Chronic Health Research Articles

Mitigating Racial Bias in Health Care Algorithms: Improving Fairness in Access to Supportive Housing.

Algorithms for guiding health care decisions have come under increasing scrutiny for being unfair to certain racial and ethnic groups. The authors describe their multistep process, using data from 3,465 individuals, to reduce racial and ethnic bias in an algorithm developed to identify state Medicaid beneficiaries experiencing homelessness and chronic health needs who were eligible for coordinated health care and housing supports. Through an iterative process of adjusting inputs, reviewing outputs with diverse stakeholders, and performing quality assurance, the authors developed an algorithm that achieved racial and ethnic parity in the selection of eligible Medicaid beneficiaries.

A Comprehensive Analysis on Non-Communicable Diseases by Quantitative Approach: Using Graphical Visualization

Non-communicable diseases (NCDs) have already become major killers in Bangladesh. Once NCDs are developed, they become chronic health and economic problems. Their primary prevention is linked to their common risk factors. This study was conducted to visualize the trend of the diseases along with the age factor in rural areas of Bangladesh. A quantitative method was used throughout the research to reach the desired goal of this study. The data was collected from a medical association to use in this research and for processing the graphical visualization some preprocessing techniques are also applied on the raw data. After completing the research, the researchers found the percentage of the patients according to the diseases and the disease count along with the patients’ age. The outcome is totally represented in graphical visualization. This research will help to find the numeric measurement of a particular disease considering age factor which can help to reduce the issues in medical sectors.

APACHE-adjusted ICU Outcomes Have Returned to Pre-pandemic Values

During the COVID-19 pandemic, severity-adjustment systems lacked longitudinal data for the coronavirus and thus could not specify diagnosis-specific risk. Without risk adjustment for the patient’s diagnosis and presenting condition, outcomes such as morbidity, mortality, and length of stay become challenging to interpret. APACHE, which risk-adjusts for acute physiology, age, and chronic health, is a widely used ICU benchmarking tool, and participating institutions identified rising and concerning standardized mortality rates in 2020. Following up on previously reported results that severity-adjusted outcomes were worse than expected for patients with COVID-19 versus traditional viral pneumonia during the first two years of the pandemic, the authors now report data that suggest the COVID-19 mortality penalty versus other viral pneumonia lessened once the Omicron variant became the predominant pathogen in early 2022. They present implications for benchmarking hospital performance and public reporting.

The Usefulness of Strain Echocardiography as Diagnostic and Prognostic Index of Cardiac Dysfunction in Septic Patients in Correlation with Cardiac Biomarkers.

Compared to standard echocardiography, speckle tracking echocardiography (STE) looks more accurate for the detection of subclinical dysfunction of the myocardium. The aim of our work was to assess the value of STE in the diagnosis of subclinical ventricular dysfunction and as a prognostic index in sepsis patients. An observational prospective study involving critically ill patients aged ≥ 18 years diagnosed with sepsis or septic shock. All patients were subjected to full history-taking, clinical assessment, and scoring system, including Acute Physiology and Chronic Health (APACHE) II score and quick sequential organ failure assessment score. Investigations were done for all patients, including laboratory (complete blood count, C-reactive protein, N-terminal pro-brain natriuretic peptide [NT-proBNP], and troponin-I and serum lactate level), ECG, and echocardiographic examination (conventional and speckle tracking) for measurement of global left ventricular strain. This study involved 50 patients, nine patients with sepsis and 41 patients with septic shock. Regarding cardiac biomarkers, the mean value of troponin-I was 0.18 ± 0.05 ng/L and for NT-proBNP was 1228.2 ± 832.9 pmol/L. All patients in the study had elevated lactate levels. There was a significant correlation between global longitudinal strain (GLS) and troponin I, NT-proBNP, and lactate levels after 3 days of admission. GLS, lactate, NT-proBNP, troponin levels, and APACHE II Score were significant predictors of mortality with a sensitivity of 76.5%, 88.2%, 88.2%, 76.5%, and 88.2%, respectively. GLS measured by speckle tracking echocardiography looks to be a sensitive diagnostic tool for early detection of subclinical left ventricular dysfunction in patients with sepsis in addition to be a sensitive predictor of in-hospital mortality.

