Delay In Health Care Research Articles

Medical Debt and the Mental Health Treatment Gap Among US Adults

Medical debt is common in the US and may hinder timely access to care for mental disorders. To estimate the prevalence of medical debt among US adults with depression and anxiety and its association with delayed and forgone mental health care. Cross-sectional, nationally representative survey study of US adult participants in the 2022 National Health Interview Survey who had current or lifetime diagnoses of depression or anxiety. Self-reported lifetime clinical diagnoses of depression and anxiety; moderate to severe symptoms of current depression (Patient Health Questionnaire-8 score ≥10) and anxiety (Generalized Anxiety Disorder-7 score ≥10) irrespective of lifetime diagnoses; and past-year medical debt. Self-reported delaying and forgoing mental health care because of cost in the past year. Among 27 651 adults (15 050 [54.4%] female; mean [SD] age, 52.9 [18.4] years), 5186 (18.2%) reported lifetime depression, 1948 (7.3%) reported current depression, 4834 (17.7%) reported lifetime anxiety, and 1689 (6.6%) reported current anxiety. Medical debt was more common among adults with lifetime depression (19.9% vs 8.6%; adjusted prevalence ratio [aPR], 1.97; 95% CI, 1.96-1.98), lifetime anxiety (19.4% vs 8.8%; aPR, 1.91; 95% CI, 1.91-1.92), current depression (27.3% vs 9.4%; aPR, 2.34; 95% CI, 2.34-2.36), and current anxiety (26.2% vs 9.6%; aPR, 2.24; 95% CI, 2.24-2.26) compared with adults without the respective mental disorders. Medical debt was associated with delayed health care among adults with lifetime depression (29.0% vs 11.6%; aPR, 2.68; 95% CI, 2.62-2.74), lifetime anxiety (28.0% vs 11.5%; aPR, 2.45; 95% CI, 2.40-2.50), current depression (36.9% vs 17.4%; aPR, 2.25; 95% CI, 2.13-2.38), and current anxiety (38.4% vs 16.9%; aPR, 2.48; 95% CI, 2.35-2.66) compared with those without these diagnoses. Medical debt was associated with forgone health care among adults with lifetime depression (29.4% vs 10.6%; aPR, 2.66; 95% CI, 2.61-2.71), lifetime anxiety (28.2% vs 10.7%; aPR, 2.63; 95% CI, 2.57-2.68), current depression (38.0% vs 17.2%; aPR, 2.35; 95% CI, 2.23-2.48), and current anxiety (40.8% vs 17.1%; aPR, 2.57; 95% CI, 2.43-2.75) compared with those without the diagnoses. Medical debt is prevalent among adults with depression and anxiety and may contribute to the mental health treatment gap. In the absence of structural reform, new policies are warranted to protect against this financial barrier to mental health care.

IJCM_15A: Health-seeking behaviour among Fishermen community mothers of under-five children on childcare– A cross-sectional study

Background: Globally in 2020 an estimated 5 million children under5 years died mostly from preventable and treatable causes. India ranks second worldwide in under5 mortality (WHO2020). Health of the children is strongly dependent on parental healthcare behaviour Fishermen-community possesses unique characteristics of a folk-society, Major portion of the life of fishermen is spent at sea, mothers assume a vital place with regard to the upbringing of the children. Objective: To study the health-seeking behaviour among Fishermen- community mothers of under-five children during acute illness and factors associated with it Methodology: A cross sectional study was conducted among 100 Mothers of Under five children in a Fishermen community, Kovalam, Chengalpattu district of Tamil Nadu over a period of 3months (October 2023–November 2023). Data collection was done using interviewer administered semi-structured questionnaire, statistical analysis was done using SPSS v21.0 Results: In total, 100 mothers with mean age of 27± 3.3 years participated in the study, all of them reported of some health morbidity. The proportion of health seeking behaviour in terms of appropriate and prompt care among the study population was 42%. The reason for delayed health care seeking among the participants were due to over-the-counter drugs(33%), self-medication(17%) and home remedies(8%). Among them 84% sought health care from private health facility. Appropriate and prompt care has found to be significantly associated with the age of the child less than 2 years (OR-3.485,95%CI-1.449-8.382), educational status of the mother (above high-school) (OR-3,95%CI-1.328-6.977), extended family type (OR- 2.679,95%CI-1.151-6.233) and perception about severity of illness during an episode of acute illness. Conclusion: Appropriate Health-seeking behaviour and seeking prompt care among parents of children was inadequate. Utilization of public health facility was less. Hence, steps can be taken to sensitize the mothers about the services available in the public health care facility.

