider communication in Oncology. We are developing a multidisciplinary, health literacy appropriate thoracic oncology PEM at Rush University Medical Center (RUMC) in Chicago, IL, which serves a diverse patient population with varying health literacy levels. This new PEM, part of an ongoing study, aims to address the knowledge translation gap. The primary outcome is to assess the mean difference in patient satisfaction between control and study groups. The secondary outcome is to assess an interaction effect between health literacy and the overall effect of the PEM on patient satisfaction. This prospective randomized control trial with IRB approval is ongoing. The PEM was developed collaboration with media designers and the RUMC Patient Education Committee. Readability of the PEM was assessed with ten common readability assessment scales, represented through a mean score. All English or Spanish speaking adults scheduled for a new patient consult during Comprehensive Lung Clinic will be included. The control group will receive the standard of care (physician encounter without the PEM), while the intervention group will receive standard of care and the PEM. All patients will complete an anonymized validated survey that measures health literacy levels, sociodemographic factors, and satisfaction of the encounter. A cumulative anonymized health-care provider survey will gather descriptive data about health-care providers' experiences using the PEM. Descriptive statistics will characterize the control and study group. Patient satisfaction will be measured on a 5-point scale. A two-sample t-test with a one-sided alternative will measure the difference of mean score of patient satisfaction between the control and study group. We will apply interaction tests to determine the differential impact of health literacy on the correlation of the PEM and patient satisfaction. Multiple linear regression modeling will be done to determine the correlation of the PEM and patient satisfaction after adjusting for other socio-demographic variables. If received well, we will explore expanding this study to other treatment sites, with the overall goal of improving health literacy appropriate PEMs in Radiation Oncology.

Sequencing during Times of Change: Evaluating SARS-CoV-2 Clinical Samples during the Transition from the Delta to Omicron Wave.

The pandemic of SARS-CoV-2 is characterized by the emergence of new variants of concern (VOCs) that supplant previous waves of infection. Here, we describe our investigation of the lineages and host-specific mutations identified in a particularly vulnerable population of predominantly older and immunosuppressed SARS-CoV-2-infected patients seen at our medical center in Chicago during the transition from the Delta to Omicron wave. We compare two primer schemes, ArticV4.1 and VarSkip2, used for short read amplicon sequencing, and describe our strategy for bioinformatics analysis that facilitates identifying lineage-associated mutations and host-specific mutations that arise during infection. This study illustrates the ongoing evolution of SARS-CoV-2 VOCs in our community and documents novel constellations of mutations that arise in individual patients. The ongoing evaluation of the evolution of SARS-CoV-2 during this pandemic is important for informing our public health strategies.

“Even if I’m undetectable, I just feel like I would die”: a qualitative study to understand the psychological and socioeconomic impacts of the COVID-19 pandemic on women living with HIV (WLWH) in Chicago, IL

BackgroundThe COVID-19 pandemic has affected the health and well-being of people worldwide, yet few studies have qualitatively examined its cumulative effects on ciswomen living with HIV (WLWH). We aimed to explore how the pandemic has impacted WLWH, including challenges related to HIV care, employment, finances, and childcare. We also investigated how HIV status and different psychosocial stressors affected their mental health.MethodsWe performed 25 semi-structured qualitative interviews with WLWH regarding the ways in which COVID-19 impacted their social determinants of health and physical well-being during the pandemic. 19 WLWH who received care at the University of Chicago Medicine (UCM) and 6 women who received care at Howard Brown Health, a federally qualified health center (FQHC) in Chicago, were interviewed remotely from June 2020 to April 2021. All interviews were audio recorded and transcribed. Interviews were thematically analyzed for commonalities regarding HIV-specific and general experiences of WLWH during the pandemic.ResultsThe majority of participants reported COVID-19 impacted their HIV care, such as appointment cancellations and difficulties adhering to antiretroviral therapy. In addition to HIV care obstacles, almost all participants described perceived heightened vulnerability to or fear of COVID-19. The pandemic also affected the socioeconomic well-being of participants, with reported financial strains and employment disruptions. Some mothers took on additional childcare responsibilities, such as homeschooling. Increased mental health concerns and negative psychological effects from the social isolation associated with the pandemic were also experienced by most participants.ConclusionsWe gained invaluable insight into how WLWH were challenged by and adapted to the COVID-19 pandemic, including its destabilizing effects on their HIV care and mental health. Women described how they undertook additional childcare responsibilities during the pandemic and how their HIV status compounded their concerns (e.g., perceived heightened vulnerability to COVID-19). Strategies to better support WLWH in maintaining their overall health throughout the pandemic include childcare assistance, access to affordable mental health services, support groups, and education from HIV care providers. These findings have significant implications for examining future health crises through the perspective of potential gender inequalities.