Trajectories of illness uncertainty among parents of children with atypical genital appearance due to differences of sex development.

The present study aimed to identify distinct trajectories of parental illness uncertainty among parents of children born with atypical genital appearance due to a difference of sex development over the first year following diagnosis. It was hypothesized that four trajectory classes would emerge, including "low stable," "high stable," "decreasing," and "increasing" classes, and that select demographic, familial, and medical factors would predict these classes. Participants included 56 mothers and 43 fathers of 57 children born with moderate to severe genital atypia. Participants were recruited from eleven specialty clinics across the U.S. Growth mixture modeling (GMM) approaches, controlling for parent dyad clustering, were conducted to examine classes of parental illness uncertainty ratings over time. A three-class GMM was identified as the best-fitting model. The three classes were interpreted as "moderate stable" (56.8%), "low stable" (33.0%), and "declining" (10.3%). Findings suggest possible diagnostic differences across trajectories. Findings highlight the nature of parents' perceptions of ambiguity and uncertainty about their child's diagnosis and treatment the year following their child's birth/diagnosis. Future research is needed to better understand how these trajectories might shift over the course of the child's development. Results support the development of tailored, evidence-based interventions to address coping with uncertainty among families raising a child with chronic health needs.

Exploring the Interplay of Humor and Quality of Life in Adults Confronting Chronic Diseases: A Comprehensive Systematic Review

IntroductionChronic diseases, often referred to as non-communicable diseases (NCDs), stand as the leading global cause of mortality. Individuals grappling with chronic ailments frequently experience a decline in their overall quality of life (QoL), encompassing psychological, social, and physical dimensions of well-being.ObjectivesRecognizing that humor has demonstrated the potential to engender favorable effects on QoL, this systematic review seeks to explore the correlation between humor and QoL among adults contending with chronic health conditions.Methods A thorough examination of quantitative data was conducted in strict adherence to the PRISMA 2020 guidelines. PubMed/MEDLINE, PsycINFO, and CINAHL were comprehensively searched from their inception until June 22, 2023. Furthermore, the reference lists of the included datasets and relevant review articles were exhaustively scrutinized (Figure 1). The Newcastle-Ottawa Scale (NOS) was employed to assess the quality of eligible studies.Results A total of eighteen studies met the inclusion criteria, encompassing a diverse spectrum of chronic disease categories, including cardiovascular diseases and various types of cancer, among others. Collectively, these studies involved a participant cohort comprising 4,325 individuals. Noteworthy findings emerged, indicating a substantial association between distinct facets of humor—such as one’s sense of humor, coping humor, humor styles, and laughter—and psychological QoL. Nevertheless, the relationship between humor and physical QoL exhibited a more intricate pattern, characterized by mixed outcomes (Figure 2).Image:Image 2:ConclusionsDespite the limited and inconsistent evidence across studies, humor appears to exhibit a positive association with QoL.Disclosure of InterestNone Declared

Prescription Adherence Rates Across Medication Categories

Prescription adherence is a major public health challenge, as non-adherence to medication instructions can lead to poorer health outcomes and higher healthcare costs. Although prescription adherence is crucial for managing patient compliance and health outcomes, adherence rates differ greatly between medication types. The main objectives of this study were to determine prescription adherence rates across six medication types (antibiotic, cardiac, chronic health, pediatric, and psychiatric) and identify sources of variation. We searched PubMed and Web of Science databases for relevant published articles. Previous research data were selected related to prescription adherences and compliance rates were included in our analysis. Results from twenty-three previous studies were included: four to five studies per medication category to limit the influences of geographic location and difference in adherence measurement. The average prescription adherence rate for antibiotics, cardiac, chronic health, pediatrics, and psychiatric medications were 58.3%, 75.6%, 68.8%, 55.2%, and 29.2% respectively. The data found highlights the medications with the highest and lowest average adherence overall. Factors affecting adherence rates include regimen length, parental control, cognitive impairment, polypharmacy, and understanding instructions. Drug counseling has been shown to improve adherence. These findings provide a foundation for future research aimed at enhancing prescription adherence and improving patient health outcomes.

