Gaps In Use Research Articles

Unveiling disparities: a non-linear decomposition analysis of the gap in menstrual hygiene material use between adolescent women in Aspirational and the remaining districts of India.

This study aimed to investigate the factors contributing to the gap in the use of hygienic materials during menstruation to collect blood among adolescent women between Aspirational and the remaining districts of India. The study sample consisted of 114805 adolescent women (20835 women from 112 Aspirational districts and 93970 women from 595 remaining districts) from the National Family Health Survey-5. Fairlie decomposition was used to identify and measure the factors contributing to the gap in the use of hygienic materials between Aspirational and the remaining districts of India. This study determined that the use of hygienic materials during menstruation varied significantly between Aspirational and the remaining districts. While only 37% of adolescent women used hygienic materials in Aspirational districts, almost 52% did so in the remaining districts. Seventy-five per cent of Aspirational districts (84 of 112 districts) reported less than 50% use of hygienic materials, which is lower than the national average and the average of the remaining districts. It was revealed that nearly 90% of the total explained gap between the two groups was accounted for by household wealth, place of residence, exposure to mass media, and education level. Wealth was the main contributor to the gap, explaining about 46% of the difference in hygienic materials use between Aspirational and the remaining districts, followed by the place of residence (18%), exposure to mass media (15%), and education level (11%). Findings suggest that targeted interventions to improve access to hygienic materials among adolescent women in Aspirational districts, particularly those in the northern states of Uttar Pradesh, Bihar, and Chhattisgarh, are necessary. Policy efforts should focus on women from poor households, improving access to education, and expanding mass media exposure in Aspirational districts to reduce the gap in menstrual hygiene practices among adolescent women in India.

Single Crystal Sn-Based Halide Perovskites.

Sn-based halide perovskites are expected to be the best replacement for toxic lead-based counterparts, owing to their similar ionic radii and the optimal band gap for use in solar cells, as well as their versatile use in light-emitting diodes and photodetection applications. Concerns, however, exist about their stability under ambient conditions, an issue that is exacerbated in polycrystalline films because grain boundaries present large concentrations of defects and act as entrance points for oxygen and water, causing Sn oxidation. A current thriving research area in perovskite materials is the fabrication of perovskite single crystals, promising improved optoelectronic properties due to excellent uniformity, reduced defects, and the absence of grain boundaries. This review summarizes the most recent advances in the fabrication of single crystal Sn-based halide perovskites, with emphasis on synthesis methods, compositional engineering, and formation mechanisms, followed by a discussion of various challenges and appropriate strategies for improving their performance in optoelectronic applications.

TECHNOLOGICAL GAP AMONG THE FARMERS REGARDING RECOMMENDED SORGHUM PRODUCTION TECHNOLOGY

In India and other Asian and African countries, millets commonly include sorghum, pearl millet, and a range of small millets (Vetriventhan et al., 2020). India is the sixth largest producer of sorghum globally (www.smartfood.org). Sorghum is mainly used for food, fodder, alcoholic beverages and production of bio fuels. Sorghum is also known as "Global Grain" due to its multipurpose uses being a 4F (food, feed, fodder and fuel) crop. Despite of its multiple uses, the area under sorghum in India has declined from 18.61 m. ha in 1969-70 to 4.96 m. ha in 2017-18. There is wide gap between national productivity and yield potential of the improved sorghum technologies developed from the research institutes. Productivity of the crop can be enhanced by adopting the improved practices. The extent of technological gap in different production components of the technology contributes differently to the yield gap. Keeping in view the afore mentioned facts, the study on Technological Gap among the farmers regarding recommended sorghum production technology was undertaken the middle of Gujarat. A sample of 300 sorghum growers were selected from all 14 villages of Vadodara district by using proportionate random sampling. Ex-post-facto research design was used. The results of the study show that higher (87.64 per cent) technological gap in use of plant protection measures, 75.30 per cent technological gap in use of seed treatment, 63.18 per cent technological gap in weed management and 61.93 per cent technological gap in use of FYM were found in adoption of recommended sorghum production technology as majority of the sorghum growers faced constraints of high cost of farm inputs ( pesticide, insecticide, FYM), non availability of seed, good quality of FYM & fungicides at proper time, inadequate knowledge about sorghum production technology, non-availability of labor at proper time for weeding & harvesting during adoption of recommended sorghum production technology. Hence, more emphasis should be given to supply inputs in time, sufficient in quantity at affordable price to farmers.