Delayed healthcare seeking and associated factors for common childhood illnesses among caregivers with under-five children who visited Yem special woreda public health facilities, Southwest Ethiopia, 2023.

For under-five children, receiving timely and appropriate medical attention is crucial in preventing serious and fatal complications. Unfortunately, evidence shows that parents of young children frequently delay seeking care, contributing to the death of many kids before they even get to a medical facility. The study aimed to assess delay in healthcare seeking and associated factors for common childhood illnesses among caregivers with under-five children visiting Yem special woreda public health facilities, 2023. A facility-based cross-sectional study was conducted among 333 caregivers of under-five children diagnosed with common childhood illnesses visiting Yem special woreda public health facilities. Systematic random sampling was employed, and data was collected using an interviewer-administered questionnaire. Delay was characterized as a long time (typically >24 hours) between disease onset and beginning of treatment. Data was entered into Epi Data version 4.7 and exported to Statistical Package for the Social Sciences version 25.0. Binary logistic regression model was fitted. Bi-variable and multivariable logistic regression analyses were conducted to identify the factors that influence the delayed healthcare seeking. Adjusted odds ratios with a 95% confidence interval were used to determine the associations. Statistically significant variables were identified based on a p-value < 0.05. A total of 326 caregivers participated in the study with a response rate of 98%. The proportion of delayed health care seeking was 74.5%. Caregivers "wait-and-see" approach is the primary reason for the delay followed by traditional home treatments. Child ≥ 12 months (AOR = 1.99, 95% CI: 1.11-3.57), rural residence (AOR = 2.41, 95% CI: 1.35-4.28), no community health insurance (AOR = 1.91, 95% CI: 1.07-3.42), traditional treatment (AOR = 2.98, 95% CI: 1.46-6.10), and initial self-medication at home (AOR = 2.73, 95% CI: 1.32-5.63) and perceiving illness as mild (AOR = 2.64, 95% CI: 1.28-5.42) were factors associated with delayed healthcare seeking. The study showed delay in health care seeking for common childhood illnesses among caregivers was high. Hence, reducing delays necessitates the implementation of public education campaigns, collaboration with local organizations, and the provision of counseling for caregivers regarding childhood illnesses.

Delayed and Forgone Health Care Among Adults With Limited English Proficiency During the Early COVID-19 Pandemic.

Individuals with limited English proficiency (LEP) have long faced barriers in navigating the health care system. More information is needed to understand whether their care was limited further during the early period of the COVID-19 pandemic. To assess the impact of English proficiency on delayed and forgone health care during the early COVID-19 pandemic. Multivariate logistic regression analysis of National Health Interview Survey data (July-December 2020; n=16,941). Outcomes were self-reported delayed and forgone health care because of cost or the COVID-19 pandemic. Delayed health care included medical, dental, mental health, and pharmacy care. Forgone health care also included care at home from a health professional. A greater percentage of LEP adults reported delayed (49%) and forgone (41%) health care than English-proficient adults (40% and 30%, respectively). However, English proficiency was not significantly associated with delayed or forgone health care, after adjusting for demographic, socioeconomic, and health factors. Among LEP adults, multivariate models showed that being uninsured, having a disability, and having chronic conditions increased the risk of delaying and forgoing health care. LEP adults of Asian race and Hispanic ethnicity were also more likely to forgo health care while those with 65+ years were less likely to forgo health care. Adults with LEP were more likely to experience challenges accessing health care early in the pandemic. Delayed and forgone health care were explained by low socioeconomic status and poor health. These findings highlight how during a period of limited health resources, deficiencies in the health care system resulted in an already disadvantaged group being at greater risk of inequitable access to care.

