Enrollment Rates Research Articles

Breast cancer clinical trial participation among diverse patients at a comprehensive cancer center

This study was designed to determine the enrollment patterns in breast cancer clinical trials (CCTs) of patients with diverse backgrounds in an equal access setting and to evaluate the factors contributing to low rates of clinical trial accrual in patients of low socioeconomic status (SES). We performed a retrospective review of a prospectively maintained database of new patients seen at the Dan L. Duncan Comprehensive Cancer Center dating from 5/2015 to 9/2021, which included 3043 patients screened for breast CCTs. We compared the rate of CCT availability, eligibility, and enrollment between two patient populations: Smith Clinic, where most patients are of low SES and uninsured, and Baylor St. Luke’s Medical Center (BSLMC) with mostly predominantly insured, higher income patients. We performed logistic regression to evaluate whether differences in age, clinic, race, trial type, and primary language may be underlying the differences in CCT enrollment. More patients were eligible for CCTs at Smith Clinic (53.7% vs 44.7%, p < 0.001). However, Smith Clinic patients were more likely to decline CCT enrollment compared to BSLMC (61.3% declined vs 39.4%, p < 0.001). On multivariate analysis, Black patients had a significantly higher rate of CCT refusal overall (OR = 0.26, 95% CI 0.12–0.56, p < 0.001) and BSLMC only (OR = 0.20, 95% CI 0.060–0.60, p = 0.006). Our data shows that it is likely an oversimplification to assume that equal access will lead to the elimination of CCT disparities. Efforts to diversify CCTs must include consideration of structural and institutional inequities as well as social needs.

Inequities in medicaid home- and community-based services waiver enrollment among people with intellectual and/or developmental disabilities: A nationwide claims-based analysis

BackgroundStates use Medicaid 1915(c) waiver programs to enable access to home- and community-based services for people with intellectual and/or developmental disabilities (I/DD). However, enrollment rates and potential inequities are not well documented, impeding efforts to improve care access and quality for waiver program enrollees, especially for racially minoritized beneficiaries experiencing compounded barriers to services and supports. ObjectiveTo characterize year-by-year 1915(c) waiver program enrollment among Medicaid-enrolled adults with I/DD from 2016 to 2019 and to analyze population-level inequities by type of I/DD and racial/ethnic group. MethodsOur data source was 2016–2019 Medicaid Transformed Medicaid Statistical Information System Analytic Files Demographic and Eligibility files for beneficiaries with Down syndrome, autism, and intellectual disability. We used generalized estimating equation linear models to estimate the associations of type of I/DD and racial/ethnic group with the probability of 1915(c) waiver program enrollment and reported (1) unadjusted estimates and (2) estimates adjusted for demographics with state and year fixed effects. ResultsFrom 2016 to 2019, across all types of I/DD and racial/ethnic groups, unadjusted 1915(c) waiver program enrollment rates ranged from 40 to 60 % nationwide. We found modest growth in 1915(c) I/DD waiver program enrollment but persistent inequities over time. Compared to beneficiaries with intellectual disabilities, beneficiaries with autism were less likely to enroll while beneficiaries with Down syndrome were more likely. While some racial/ethnic groups had higher unadjusted mean enrollment, after adjustment, racially minoritized beneficiaries were 3.66–12.0 percentage points less likely to enroll compared to white non-Hispanic beneficiaries. ConclusionsGiven extensive waiting lists for 1915(c) waiver programs, Medicaid programs should evaluate existing enrollment and authorization processes and consider alternative HCBS program authorities.