Healthy ageing in remote Cape York: a co-designed Integrated Allied Health Service Model.

Allied health services in rural and remote hospitals often work in siloed and solo discipline-specific positions. They are often part of general multi-disciplinary teams without a clearly articulated service model that integrates care for individuals and addresses broader community health needs. Integrated care service models for clients with complex disabilities or chronic health needs have demonstrated improved outcomes, but feasible service models are rarely described in the context of rural, remote and Aboriginal and Torres Strait Islander communities. Integration can support primary health care in remote communities where resources are thin, and the breadth of multidisciplinary service providers is not available. A remote health service, in collaboration with a University Department of Rural Health and community partners, developed a community rehabilitation and lifestyle service for adults who experience chronic disease, disability or were at risk of functional decline due to frailty. Using an integrated approach, this model of care improves access to specialist and primary healthcare services, delivers targeted group-based rehabilitation and preventative activities, and addresses community and workforce capacity to meet the needs of the remote community. This paper describes a remote primary health care, Integrated Allied Health Service Model, developed with a focus on the co-ordination and integration of care and resources between the health service, education and community.

Are retired persons fitter in their psychological capacities than unemployed? A cross-sectional representative study in Germany

ObjectivesBeyond specific aspects of numerical or verbal intelligence or cognitive speed, a broad range of psychological capacities are generally important in school, job and social life for all age groups....

Diagnosis and Prognosis Evaluation of Severe Pneumonia by Lung Ultrasound Score Combined with Serum Inflammatory Markers.

To analyze the significance of lung ultrasound score (LUS) combined with serum inflammatory indexes in different severities of severe pneumonia and its clinical value on prognosis. 100 patients with severe pneumonia treated in the Gansu Provincial Hospital from June 2017 to June 2021 were selected as the research objects. According to the acute physiology and chronic health (APACHE II) score, they were divided into a low-risk group (28 cases), a medium-risk group (39 cases) and a high-risk group (33 cases). The general clinical data of the patients (age, gender, smoking history, and underlying diseases) were collected, the lung ultrasound score (LUS) of the patients was measured, and the serum inflammatory indicators (IL-6, IL-10, TNF-α, CRP and NLR) levels; Pearson correlation analysis to evaluate the correlation between LUS score, serum inflammatory index levels and disease severity; receiver operating characteristic (ROC) curve analysis to evaluate the prognostic value of the combined diagnosis of LUS score and serum inflammatory index for the severity of severe pneumonia. With the increase in the severity of severe pneumonia, the LUS score and the level of inflammation in the body continued to increase, and LUS combined with serum inflammatory indexes could distinguish the severity of low-risk, medium-risk and high-risk severe pneumonia and had high diagnostic value. In addition, the combined diagnosis of LUS and serum inflammatory markers is also closely related to the prognosis of patients with severe pneumonia, which can distinguish the prognosis. LUS combined with serum inflammatory indicators (IL-6, IL-10, TNF-α, CRP and NLR) can differentiate the severity and prognosis of severe pneumonia, which may be a new direction for diagnosing severe pneumonia and guide early clinical intervention.

Assessing the effectiveness of artificial neural networks (ANN) and multiple linear regressions (MLR) in forcasting AQI and PM10 and evaluating health impacts through AirQ+ (case study: Tehran)

Air pollution is one of the major concerns for the population and the environment due to its hazardous effects. PM10 has affected significant scientific and regulatory interest because of its strong correlation with chronic health such as respiratory illnesses, lung cancer, and asthma. Forcasting air quality and assessing the health impacts of the air pollutants like particulate matter is crucial for protecting public health.This study incorporated weather, traffic, green space information, and time parameters, to forcst the AQI and PM10. Traffic data plays a critical role in predicting air pollution, as it significantly influences them. Therefore, including traffic data in the ANN model is necessary and valuable. Green spaces also affect air quality, and their inclusion in neural network models can improve predictive accuracy. The key factors influencing the AQI are the two-day lag time, the proximity of a park to the AQI monitoring station, the average distance between each park and AQI monitoring stations, and the air temperature. In addition, the average distance between each park, the number of parks, seasonal variations, and the total number of vehicles are the primary determinants affecting PM10.The straightforward effective Multilayer Perceptron Artificial Neural Network (MLP-ANN) demonstrated correlation coefficients (R) of 0.82 and 0.93 when forcasting AQI and PM10, respectively. This study also used the forcasted PM10 values from the ANN model to assess the health effects of elevated air pollution. The results indicate that elevated levels of PM10 can increase the likelihood of respiratory symptoms. Among children, there is a higher prevalence of bronchitis, while among adults, the incidence of chronic bronchitis is higher. It was estimated that the attributable proportions for children and adults were 6.87% and 9.72%, respectively. These results underscore the importance of monitoring air quality and taking action to reduce pollution to safeguard public health.