The magnitude of health care seeking delay and associated factors for tuberculosis suggestive symptoms in Sidama Region Ethiopia: Community-based cross-sectional study

BackgroundHealth care seeking delay for tuberculosis suggestive symptoms is a great challenge for controlling the disease. Therefore, the study aimed to determine the magnitude and identify factors associated with delayed healthcare seeking among presumptive tuberculosis cases for suggestive tuberculosis symptoms. MethodsA community-based cross-sectional study was conducted among 476 subjects with symptoms suggestive of tuberculosis. Data were collected using a structured questionnaire, entered into Epi-data software version 3.1, and exported to SPSS software version 25.0 for analysis. The multivariable logistic regression models included variables like sex, marital status, knowledge, education level, and distance from health facility that show a significant association with health care seeking delay in the binary logistic regression at a P value 0.25. Tables, graphs, and charts were then used to display the results. ResultThe proportion of delayed health care seeking was found to be 46.7 % (95 % CI, 43.5–48.9). The study also revealed that being married, not attending formal education, having a lower monthly income, and having poor knowledge of tuberculosis were significantly associated with delayed tuberculosis-suggestive symptoms. ConclusionIn this study, delays in health care seeking among TB-suspected patients were high compared to the Ethiopian Ministry of Health target. Different systems should be built to increase community awareness of health care.

Hurt on Both Sides: Political Differences in Health and Well-Being during the COVID-19 Pandemic.

Republicans and conservatives report better self-rated health and well-being compared to Democrats and liberals, yet they are more likely to reside in geographic areas with heavy COVID-19 morbidity and mortality. This harmed health on "both sides" of political divides, occurring in a time of rapid sociopolitical upheaval, warrants the revisiting of psychosocial mechanisms linked to political health differences. Drawing on national Gallup data (early 2021), we find that predicted differences in health or well-being vary substantially by ideology, party, voting behavior, and policy beliefs, with model fit depending on how politics are measured. Differences in self-rated health, psychological distress, happiness, trouble sleeping, and delayed health care tend to reveal worse outcomes for Democrats or liberals. Such differences often are reduced to insignificance by some combination of mastery, meritocratic beliefs, perceived social support, and COVID-19-related exposures and attitudes. Policy beliefs predict health differences most robustly across outcomes and mechanism adjustments.

Delayed Health Care.

Delayed Health Care.

Food insecurity and delayed or forgone health care among pregnant and postpartum women in the United States, 2019–2021

ObjectiveDespite the growing food insecurity crisis in the United States, limited evidence exists about the effects of food insecurity on the unmet health care needs of peripartum (pregnant and postpartum) women. The aim of this study was to examine the association between food insecurity and delayed or forgone health care among peripartum women in the United States from 2019 to 2021. MethodsWe conducted a pooled cross-sectional analysis using data from the 2019, 2020, and 2021 National Health Interview Surveys. Food security status was defined by type (high/marginal, low, and very low). Descriptive analysis and multivariable logistic regression, adjusted for sociodemographic and health-related characteristics, were conducted to estimate the overall and specific delayed or forgone health care (yes or no) between the different categories of food security. ResultsOf the 1525 peripartum women (weighted, N = 5,580,186), 11% of peripartum women in the United States experienced suboptimal food security in the 12 mo between 2019 and 2021, with 5% experiencing low and 5% experiencing very low food security. This included 6% (95% confidence interval [CI], 5–8%) who reported delaying filling a medical prescription, 6% (95% CI, 5–8%) who required counseling or therapy from a mental health professional but did not receive it, 6% (5–8%) who delayed counseling or therapy from a mental health professional, 8% (95% CI, 6–10%) who needed medical care but did not receive it, and 9% (95% CI, 7–10%) who delayed medical care. Peripartum women with low and very food security were more likely to delay or forego health care due to cost concerns than food-secure peripartum women. In the multivariable analyses adjusted for predisposing, enabling, and need-based factors, women with low and very low food security had higher risk for delayed or forgone health care than those with marginal or high food security. ConclusionThis study demonstrated a positive association between food insecurity and cost-related unmet health care needs among peripartum women. Future empirical studies are needed to assess the effects of peripartum health care interventions targeting food insecurity on reducing health care access disparities associated with costs and improving peripartum health outcomes.