A Protocol for the Inclusion of Minoritized Persons in Alzheimer Disease Research From the ADNI3 Diversity Taskforce

Black or African American (hereinafter, Black) and Hispanic or Latino/a/x (hereinafter, Latinx) adults are disproportionally affected by Alzheimer disease, but most research studies do not enroll adequate numbers of both of these populations. The Alzheimer's Disease Neuroimaging Initiative-3 (ADNI3) launched a diversity taskforce to pilot a multipronged effort to increase the study inclusion of Black and Latinx older adults. To describe and evaluate the culturally informed and community-engaged inclusion efforts to increase the screening and enrollment of Black and Latinx older adults in ADNI3. This cross-sectional study used baseline data from a longitudinal, multisite, observational study conducted from January 15, 2021, to July 12, 2022, with no follow-up. The study was conducted at 13 ADNI3 sites in the US. Participants included individuals aged 55 to 90 years without cognitive impairment and those with mild cognitive impairment or Alzheimer disease. Efforts included (1) launch of an external advisory board, (2) changes to the study protocol, (3) updates to the digital prescreener, (4) selection and deployment of 13 community-engaged research study sites, (5) development and deployment of local and centralized outreach efforts, and (6) development of a community-science partnership board. Screening and enrollment numbers from centralized and local outreach efforts, digital advertisement metrics, and digital prescreener completion. A total of 91 participants enrolled in the trial via centralized and local outreach efforts, of which 22 (24.2%) identified as Latinx and 55 (60.4%) identified as Black (median [IQR] age, 65.6 [IQR, 61.5-72.5] years; 62 women [68.1%]). This represented a 267.6% increase in the monthly rate of enrollment (before: 1.11 per month; during: 4.08 per month) of underrepresented populations. For the centralized effort, social media advertisements were run between June 1, 2021, and July 31, 2022, which resulted in 2079 completed digital prescreeners, of which 1289 met criteria for subsequent site-level screening. Local efforts were run between June 1, 2021, to July 31, 2022. A total of 151 participants underwent site-level screening (100 from local efforts, 41 from centralized efforts, 10 from other sources). In this cross-sectional study of pilot inclusion efforts, a culturally informed, community-engaged approach increased the inclusion of Black and Latinx participants in an Alzheimer disease cohort study.

Running the enrollment numbers on ophthalmic clinical trials in the United States.

This is one of the first reports to summarize the enrollment metrics for ophthalmology trials completed in the United States (US). This study aimed to describe US ophthalmology clinical trial enrollment metrics to facilitate planning and budgeting of US Food and Drug Administration-regulated ophthalmological drugs trials. A GlobalData PLC search was conducted on or before February 27, 2024, to evaluate the clinical trial landscape for completed ophthalmology clinical trials conducted in the US. The primary search contained only the term "ophthalmology," which was restricted to trials that were completed and were conducted within the US. Trials were classified as multicenter when trials included three sites or more, and when the enrollment search resulted in ≥30 multicenter trials for an individual indication, enrollment data were further broken down by Food and Drug Administration trial phase. The search yielded 2229 trials, which analyzed 980 different drugs produced by 854 different sponsors. The most common indications evaluated in US trials were macular degeneration, glaucoma, macular edema, allergies, and keratoconjunctivitis. Multicenter trials by indication had an overall median enrollment period range of 4.8 to 35.1 months; number of subjects enrollment, range of 36 to 518 subjects; number of sites utilized, range of 4 to 74 sites; and enrollment rate, range of 0.11 to 4.04 subjects/sites per month. There were 17 indications with ≥30 multicenter trials, which allowed for enrollment metric calculation by trial phase. This study provides sponsors with an understanding of the number of subjects and sites needed to complete a trial while also setting realistic enrollment timelines. Although this work represents the US market, more work is needed to better understand other countries given that country-specific guidelines and subject beliefs may impact enrollment metrics.

The Abolition of the One-Child Policy and Its Impact on Household Investment in Educating Girls in China

Implemented in 1979, the One-Child Policy was a controversial measure aimed at controlling population growth but resulted in significant unintended consequences, including gender imbalances and economic strains. The policy's relaxation in 2016 to allow two children, and later up to three children, was a response to demographic and socio-economic challenges. This article examines the short-term impacts of these policy changes on educational investments for girls, noting increases in enrollment rates and evolving parental attitudes towards gender equality. It also considers the long-term effects, such as improved gender parity in education and its implications for workforce and economic growth. However, persistent cultural biases, regional disparities, and economic burdens continue to challenge progress. The findings suggest that while the policy shift has fostered greater educational investment in girls, comprehensive efforts are necessary to address enduring inequalities and ensure equitable educational opportunities across all regions.