Treatment patterns of patients with worsening heart failure with reduced ejection fraction.

Patients with HFrEF and worsening HF events (WHFE) are at particularly high risk and urgently need disease-modifying therapy. CHART-HF assessed treatment patterns and reasons for medication decisions among HFrEF patients with and without WHFE. CHART-HF collected retrospective electronic medical records of outpatients with HF and EF<45% between 2017-2019 from a nationwide panel of 238 cardiologists (458 patients) and the Geisinger Health System (GHS) medical record (1000 patients). The index visit in the WHFE cohort was the first outpatient cardiologist visit ≤6months following the WHFE, and in the reference cohort was the last visit in a calendar year without WHFE. Demographic characteristics were similar between patients with and without WHFE in both the nationwide panel and GHS. In the nationwide panel, the proportion of patients with versus without WHFE receiving ≥50% of guideline-recommended dose on index visit was 35% versus 40% for beta blocker, 74% versus 83% for ACEI/ARB/ARNI, and 48% versus 49% for MRA. The proportion of patients receiving ≥50% of guideline-recommended dose was lower in the GHS: 29% versus 34% for beta-blocker, 16% versus 31% for ACEI/ARB/ARNI, and 18% versus 22% for MRA. For patients with and without WHFE, triple therapy on index date was 42% and 44% of patients from the nationwide panel, and 14% and 17% in the GHS. Comparing end of index clinic visit with 12-month follow-up in the GHS, the proportion of patients on no GDMT increased from 14% to 28% in the WHFE cohort and from 14 to 21% in the non-WHFE group. Major gaps in use of GDMT, particularly combination therapy, remain among US HFrEF patients. These gaps persist during longitudinal follow-up and are particularly large among patients with recent WHFE.

Forest-goers as a heterogeneous population at high-risk for malaria: a case–control study in Aceh Province, Indonesia

BackgroundA major challenge to malaria elimination is identifying and targeting populations that are harbouring residual infections and contributing to persistent transmission. In many near-elimination settings in Southeast Asia, it is known that forest-goers are at higher risk for malaria infection, but detailed information on their behaviours and exposures is not available.MethodsIn Aceh Province, Indonesia, a near-elimination setting where a growing proportion of malaria is due to Plasmodium knowlesi, a case–control study was conducted to identify risk factors for symptomatic malaria, characteristics of forest-goers, and key intervention points. From April 2017 to September 2018, cases and controls were recruited and enrolled in a 1:3 ratio. Cases had confirmed malaria infection by rapid diagnostic test or microscopy detected at a health facility (HF). Gender-matched controls were recruited from passive case detection among individuals with suspected malaria who tested negative at a health facility (HF controls), and community-matched controls were recruited among those testing negative during active case detection. Multivariable logistic regression (unconditional for HF controls and conditional for community controls) was used to identify risk factors for symptomatic malaria infection.ResultsThere were 45 cases, of which 27 were P. knowlesi, 17 were Plasmodium vivax, and one was not determined. For controls, 509 and 599 participants were recruited from health facilities and the community, respectively. Forest exposures were associated with high odds of malaria; in particular, working and sleeping in the forest (HF controls: adjusted odds ratio (aOR) 21.66, 95% CI 5.09–92.26; community controls: aOR 16.78, 95% CI 2.19–128.7) and having a second residence in the forest (aOR 6.29, 95% CI 2.29–17.31 and 13.53, 95% CI 2.10–87.12). Male forest-goers were a diverse population employed in a variety of occupations including logging, farming, and mining, sleeping in settings, such as huts, tents, and barracks, and working in a wide range of group sizes. Reported use of protective measures, such as nets, hammock nets, mosquito coils, and repellents was low among forest-goers and interventions at forest residences were absent.ConclusionsSecond residences in the forest and gaps in use of protective measures point to key malaria interventions to improve coverage in forest-going populations at risk for P. knowlesi and P. vivax in Aceh, Indonesia. Intensified strategies tailored to specific sub-populations will be essential to achieve elimination.