Addressing disparities in speech-language pathology and laryngology services with telehealth

The COVID-19 pandemic disproportionately affected the health and well-being of marginalized communities, and it brought greater awareness to disparities in health care access and utilization. Addressing these disparities is difficult because of their multidimensional nature. Predisposing factors (demographic information, social structure, and beliefs), enabling factors (family and community) and illness levels (perceived and evaluated illness) are thought to jointly contribute to such disparities. Research has demonstrated that disparities in access and utilization of speech-language pathology and laryngology services are the result of racial and ethnic differences, geographic factors, sex, gender, educational background, income level and insurance status. For example, persons from diverse racial and ethnic backgrounds have been found to be less likely to attend or adhere to voice rehabilitation, and they are more likely to delay health care due to language barriers, longer wait times, a lack of transportation and difficulties contacting their physician. The purpose of this paper is to summarize existing research on telehealth, discuss how telehealth offers the potential to eliminate some disparities in the access and utilization of voice care, review its limitations, and encourage continued research in this area. A clinical perspective from a large volume laryngology clinic in a major city in northeastern United States highlights the use of telehealth in the provision of voice care by a laryngologist and speech-language pathologist during and after the COVID19 pandemic.

Fintech and medical expenses: What social workers should know

ABSTRACT Individuals who cannot afford out of pocket medical expenses may reduce health care use, resulting in poorer health outcomes. To ease the situation, employers turn to financial technology (“fintech”) health care credit applications. We examine whether an employer-sponsored credit fintech application (MedPut) helps employees manage medical expenses. Results of the analysis of variance (ANOVA) and probit regression models reveal MedPut users did worse financially and delayed health care due to cost more often than employees who did not use MedPut. Results may inform social work policy and direct practice perspectives on fin-tech and medical expenses.

Pre-pandemic factors associated with delayed health care among US older adults during the COVID-19 pandemic.

During the first year of the COVID-19 pandemic, more than one-third of US older adults (aged 65 years and older) reported delaying medical care. Delayed health care may exacerbate short- and long-term health changes in older adults. Older adults more likely to delay health care may benefit from targeted follow-up to return these individuals to the health care system. The aim of this study was to describe pre-pandemic sociodemographic, psychological, cognitive, and medical factors associated with delayed health care among US older adults during the COVID-19 pandemic. We conducted a secondary analysis of 2905 participants from the National Health and Aging Trends Study (NHATS), a nationally representative, prospective cohort of US older adult Medicare beneficiaries. Pre-pandemic factors were reported at the Round 9 interview (2019). Delayed health care, including medical (e.g. usual doctor) and supplementary (e.g. dental) care, was reported on the COVID-19 questionnaire (2020). We calculated adjusted odds ratios using weighted logistic regression, accounting for the NHATS sampling design. Overall, 40% of participants reported delayed care. After adjustment, female participants and those reporting fair (vs good) health were consistently more likely to delay health care while persons with lower income or excellent health were less likely to delay care. Other associations varied by care type. Women and those with higher income or fair health before the COVID-19 pandemic were more likely to delay care during the pandemic. Our results may inform targeted outreach to older adults who delayed care during the COVID-19 pandemic, or other disruptions to the health care system, to return these individuals to care and promote better management of their health needs.