Special Supplemental Nutrition Program for Women, Infants, and Children Enrollment and Adverse Pregnancy Outcomes Among Nulliparous Individuals.

To evaluate the relationship between changes in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrollment during pregnancy from 2016 to 2019 and rates of adverse pregnancy outcomes in U.S. counties in 2019. We conducted a serial, cross-sectional ecologic study at the county level using National Center for Health Statistics natality data from 2016 to 2019 of nulliparous individuals eligible for WIC. The exposure was the change in county-level WIC enrollment from 2016 to 2019 (increase [more than 0%] vs no change or decrease [0% or less]). Outcomes were adverse pregnancy outcomes assessed in 2019 and included maternal outcomes (ie, gestational diabetes mellitus [GDM], hypertensive disorders of pregnancy, cesarean delivery, intensive care unit [ICU] admission, and transfusion) and neonatal outcomes (ie, large for gestational age [LGA], small for gestational age [SGA], preterm birth, and neonatal intensive care unit [NICU] admission). Among 1,945,914 deliveries from 3,120 U.S. counties, the age-standardized rate of WIC enrollment decreased from 73.1 (95% CI, 73.0-73.2) per 100 live births in 2016 to 66.1 (95% CI, 66.0-66.2) per 100 live births in 2019, for a mean annual percent change decrease of 3.2% (95% CI, -3.7% to -2.9%) per year. Compared with individuals in counties in which WIC enrollment decreased or did not change, individuals living in counties in which WIC enrollment increased had lower rates of maternal adverse pregnancy outcomes, including GDM (adjusted odds ratio [aOR] 0.71, 95% CI, 0.57-0.89), ICU admission (aOR 0.47, 95% CI, 0.34-0.65), and transfusion (aOR 0.68, 95% CI, 0.53-0.88), and neonatal adverse pregnancy outcomes, including preterm birth (aOR 0.71, 95% CI, 0.56-0.90) and NICU admission (aOR 0.77, 95% CI, 0.60-0.97), but not cesarean delivery, hypertensive disorders of pregnancy, or LGA or SGA birth. Increasing WIC enrollment during pregnancy at the county level was associated with a lower risk of adverse pregnancy outcomes. In an era when WIC enrollment has decreased and food and nutrition insecurity has increased, efforts are needed to increase WIC enrollment among eligible individuals in pregnancy.

Measuring Relationship Influences on Romantic Couples' Cancer-Related Behaviors During the COVID-19 Pandemic: Protocol for a Longitudinal Online Study of Dyads and Cancer Survivors.

Research has established the effects of romantic relationships on individuals' morbidity and mortality. However, the interplay between relationship functioning, affective processes, and health behaviors has been relatively understudied. During the COVID-19 pandemic, relational processes may influence novel health behaviors such as social distancing and masking. We describe the design, recruitment, and methods of the relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study. This study was developed to understand how relational and affective processes influence romantic partners' engagement in cancer prevention behaviors as well as health behaviors introduced or exacerbated by the COVID-19 pandemic. The relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study used online survey methods to recruit and enroll 2 cohorts of individuals involved in cohabiting romantic relationships, including 1 cohort of dyads (n=223) and 1 cohort of cancer survivors (n=443). Survey assessments were completed over 2 time points that were 5.57 (SD 3.14) weeks apart on average. Health behaviors assessed included COVID-19 vaccination and social distancing, physical activity, diet, sleep, alcohol use, and smoking behavior. We also examined relationship factors, psychological distress, and household chaos. Data collection occurred between October 2021 and August 2022. During that time, a total of 926 participants were enrolled, of which about two-thirds were from the United Kingdom (n=622, 67.8%) and one-third were from the United States (n=296, 32.2%); about two-thirds were married (n=608, 66.2%) and one-third were members of unmarried couples (n=294, 32%). In cohorts 1 and 2, the mean age was about 34 and 50, respectively. Out of 478 participants in cohort 1, 19 (4%) identified as Hispanic or Latino/a, 79 (17%) as non-Hispanic Asian, 40 (9%) as non-Hispanic Black or African American, and 306 (64%) as non-Hispanic White; 62 (13%) participants identified their sexual orientation as bisexual or pansexual, 359 (75.1%) as heterosexual or straight, and 53 (11%) as gay or lesbian. In cohort 2, out of 440 participants, 13 (3%) identified as Hispanic or Latino/a, 8 (2%) as non-Hispanic Asian, 5 (1%) as non-Hispanic Black or African American, and 398 (90.5%) as non-Hispanic White; 41 (9%) participants identified their sexual orientation as bisexual or pansexual, 384 (87.3%) as heterosexual or straight, and 13 (3%) as gay or lesbian. The overall enrollment rate for individuals was 66.14% and the overall completion rate was 80.08%. We discuss best practices for collecting online survey data for studies examining relationships and health, challenges related to the COVID-19 pandemic, recruitment of underrepresented populations, and enrollment of dyads. Recommendations include conducting pilot studies, allowing for extra time in the data collection timeline for marginalized or underserved populations, surplus screening to account for expected attrition within dyads, as well as planning dyad-specific data quality checks. DERR1-10.2196/48516.