History and physical exam: a retrospective analysis of a clinical opportunity

BackgroundAll learners at the Northern Ontario School of Medicine University complete a longitudinal integrated clerkship experience in their third year, which serves to improve learner experience with community and clinical acute and chronic health needs. Early in the program, Muskoka faculty (two of the 15 LIC sites of NOSM U) became aware that learners never had the occasion to complete a full history and physical exam on a real patient with complex needs. Recognizing this as a critical experience, a program was initiated to provide learners with this opportunity. This manuscript reports on the effectiveness and impact of this novel program and outlines the procedure developed to incorporate a similar program should communities see the relevance.MethodsUsing a mixed method design, feedback was collected from learners and preceptors following the implementation of a novel learning opportunity for clinical clerks. Learners completed a full history and physical exam on volunteer complex patients, with supervision and immediate feedback. Using semi structured surveys, data was collected from each learner and preceptor to determine the program impact and optimize the program. Laurentian University research ethics board, certificate number 6021120.ResultsBoth learners and preceptors agreed this was a valuable experience for learners, a good use of their time and contributed to essential skills including, communication, time management and appropriate data collection. The use of real patients was reported to be very appropriate by learners and faculty and often highlighted gaps in the learner’s knowledge that they were then able to address.ConclusionFeedback collected in this study confirms that providing medical learners the opportunity to complete a full history and physical exam with supervision and feedback was significantly beneficial from both a clinical and a skills-based aspect. Requiring learners to complete this task within the established period forced them to manage their time, focus on clinical consideration and remain on task. Enhancing learning opportunities is associated with improved outcomes and understanding in medical learners. Positive community experience is also related to learner retention, which is paramount for attracting new physicians in a time with significantly limited human health resources.

Obesity and male infertility.

The worldwide prevalence of obesity is increasing among both sexes, with associated impacts on chronic health and medical comorbidities. Similarly, the effects of obesity on reproductive health are increasingly being recognized. Adiposity is associated with reduced fertility in men, with a complex and multifactorial etiology. The reported effects of obesity on semen parameters and impaired fertility are contrasting, with some studies showing a clear reduction in reproductive outcomes associated with increased body mass index, while others do not show such impacts. These controversies may be due to the complex pathophysiology and interplay between gonadotropins and end organs, as well as genetic and epigenetic changes and oxidative stress on male fertility and function. These different aspects have led to heterogeneous participants in studies and varying implications for assisted reproductive outcomes as well as offspring health. Treatment modalities to manage obesity include lifestyle, medical, and surgical options, with emerging and effective medical treatments showing promise in reproductive outcomes.

Using a Smartwatch App to Understand Young Adult Substance Use: Mixed Methods Feasibility Study.