230: ASSOCIATION BETWEEN THE COVID-19 PANDEMIC AND ICU UTILIZATION FOR CHILDREN WITH HYPERGLYCEMIC CRISIS

Introduction: Admissions to the intensive care unit (ICU) for children with hyperglycemic crisis (HGC, defined as diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, or hyperosmolar ketoacidosis) increased during the COVID-19 pandemic, possibly from social distancing resulting in decreased or delayed health care access. We sought to determine if severity of illness for HGC changed from pandemic year 1 to year 2 as social distancing restrictions lightened. Methods: Retrospective study of children ≤ 18 y/o hospitalized from 3/2017 to 3/2022 in the Pediatric Health Information System for HGC. PreCOVID years (3/2017-3/2020), COVID-19 year 1 (3/2020-3/2021), and COVID-19 year 2 (3/2021-3/2022). The primary outcome was ICU admission. Secondary outcomes included ICU length of stay (LOS) >3 days, use of therapies for neurologic compromise, and cost. Results: From 42 hospitals, 46,220 patients were admitted with HGC, of these, 19,889 patients were admitted to the ICU. There was a decrease in ICU admissions from COVID-19 year 1 (47.4%) to year 2 (44.6%) but both remained higher than PreCOVID (40.7%). Median admission cost remained elevated in year 1 ($11,134 [IQR $6,412, $13,060) and year 2 ($11,057 [IQR $7,974, $15,997]) compared to PreCovid ($9,206 [IQR $7,741, $16,069]). In multivariable analysis, when compared to PreCOVID, ICU admissions for HGC were higher in COVID-19 year 1 (OR 1.31 [95%CI 1.25–1.37], p< 0.01) and year 2 (OR 1.16 [95% CI 1.10–1.22], p< 0.01) after controlling for confounding variables. However, ICU admissions were higher in year 1 than year 2 (OR 1.13, 95% CI [1.075-1.20], p=< 0.01). ICU LOS >3days increased when compared to PreCOVID years (COVID-19 Year 1: OR 1.70, [95% CI: 1.38-2.09], p< 0.01, Year 2: OR: 1.6 [95% CI 1.3-1.97], p< 0.001) but there was no difference between year 1 and 2 (p=0.6). Therapies for neurologic compromise increased in COVID-19 year 1 (p< 0.01) and year 2 (p < 0.01) in comparison to PreCOVID years but there was no change between COVID-19 years (p=0.15). Conclusions: During the COVID-19 pandemic, children with HGC were admitted with a higher severity of illness than pre-COVID. This pattern continued during Covid-19 year 2 despite reduction in social distancing although need for ICU admission was higher in COVID-19 Year 1 than Year 2.

Outcomes of Delay of Care After the Onset of COVID-19 for Patients Managing Multiple Chronic Conditions.

Many patients delayed health care during COVID-19. We assessed the extent to which patients managing multiple chronic conditions (MCC) delayed care in the first months of the pandemic, reasons for delay, and impact of delay on patient-reported physical and behavioral health (BH) outcomes. As part of a large clinical trial conducted April 2016-June, 2021, primary care patients managing MCC were surveyed about physical and behavioral symptoms and functioning. Surveys administered between September 3, 2020, and March 16, 2021, included questions about the extent of and reasons for any delayed medical and BH care since COVID-19. Multivariable linear regression was used to assess health outcomes as a function of delay of care status. Among patients who delayed medical care, 58% delayed more than once. Among those who delayed behavioral health care, 63% delayed more than once. Participants who delayed multiple times tended to be younger, female, unmarried, and reported food, financial, and housing insecurities and worse health. The primary reasons for delaying care were lack of availability of in-person visits and perceived lack of urgency. Participants who delayed care multiple times had significantly worse outcomes on nearly every measure of physical and mental health, compared with participants who delayed care once or did not delay. Delay of care was substantial. Patients who delayed care multiple times were in poorer health and thus in need of more care. Effective strategies for reengaging patients in deferred care should be identified and implemented on multiple levels. ClinicalTrials.gov NCT02868983. Registered on August 16, 2016.

Knowledge, experiences, and practices of women affected by female genital schistosomiasis in rural Madagascar: A qualitative study on disease perception, health impairment and social impact.

Female genital schistosomiasis (FGS) is a neglected manifestation of urogenital schistosomiasis caused by S. haematobium. The disease presents with symptoms such as pelvic pain, vaginal discharge and bleeding and menstruation disorders, and might lead to infertility and pregnancy complications. The perspectives of women with FGS have not been studied systematically. The aim of the study was to understand knowledge, experiences, and practices of women with FGS. We performed a qualitative study with seventy-six women diagnosed of having FGS, in the Ambanja district in Northwest Madagascar. Data collection was either through focus group discussion (N = 60) or in an individual semi-structured interview (N = 16). FGS was diagnosed by colposcopy. The data was analysed using Mayring´s qualitative content analysis. Knowledge on how the disease is acquired varied and ideas on prevention remained vague. Patients suffered from vaginal discharge and pelvic complaints. Some women expressed unbearable pain during sexual intercourse and compared their pain to an open wound being touched. FGS considerably impaired women´s daily activities and their quality of life. Infertility led to resignation and despair, conflicts with the partner and to social exclusion from the community. Women fearing to sexually transmit FGS refrained from partnership and sexual relations. Many women with FGS reported stigmatisation. A coping strategy was to share strain with other women having similar complaints. However, concealing FGS was a common behaviour which led to social isolation and delayed health care seeking. Our study underlines that FGS has an important impact on the sexual health of women and on their social life in the community. Our results highlight the importance of providing adequate health education and structural interventions, such as the supply of water and the provision of sanitation measures. Further, correct diagnosis and treatment of FGS in adolescent girls and women should be available in all S. haematobium-endemic areas. The qualitative study was embedded in a randomised controlled trial (RCT) in which two doses of praziquantel were compared (https://clinicaltrials.gov/ct2/show/NCT04115072).