Upward Bound Program Supports Success of Low-Income and/or First-Generation College Students at a STEM-Focused HSI

A deeper understanding of low-income and first-generation college student experiences is essential to advancing diversity and equity in higher education. Due to a significant gap in college enrollment and graduation rates for low-income and first-generation college students, specifically after COVID-19, it is important to identify factors affecting their success. The Upward Bound Math and Science (UBMS) Program at New Mexico Tech (NMT) supports high school students who are either first-generation college students and/or from low-income families to prepare them with the skills and motivation necessary to complete high school and enter and succeed in a program of postsecondary education. These students face unique challenges during their time at college. To identify the factors that affect the success of these students, we surveyed several of our UBMS program participants who chose to attend NMT after completing high school. All participants said support from UBMS staff was critical when starting college at NMT. Participants also mention building a support system with their fellow UBMS alumni to deal with the struggles that being at STEM-focused institutions brings. This study also resulted in several suggestions for faculty and staff members to improve academic outcomes for all students.

Urdu-Language Translation and Validation of the Ask Suicide-Screening Questions (ASQ) Tool: A Focus on Connotation and Context.

Background Suicide is a significant cause of death in the world, and Pakistan, a low- and middle-income country, is no exception. Despite the increasing number of suicides, Pakistan does not have a validated suicide risk screening tool to identify suicide risk in the national language, Urdu, accurately. This study aims to translate and validate the Ask Suicide-Screening Questions (ASQ) tool into Urdu for suicide risk screening in Pakistan. Methodology We conducted this study at the Services Institute of Medical Sciences (SIMS), a large teaching hospital in Lahore, Pakistan, after receiving the approval of the SIMS Institutional Review Board. The study used a cross-sectional instrument validation study design. The inclusion criteria were youth and adults of both sexes aged 15-45 years, with an ability to understand, speak, read, and write in the Urdu language, who had no cognitive or intellectual limitation to consenting, and who were medically stable to participate. Exclusion criteria included any medical, physical, or cognitive unstable condition to consent or participate. We enrolled 300 participants in our convenience sample from the emergency department (ED), inpatient, and outpatient settings. The ASQ and the ASQ Brief Suicide Safety Assessment (BSSA) were translated and back-translated by Urdu language experts and modified to accommodate cultural and linguistic nuances. The clinician-administered BSSA Urdu version was used as a standard criterion to validate the ASQ by comparing the ASQ-Urdu responses vs. BSSA-Urdu responses. RStudio (version 2023.09.1+494) was used for statistical analyses Results The sample had an enrollment rate of 99.7% (300/301). The sample was 52% female (158/300); the mean age was 27.1 years (SD = 9.4), the overall screen-positive rate was 41.7% (125/300), and 9.3% (28/300) of the participants endorsed a past suicide attempt. In our sample, 35.9% (33/92) of outpatients, 32.2% (19/59) of inpatients, and 49.0% (73/149) of ED patients screened positive on the Urdu ASQ. The screen-positive rate was 16.9% (10/59) for participants aged 17 years and younger, 40.7% (35/86) for participants aged 18 to 25 years, and 51.6% (80/155) for participants aged 26 years and older. Compared to the criterion standard clinician-administered assessment, the Urdu ASQ had a sensitivity of 94.2% (95% confidence interval (CI) = 85.8%-98.4%), a specificity of 73.9% (95% CI = 67.7%-79.5%), a negative predictive value of 97.7% (95% CI = 94.2%-99.1%), and a positive predictive value of 52.0% (95% CI = 46.4%-57.6%). Conclusions The Urdu ASQ has strong psychometric properties, allowing healthcare professionals in Pakistan and worldwide with Urdu-speaking diaspora to identify individuals at risk for suicide efficiently. Utilizing cultural contexts in adapted screening tools improves the accuracy of suicide detection by ensuring that the tools are relevant, sensitive, and respectful to the cultural context of the individuals being assessed. High screen-positive rates in our pilot study underscore the need for early detection and intervention of suicide as a major global public health problem.