Young adults in the United States exhibit some of the highest rates of substance use compared to other age groups. Heavy and frequent substance use can be associated with a host of acute and chronic health and mental health concerns. Recent advances in ubiquitous technologies have prompted interest and innovation in using technology-based data collection instruments to understand substance use and associated harms. Existing methods for collecting granular, real-world data primarily rely on the use of smartphones to study and understand substance use in young adults. Wearable devices, such as smartwatches, show significant potential as platforms for data collection in this domain but remain underused. This study aims to describe the design and user evaluation of a smartwatch-based data collection app, which uses ecological momentary assessments to examine young adult substance use in daily life. This study used a 2-phase iterative design and acceptability evaluation process with young adults (aged 18-25 y) reporting recent alcohol or cannabis use. In phase 1, participants (8/15, 53%) used the data collection app for 14 days on their Apple Watches to report their substance use patterns, social contexts of substance use, and psychosocial risk factors (eg, affect). After this 14-day deployment, the participants completed a user experience survey and a semistructured interview to record their perspectives and experiences of using the app. Formative feedback from this phase informed feature modification and refinement of the app. In phase 2, an additional cohort (7/15, 47%) used the modified app for 14 days and provided feedback through surveys and interviews conducted after the app use period. Analyses of overall app use patterns indicated high, consistent use of the app, with participants using the app for an average of 11.73 (SD 2.60) days out of 14 days of data collection. Participants reported 67 instances of substance use throughout the study, and our analysis indicates that participants were able to respond to ecological momentary assessment prompts in diverse temporal and situational contexts. Our findings from the user experience survey indicate that participants found the app usable and functional. Comparisons of app use metrics and user evaluation scores indicate that the iterative app design had a measurable and positive impact on users' experience. Qualitative data from the participant interviews highlighted the value of recording substance use patterns, low disruption to daily life, minimal overall burden, preference of platforms (smartphones vs smartwatches), and perspectives relating to privacy and app use in social contexts. This study demonstrated the acceptability of using a smartwatch-based app to collect intensive, longitudinal substance use data among young adults. The findings document the utility of smartwatches as a novel platform to understand sensitive and often-stigmatized behaviors such as substance use with minimal burden.

Poor health-related quality of life in postural orthostatic tachycardia syndrome in comparison with a sex- and age-matched normative population

PurposeThe effect of postural orthostatic tachycardia syndrome (POTS) on health-related quality of life (HrQoL) remains poorly studied. Here, we sought to compare the HrQoL in individuals with POTS to a normative age-/sex-matched population.MethodsParticipants enrolled in the Australian POTS registry between 5 August 2021 and 30 June 2022 were compared with propensity-matched local normative population data from the South Australian Health Omnibus Survey. The EQ-5D-5L instrument was used to assess HrQoL across the five domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) with global health rating assessed with a visual analog scale (EQ-VAS). A population-based scoring algorithm was applied to the EQ-5D-5L data to calculate utility scores. Hierarchical multiple regression analyses were undertaken to explore predictors of low utility scores.ResultsA total of 404 participants (n = 202 POTS; n = 202 normative population; median age 28 years, 90.6% females) were included. Compared with the normative population, the POTS cohort demonstrated significantly higher burden of impairment across all EQ-5D-5L domains (all P < 0.001), lower median EQ-VAS (p < 0.001), and lower utility scores (p < .001). The lower EQ-VAS and utility scores in the POTS cohort were universal in all age groups. Severity of orthostatic intolerance symptoms, female sex, fatigue scores, and comorbid diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome were independent predictors of reduced HrQoL in POTS. The disutility in those with POTS was lower than many chronic health conditions.ConclusionsThis is the first study to demonstrate significant impairment across all subdomains of EQ-5D-5L HrQoL in the POTS cohort as compared with a normative population.Trial registrationACTRN12621001034820

Young people with AOD issues and at least one other comorbidity or complex health issue and health service use: A brief literature review 2016–2021

This rapid literature review summarises evidence around best practice in the management of young people who present at health services with alcohol and other drugs (AOD) issues plus at least one comorbidity or chronic health need. The findings were used to develop and trial Formalised Case Management Guidelines that promote continuity of care for vulnerable youth accessing Primary Health Care services.

Innovative models of healthcare delivery: an umbrella review of reviews

ObjectiveTo undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals.DesignUmbrella review.SettingInterventions delivered inside and outside of acute care settings.ParticipantsChildren and...

Community Perception and Attitude towards COVID-19 Vaccination for Children in Saudi Arabia.