Associations among enacted weight stigma, weight self-stigma, and multiple physical health outcomes, healthcare utilization, and selected health behaviors.

This study examined the relationship among enacted weight stigma, weight self-stigma, and multiple health outcomes. Weight stigma, a stressor experienced across all body sizes, may contribute to poorer physical health outcomes by activating the nervous and endocrine system or by triggering counterproductive health behaviors like lower physical activity, maladaptive eating patterns, and delayed health care, as well as provider bias that may cause a medical concern to be discounted. While associations of weight stigma with mental health issues are well documented, less is known about its association with physical health. We enrolled 3821 adults who completed an online survey assessing enacted weight stigma, weight self-stigma, multiple self-reported physical health outcomes, healthcare utilization, and selected health behaviors. After controlling for BMI, health care delay or avoidance, sedentary behavior, and selected demographic characteristics, enacted weight stigma, significantly increased the odds of six physical health problems including hypertension (OR 1.36; CI 1.08, 1.72), hyperglycemia (OR 1.73; CI 1.29, 2.31), thyroid disorder, (OR 1.65; CI 1.27, 2.13), any arthritis (OR 1.70; CI 1.27, 2.26), non-arthritic chronic pain (OR 1.76; CI 1.4, 2.29), and infertility (OR 1.53; CI 1.14, 2.05). Weight self-stigma significantly increased the odds for three physical health problems including hypertension (OR 1.43; CI 1.16, 1.76), hyperglycemia (OR 1.37; CI 1.03, 1.81), and non-arthritic chronic pain (OR 1.5; CI 1.2,1.87). Enacted stigma was associated with more than a four-fold increase in odds of believing that a medical concern was disregarded by a health care provider. In this study, enacted stigma and weight self-stigma were independently associated with heightened risk for multiple physical health problems, as well as, believing health concerns were discounted by providers. Reducing weight stigma may be an important component of managing multiple physical health conditions.

Material circumstances, health care access, and self-reported health: A latent class analysis.

Latent class analysis was used to explore intersections of material circumstances and health care access among 308 adults, and associations between classes with health outcomes. Good fit was found for a four-class model: Resource Stable (Class 1, 62.43%), Unbalanced Meals with Health Care (Class 2, 16.91%), Resource Insecurity with Delayed Health Care (Class 3, 14.75%), and Resource Stability without Access to Health Care (Class 4, 5.91%). Class 1 reported greater well-being and self-rated health than Class 2 and 3. Class 1 reported lower BMI than Class 2. Findings document intersections among economic marginalization indicators with varying health outcomes among classes.

"I am hesitant to visit the doctor unless absolutely necessary": A qualitative study of delayed care, avoidance of care, and telehealth experiences during the COVID-19 pandemic.

The COVID-19 pandemic has disrupted the health care system, resulting in decreased health care utilization. During the pandemic, some patients chose to postpone clinic visits or avoid them altogether while health care providers concurrently scaled back their services. As a result, health care has shifted to a greater reliance on telehealth and virtual care.This study uses a qualitative descriptive design, focused on providing summaries of participant experiences of health care and telehealth utilization during the COVID-19 pandemic.Three primary themes emerged during analysis: delayed health care, avoidance of care, and experiences of telehealth. Sub-themes of delayed health care included care delays and scheduling difficulties. Participants reported avoidance of health care due to fear of COVID-19 infection, as well as general changes to care-seeking behaviors. Participants also reported positive experiences with telehealth, with some respondents noting limitations of telehealth systems, such as limitations on procedures and patient-centered monitoring of chronic illness.Our findings support studies that have found both health care delays and changes in health care utilization patterns during the pandemic. Most importantly, this study expands the literature concerning links between fear of COVID-19 and altered care-seeking behaviors, which is the first study to do so focusing on these concerns in the participants’ own words. Finally, while telehealth is promising in preserving continuity of care during pandemics, long-term integration into the health care system is not without challenges, and this study provides insights into how patients experienced telehealth during COVID-19 in their own words.Data collection, survey design, and research priorities for this study were based on input from ongoing community partnerships.