Study of Contributing Factors and Countermeasures of Job Burnout of Teachers in Junior Middle Schools

Under the situation of emphasizing the enrollment rate, teachers in junior middle school work under enormous pressure for a long time, which easily results in job burnout. It not only has negative impact on teachers’ physical and mental health, but also poses a great threat to the quality of teaching and the stability of teaching staff. Regarding this issue, this study mainly analyzes the main causes of teachers’ job burnout from four aspects: society, schools, students, and teachers, as well as offers countermeasures to alleviate it from the above aspects.

Residential consumer enrollment in demand response: An agent based approach

Residential consumers play an important role in the sustainable transition of the energy system by leveraging their household loads for demand response (DR). This paper aims to analyze the enrollment rates of residential consumers within DR through an agent-based model (ABM). Both economic and noneconomic (social/behavioral) parameters that influence the consumer enrollment in DR are considered. An energy management model, a home energy management system (HEMS), is used to identify the potential economic savings of consumers enrolling in DR. Consumers are randomly assigned to different neighborhoods and have different social relationships (e.g., friends, neighbors), which, in turn, influences their decision-making in the ABM. The results of this paper highlight the indirect relationship of expected annual savings and direct relationship of the share of consumers having electric vehicles (EV), photovoltaics (PV), and battery energy storage systems (BESSs) on the DR enrollment rates. Based on the enrollment rates, the maximum energy savings were obtained in April and the minimum during the last quarter of the year. Monte Carlo analysis is employed to handle the randomness associated with different variable selections, which provides a ±10% variation of consumer enrollment rate in DR. The results of this study have practical implications for energy flexibility in the residential sector.

Intimate partner violence against adolescent girls: regional and national prevalence estimates and associated country-level factors

Intimate partner violence is a serious public health problem and negatively affects short-term and long-term health, development, and wellbeing of adolescent girls. Global estimates from WHO have shown that adolescent girls aged 15-19 years experience high rates of intimate partner violence. We aimed to estimate the lifetime and past-year prevalence and patterns of physical or sexual intimate partner violence against adolescent girls by male partners across 161 countries and areas, and to examine the country-level factors, including the prevalence of child marriage, associated with the lifetime and past-year prevalence of intimate partner violence in this age group. These analyses used the 2018 global, regional, and country estimates on intimate partner violence published by WHO and economic, social, and political metadata from subject-specific databases. Drawing on data from the WHO Global Database on Prevalence of Violence Against Women, we used hierarchical Bayesian modelling techniques to estimate lifetime and past-year prevalence of physical or sexual (or both) intimate partner violence against adolescent girls aged 15-19 years by country. Linear regression methods were used to examine contextual social, economic, and political factors associated with intimate partner violence against adolescent girls in the 101 countries (lifetime prevalence) and 105 countries (past-year prevalence) for which these metadata were available. The estimated global prevalence of physical or sexual intimate partner violence against ever-partnered adolescent girls aged 15-19 years was 24% (95% uncertainty interval 21-28) in their lifetime and 16% (14-19) in the past year. Prevalence varied greatly across countries and regions, with lifetime prevalence ranging from 6% (3-11) in Georgia to 49% (35-64) in Papua New Guinea. Overall, the prevalence of both lifetime (154 countries) and past-year (157 countries) intimate partner violence against adolescent girls was higher in low-income and lower-middle-income countries and regions than in high-income countries and regions. Countries with higher rates of female secondary school enrolment and those with inheritance laws that are more gender-equal had lower prevalence of intimate partner violence against adolescent girls. Lower-income countries and societies with a high prevalence of child marriage had higher prevalence of physical or sexual intimate partner violence against adolescent girls. Our findings highlight the widespread prevalence of intimate partner violence against adolescent girls across the globe and its relationship with country-level contextual factors. They emphasise the need for promoting and ensuring policies and programmes that increase and ensure gender equality. Countries should strive to provide secondary education for all girls, ensure equal property rights for women, eliminate discriminatory gender norms, and address harmful practices such as child marriage. UN Women-WHO Joint Programme on Strengthening Violence Against Women Data funded by the UK Foreign and Commonwealth Development Office and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development, and Research Training in Human Reproduction.