Vaccines are an important part of the COVID-19 pandemic response plan. This study was undertaken to find out the percentage of supporters in the Saudi population for COVID-19 vaccination among children, and to assess the study population's perceptions towards COVID-19 vaccination among children. This nationwide study adopted a cross-sectional survey of adult participants, conducted by trained medical students. The anonymous questionnaire was published on social media tools. Statistical analysis was conducted using two-tailed tests. Six hundred and twenty (620) participants were recruited for this study. Nearly 17.0% of participants had a chronic health problem/comorbidity. About 28.7% of the study participants reported having COVID-19 infection. The COVID-19 vaccine was received among 94.7% of the study respondents. The majority of the vaccination supporters (89.0%) wanted to get the third dose. There was a statistically significant association between the participant's attitudes towards getting vaccinated themselves, and their attitude towards children's vaccination. Vaccine newness, as a reason for hesitating to get vaccinated, was most reported among non-vaccine supporters. False religious beliefs were found to significantly influence the opposing attitude towards children's vaccination. Health professionals and policy makers should implement and support strategies to ensure children are vaccinated against COVID-19. They also need to educate parents and families regarding the importance of vaccination against COVID-19.

“They go hand in hand”: a patient-oriented, qualitative descriptive study on the interconnectedness between chronic health and mental health conditions in transition-age youth

BackgroundTransition-age youth (TAY) with chronic health conditions frequently experience co-occurring mental health conditions. However, little is known about the perspectives of TAY with co-occurring diagnoses preparing to exit pediatric health and mental health services. Research is needed to understand the impact of a mental health condition on transition readiness and self-management in TAY with chronic health conditions.MethodsTAY (aged 16–20 years) with co-occurring chronic health and mental health conditions were recruited in Alberta, Canada. Nine semi-structured individual interviews were completed by phone or videoconference, and transcribed verbatim. Guided by qualitative description, we analyzed the data using thematic analysis in partnership with five young adults with lived experience in the health/mental health systems.ResultsParticipants shared their experiences living with simultaneous physical and mental health concerns and preparing for transition to adult care. Our analysis revealed three overarching themes: 1) “they’re intertwined”: connections between chronic health and mental health conditions in TAY, 2) impact of mental health on transition readiness and self-management, and 3) recommendations for service provision from the perspectives of TAY.ConclusionsOur findings highlighted the myriad ways in which physical and mental health are connected as TAY prepare for service transitions using specific examples and powerful metaphors. TAY endorsed the importance of providers discussing these connections in routine clinical care. Future research should involve co-designing and evaluating educational material addressing this topic with diverse TAY, caregivers, and service providers.

Comparison of Patients with Ventilator-Associated Pneumonia Developed in Two Different Intensive Care Units of a Tertiary Hospital

Aim: Our purpose is to compare the characteristics and 30-day mortality of ventilator-associated&#x0D; pneumonia (VAP) patients that developed in two different intensive care units (ICUs) in a tertiary hospital.&#x0D; Material and Methods: Patients who were over the age of 18 who developed VAP in two different&#x0D; ICUs of our hospital over two years were included in the study. Acute Physiology and Chronic Health&#x0D; Assessment II (APACHE II), Sepsis-Related Organ Failure Assessment (SOFA), Glasgow Coma Score&#x0D; (GCS), Clinical Pulmonary Infection Score (CPIS), infection markers, and 30-day mortality of the&#x0D; patients were evaluated. Physical conditions of Group 1 and Group 2, hand hygiene rates in ICU, nurse&#x0D; education level, and hospitalization rate in intensive care units were compared.&#x0D; Results: A total of 104 patients, 48 being in Group 1 and 56 being in Group 2, were analyzed. There&#x0D; was no significant difference between the two groups with regards of GKS, SOFA and CPIS scores.&#x0D; Acinetobacter baumanni was the most common agent in both groups. The hospitalization rate was&#x0D; found to be significantly higher in Group 2. 30-day mortality was 45.8% in Group 1 and 48.2% in Group&#x0D; 2. It was found that a one unit increase in the SOFA hospitalization period reduced the risk of 30-day&#x0D; mortality. It was determined that a one unit increase in the age ratio in Group 2 increased the risk of&#x0D; 30-day mortality 1.085 times, and the increase in the mean SOFA score in all patients and Group 1&#x0D; decreased the length of the hospitalization period.&#x0D; Conclusion: We found a 30-day mortality rate of 47.1% in patients diagnosed with VAP. An increase in&#x0D; SOFA score increases the risk of 30-day mortality, while a prolonged hospitalization period decreases&#x0D; the risk of mortality.