Delay of routine health care during the COVID-19 pandemic: A theoretical model of individuals’ risk assessment and decision making

Delaying routine health care has been prevalent during the COIVD-19 pandemic. Macro-level data from this period reveals that U.S. patients under-utilized routine health care services such as primary care visits, preventative tests, screenings, routine optometry care, dental appointments, and visits for chronic disease management. Yet, there is a gap in research on how and why patients understand risks associated with seeking or delaying routing health care during an infectious disease pandemic. Our research addresses this gap based on semi-structured interviews with 40 participants living in regions across the United States. By building upon Unger-Saldaña and Infante-Castañeda's model of delayed health care, we extend this model by articulating how health care delays happen during an infectious disease pandemic. Specifically, we show how perceptions of uncertainty and subjective risk assessments shape people's decisions to delay routine health care while they operate at two levels, internal and external to one's social bubble, interacting with each other.

Impact of the Covid-19 Pandemic on Children and Families in PICU Follow-Up Clinic

AbstractThe novel coronavirus disease 2019 (COVID-19) pandemic disrupted the lives of many families, especially those of children with chronic health problems. Little is known about the impact of this pandemic on the health and well-being of critically ill children and their families after their discharge from pediatric intensive care unit (PICU) hospitalization. This study describes the repercussions of the COVID-19-related lockdown on the physical and psychological wellbeing, quality of life, and access to resources of PICU survivors and their families. This was a prospective cohort study of children and families followed at the Centre Hospitalier Universitaire Ste-Justine PICU follow-up clinic from October 2018 to February 2020. Families were contacted by phone to complete validated questionnaires (Pediatric Quality of Life Inventory, Hospital Anxiety and Depression Scale) and to evaluate the impact of the COVID-19 pandemic on their access to medical care and extrafamilial support. Fifty-five families were contacted between November and December 2020. Quality of life scores were 88.1 ± 16.9 and 83.8 ± 13.9 for physical and psychosocial aspects, respectively. Symptoms of anxiety and depression were detected in 23.6 and 3.6% of respondent parents, respectively. A significant proportion of families reported canceled or delayed health care appointments (65.5%) and difficulty with medication access (12.7%). Twenty-five families (45.5%) reported a significant decrease in income. We could not identify any statistically significant predictors for lower quality of life scores. Difficulty accessing medical care was associated with higher symptoms of anxiety and/or depression in parents on multivariate analysis (p = 0.02). In conclusion, the COVID-19 pandemic has had a significant negative impact on PICU survivors' access to medical resources and extrafamilial support.

Body Mass Index and Breast and Cervical Cancer Screening.

Background:Breast and cervical cancer screening are responsible for dramatically reducing cancer deaths. Overweight and obesity are associated with deleterious health outcomes, including increased risk of developing cancer. This study adds to the existing literature examining the association of having overweight and obesity and receipt of breast or cervical cancer screening.Methods:Using the 2013 Brazos Valley Community Health Needs Assessment, we examined the association between body mass index (BMI) and receipt of breast or cervical cancer screening among women meeting age recommendations for breast cancer and cervical cancer screening (n = 1979 and n = 2040), respectively. We used SPSS 22 statistical software for descriptive and logistic regression analysis.Results:Overall, 26.6% of women missed the breast cancer screening guidelines, and 13.3% missed the cervical cancer screening guidelines. BMI had a weak association with missing cervical cancer screenings (odds ratio [OR] = 1.02; confidence interval [CI] = 1.01–1.04), but no association with missing breast cancer screenings (OR = 1.01; CI = 0.99–1.03). Higher age, race (non-White), rural area, no health insurance, smoking, and delayed health care were associated with missing breast cancer screenings. Higher age, marital status (single), lower education, no health insurance, smoking, and delayed health care were associated with missing cervical cancer screening. Further research is needed to better understand the association using larger, more diverse samples.