Information and resources VA health system leaders need to manage enrollment and retention for Post-9/11 veterans.

To understand Veterans Health Administration (VA) leaders' information and resource needs for managing post-9/11 Veterans' VA enrollment and retention. Interviews conducted from March-May 2022 of VA Medical Center (VAMC) leaders (N = 27) across 15 sites, using stratified sampling based on VAMC characteristics: enrollment rates, number of recently separated Veterans in catchment area, and state Medicaid expansion status. Interview questions were developed using Petersen et al.'s Factors Influencing Choice of Healthcare System framework as a guide. Interviews were transcribed verbatim, and two coders analyzed the interviews using Atlas.ti, a qualitative software program. Coders followed the qualitative coding philosophy developed by Crabtree and Miller, a process of developing codes for salient concepts as they are identified during the analysis process. Two coders analyzed 22% (N = 6) of the interviews and discussed and adjudicated any discrepancies. One coder independently coded the remainder of the interviews. Several key themes were identified regarding facilitators and barriers for VA enrollment including reputation for high-quality VA care, convenience of VA services, awareness of VA services and benefits, and VA mental health services. Nearly every VA leader actively used tools and data to understand enrollment and retention rates and sought to enroll and retain more Veterans. To improve the management of enrollment and retention, VA leaders would like data shared in an easily understandable format and the capability to share data between the VA and community healthcare systems. Enrollment and retention information is important for healthcare leaders to guide their health system decisions. Various tools are currently being used to try to understand the data. However, a multifunctional tool is needed to better aggregate the data to provide VA leadership with key information on Veterans' enrollment and retention.

The Role of Muslim Youth in Promotion Education in Cambodia

The Muslim community in Cambodia, generally known as “Cham”, descended from refugees from the ancient Kingdom of Champa who fled central Vietnam 500 years ago. The community has faced two main dramatic periods of persecution. The first began with the end of the Champa kingdom in the 16th century and the Khmer Rouge period lives on in the collective memory of Cambodians from 1975 to 1979, up to 2 million Cambodians were killed, with many more displaced and separated from their families. This study is to describe the situational context of the Cham Muslim minority setting in Cambodia as well as specific problems in the formal education using literature review and data analysis. On the way towards universal primary education, Cambodia has made good progress over the past fifteen years. In 2014, the net enrolment rate in primary school was 98.4 per cent, the primary school completion rate was 89.9 per cent and the literacy rate of people aged 15-24 years was 91 per cent. In Islamic education, MoEYS allocated 1,500 teaching positions with civil service status to the Islamic education school system. Of those, currently, 1,391 Islamic school teachers hold that title and receive their salaries from the RGC. Recruitment of the 1,391 Islamic school teachers to become civil service teachers was done by MoEYS, in collaboration with the Highest Council for Islamic Religious Affairs in Cambodia (referred to as Mufti), which has a leadership team appointed by the RGC. The qualitative data confirms that Islamic schools are not a monolithic entity. There are a variety of ways Islamic schools are administered, offering different curricula and serving diverse Muslim communities across Cambodia