A Novel Use of Latent Class Analysis to Identify Patterns of Workplace Hazards among Informally Employed Domestic Workers in 14 Cities, United States, 2011-2012.

Few studies, mostly descriptive, have quantitatively analyzed the working conditions of domestic workers (DWers) informally employed by private households in the USA. These workers are explicitly or effectively excluded from numerous workplace protections, and scant data exist on their exposures or how best to categorize them. We analyzed data from the sole nationwide survey of informally employed US DWers with work-related hazards data, conducted by the National Domestic Workers Alliance, the University of Illinois Chicago Center for Urban Economic Development, and the DataCenter in 14 US cities (2011-2012; N = 2086). We used exploratory latent class analysis to identify groups of DWers with distinct patterns of exposure to 21 self-reported economic, social, and occupational workplace hazards (e.g. pay violations, verbal abuse, heavy lifting). We then used multinomial logistic latent class regression to examine associations between workers' individual, household, and occupational characteristics and latent class membership. Among the 2086 DWers, mean age was 42.6 years, 97.3% were women, 56.0% Latina/o, 26.5% White, 33.2% undocumented immigrants, and 11.7% live-in. 53.5%, 32.0%, and 14.5% primarily worked doing housecleaning, child care, and adult care, respectively. 49.9% of workers reported ≥3 hazards. Latent class analysis identified four groups of DWers doing: 'Low hazard domestic work' (lowest exposure to all hazards), 'Demanding care work' (moderate exposure to pay violations [item response probability (IRP) = 0.42] and contagious illness care [IRP = 0.39]), 'Strenuous cleaning work' (high exposure to cleaning-related occupational hazards, such as climbing to clean [IRP = 0.87]), and 'Hazardous domestic work' (highest exposure to all but one hazard). Covariates were strongly associated, in many cases, with latent class membership. For example, compared to other DWers, DWers doing 'hazardous domestic work' had the largest predicted probability of being economically insecure (0.53) and living-in with their employers (0.17). Results indicate that informally employed US DWers experience distinct patterns of workplace hazards, and that it is informative to characterize DWers' exposures to different sets of multiple hazards using latent class analysis.

Teaching Health Equity: A Medical School and a Community-Based Research Center Partnership.

To address the persistent health inequities in the United States, medical education must prepare future physicians to understand the systemic causes of these inequities, as well as health care's role in alleviating them. Limited time and faculty expertise often necessitate innovative strategies to augment existing medical education curriculum with content and experiences to expose medical students to these facets of health inequity. In this report, we describe a partnership between the Chicago Medical School (CMS), a community-based medical school, and the Sinai Urban Health Institute (SUHI), a community-focused research center in Chicago, Illinois. As a part of this partnership, SUHI hosts a summer internship for 7 to 15 medical students per year to teach about health equity, population health, and public health research. The internship includes project-based learning, a structured curriculum, and community tours and volunteering. A total of 62 CMS medical students have participated. Student surveys consistently showed high levels of satisfaction with the program across all years (2013-2018, 2020). Almost all students report that they were exposed to new ideas and issues (96.6%), and that the new knowledge and skills were applicable to their future work as physicians (91.7%). Other medical schools may benefit from collaborative models with public health research organizations to complement existing curriculum, opportunities for research, and engagement with marginalized populations.