Role of United Nation High Commission for Refugee (UNHCR) for the Provision of Basic Education to Afghan Refugees in Hazara Division, Pakistan

This thesis examines the pivotal role played by the United Nations High Commissioner for Refugees (UNHCR) in facilitating access to basic education for Afghan refugees residing in Hazara Division Khyber Pakhtunkhwa (KP), Pakistan. As KP hosts a significant Afghan refugee population, ensuring their access to education is paramount. This research investigates the current state of education for Afghan refugees in Hazara Division of KP, with a focus on enrollment rates, school access, and education quality. It assesses the challenges hindering education, including financial, linguistic, and cultural barriers, and evaluates initiatives by the Pakistani government and UNHCR to improve the situation. Through a mixed-method approach, combining qualitative interviews and quantitative surveys, the study provides insights into the impact of education on the refugees' lives and their empowerment prospects. The findings contribute to understanding the effectiveness of UNHCR's efforts and offer recommendations for enhancing education opportunities for Afghan refugees in KP and similar contexts globally.

Associations of longitudinal BMI percentile classification patterns in early childhood with neighborhood-level social determinants of health.

Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable. We extracted EHR data from 2012-2019 for a children's health system that includes 2 hospitals and wide network of outpatient clinics spanning 5 East Coast states in the US. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately. From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity (n=429; 1.16%), overweight most of the time (n=15,006; 40.65%), increasing BMI-percentile (n=9,060; 24.54%), decreasing BMI-percentile (n=5,058; 13.70%), and always normal weight (n=7,357; 19.89%). Compared to children in the decreasing BMI-percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment. Neighborhood-level SDOH factors have significant associations with children's BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them. This study demonstrates the association between longitudinal BMI-percentile patterns and SDOH in early childhood. Five distinct clusters with different BMI-percentile trajectories are found and a strong association between these clusters and SDOH is observed. Our findings highlight the importance of targeted prevention and treatment interventions based on children's SDOH.

Tailored approach to participant recruitment and retention to maximize health equity in pediatric cancer research

BackgroundLack of diversity in participants throughout the research process limits the generalizability of findings and may contribute to health disparities. There are unique challenges to recruitment of families to pediatric cancer research studies, especially for those from disadvantaged backgrounds. Thus, there is a need to evaluate the most effective recruitment and retention strategies to optimize equitable recruitment of diverse participants.MethodsThe present study adapted and implemented methods outlined previously in the literature. These previous efforts were developed to address barriers to pediatric research, behavioral health intervention research and research with Black adolescents. Recruitment and retention strategies are described across four different time points: pre-approach, initial connection, building connection and follow-up. Eligible families of children with a pediatric cancer diagnosis were approached during a routine oncology visit. Once consented, enrollment and retention rates over three timepoints of data collection were recorded and evaluated.ResultsResults indicated high rates of enrollment (86%) and retention (95%) for eligible participants. There were no trends in heightened attrition for any specific subgroup.ConclusionsThe findings of this study are promising and suggest these recruitment and retention strategies may be useful in recruiting individuals from disadvantaged backgrounds.

Predictive Modeling of Future Trends in US Healthcare Data and Outcomes

Predictive modeling has great potential to help guide healthcare policymaking and planning through forecasting future trends in domains such as disease prevalence, resource utilization, and costs. However, past research in this area has been limited by mostly examining small, narrow datasets that only captured specific illnesses or geographic regions. This study aimed to leverage more sophisticated predictive analytics to generate informed estimations of the most consequential healthcare trends anticipated in the United States throughout the next decade. The analysis drew upon an extensive collection of over 50 million longitudinal electronic health records spanning a 5-year timeframe, comprehensive national public health statistics from the same period, and Medicare claims encompassing 72 million beneficiaries. Advanced machine learning techniques, including neural networks and Bayesian additive regression trees, were applied to identify nonlinear relationships and temporal patterns across 500 variables related to patient demographics, medical diagnoses, therapeutic procedures, reimbursement amounts, and clinical outcomes. Models were trained using data from 2010 to 2015 then utilized to project trends and forecasts for the years 2020 to 2025. Five-fold cross-validation testing was conducted to evaluate the accuracy and generalizability of the predictive models. The model projections indicate that chronic disease prevalence nationwide will rise by approximately 40% by the conclusion of 2025, primarily fueled by growing epidemics of obesity and an increasingly aging American population. Additionally, heart disease and stroke are estimated to maintain their positioning as leading causes of death, but cases of dementia and Alzheimer's disease specifically are projected to climb even more sharply at over a 50% increase. Healthcare costs on the whole are anticipated to rise on average between 4-6% annually, and costs may potentially double for elderly patients presenting with multiple morbidities. As outpatient and home-based care options expand further, inpatient hospital facility utilization may drop marginally between 10-15%. Improved management of chronic medical conditions within local community settings could reduce preventable hospital readmissions from 25-30%. Primary care, nursing, and mental healthcare roles are likely to face looming staffing shortages as well. Telehealth adoption is forecasted to surge by approximately 45% as virtual visit formats help address access obstacles. By 2025, biologics and gene therapies could account for over 25% of total drug spending pertaining to oncology and rare disease treatment. Larger Medicaid, Medicare, and ACA commercial coverage markets may motivate higher rates of health insurance enrollment over the next few years.

Predictors of Life Expectancy at Birth In Turkiye: A Longitudinal Study

ABSTRACT Objective: The aim of this study is to examine the impact of social, behavioral, economic and healthcare system related factors on life expectancy at birth in Turkiye. Methods: Enrollment rate in tertiary education, tobacco consumption gram per capita, out-of-pocket payments and GDP per capita were included as predictors. The data was obtained from the database of OECD, World Bank and Health Statistics Yearbooks published by Ministry of the Health for 2000-2019. Johansen Cointegration test was used to define the existence of the long-run statistical relationship between life expectancy at birth and the predictors. Results: Enrollment rate in tertiary education, GDP per capita and out-of-pocket payments are positively associated with life expectancy, while tobacco consumption gram per capita has a negative association. It has been concluded that short-term deviations from the equilibrium, using an error correction model, will reach long-term equilibrium approximately one year later. Granger causality test and the estimation result revealed that enrollment rate in tertiary education, tobacco consumption, out-of-pocket health expenditure, GDP per capita are the short-term and long-term causes of life expectancy at birth. Conclusion: This study provides important evidence for policymakers to allocate resources to the social, behavioral, healthcare-related and economic determinants of health status to increase life expectancy. In addition, the determination of out-of-pocket payments to have a positive relationship with life expectancy gives a clue about the need to make more efforts regarding the economic accessibility of healthcare services in the Turkish health system.

Enrolling High-Acuity Emergency General Surgery Patients in a Prospective Longitudinal Cohort Study.

Over three million patients are admitted to hospitals annually with high-acuity conditions mandating emergency abdominal or skin/soft-tissue operation. Patients with these high-acuity emergency general surgery (HA-EGS) diseases experience significant morbidity/mortality, yet the quality of life (QOL) impact on survivors is not well studied. Acuity, transfer patterns, and adverse social determinants of health (SDOH) documented in epidemiologic studies are cited reasons for inability to measure patient-reported outcomes (PROs) among HA-EGS survivors. We conducted a feasibility study to understand facilitators and barriers of conducting a prospective study of changes in QOL after surviving HA-EGS. From September 2019 to April 2021, we collected baseline (pre-admission) and 30/60-days post-surgery data on activities of daily living, depression, self-efficacy, resilience, pain, work limitations, social support, and substance use from patients who enrolled during index hospitalization. 100 patients were consented to participate in the study (71.9% enrollment rate). The retention rate was 65.9% for 30-day calls and 53.8% for 60-day calls. Median time to complete each time point remained under 25 minutes. Patients with a longer length of stay and nicotine users didn't complete their 30-day interview while those with systemic complications didn't complete their 60-day interview. These results set the foundation for future PRO studies.