저소득층 학생의 디지털 정보격차에 미치는 요인 분석 연구

Objectives This study was conducted to analyze the types and causes of the digital information gap among low- income students, identify prerequisites for resolving the digital information gap, and derive implications to help with subsequent research related to this.&#x0D; Methods Using the digital information gap survey data collected by the Korea Intelligence Information Society Promotion Agency in 2021, a factor analysis of 22 questions was conducted to determine the types of digital information gap, and a step-by-step selection method was used to analyze the causes of each type of digital information gap. Multiple regression analysis was performed using.&#x0D; Results The average monthly household income of low-income students was analyzed to affect the access gap. In addition, it was found that the older the age, the higher the ability to use PCs and mobile devices, and the higher the household average monthly income, the relatively higher the ability to use PCs and mobile devices. On the other hand, it was found that women were less capable of using PCs. Additionally, students with a positive attitude toward digital technology say they are familiar with the basic functions of digital devices, and the efficacy of using digital devices appears to have an impact on the gap in use of low-income students.&#x0D; Conclusions The types of digital information gap among low-income students were classified into ‘access gap’, ‘use gap’, and ‘utilization gap’, which were discussed in existing information gap research. This implies that students from low-income families also have access problems related to physical access and are experiencing difficulties in accessing and utilizing digital devices and networks. Moreover, the gap in use and utilization of low-income students was identified as containing problems caused by the absence of a digital education environment, and as a way to resolve this, a digital education plan to strengthen attitudes toward digital technology and efficacy in using digital devices can be expected.

A Clinician's Guide to the Implementation of Point-of-Care Ultrasound (POCUS) in the Outpatient Practice.

Point-of-care ultrasound (POCUS) is a valuable clinical tool used at the patient bedside to rapidly assess a wide variety of symptoms and problems which would otherwise take hours or even days. Though it has become the standard of care in Emergency Medicine and is becoming so in hospital internal medicine, less uptake has been appreciated in the outpatient setting despite reported interest from clinicians practicing there. A number of common barriers have been cited to explain this gap in use, which usually include access to equipment, mentorship, and time. In this review we present a proposed framework for clinicians who have an interest in implementing POCUS in their outpatient practice which we hope can mitigate some of these barriers and provide a more streamlined pathway to their desired goals.

Clinician perceptions and reasons for non-use of guideline-directed medical therapy for heart failure with reduced ejection fraction in the United States

Abstract Background Despite evidence that guideline-directed medical therapy (GDMT) improves outcomes in heart failure with reduced ejection fraction (HFrEF), many eligible patients remain untreated in the United States (US). Purpose To explore reasons why patients are not receiving GDMT and physician perceptions in management of their patients. Methods We conducted a cross-sectional survey of HF treatment practices (Adelphi Real World Heart Failure Disease Specific Programme) between August 2022 and February 2023, following publication of the 2022 US HF guidelines recommended that patients with HFrEF receive: angiotensin receptor/neprilysin inhibitors (ARNI), beta-blocker, mineralocorticoid receptor antagonists (MRA), and SGLT-2 inhibitors (SGLT2i). A total of 63 cardiologists and 39 primary care physicians in the US provided clinical and treatment patterns data on adult patients with HFrEF (ejection fraction ≤ 40%) and completed an attitudinal survey detailing reasons for treatment initiation. Results The study group included 323 patients with HFrEF (median age of 67 years [IQR 56-74]; 39% females) of which 59.4% were White, 19.8% African American and 9.6% Hispanic; half of the sample was insured by Medicare (50.2%), followed by commercial insurance (36.5%). GDMT prescription rates are presented in Table 1. Overall, 57.3% were not prescribed ARNI (185/323), 16.4% (53/323) were not prescribed a beta-blocker; 71.5% (231/323) were not prescribed MRA, and 65.3% (211/323) were not prescribed SGLT2i. Among patients not receiving GDMT, the most frequently reported physician reason for not prescribing ARNIs (54.1%), beta-blockers (43.4%), MRAs (54.5%) or SGLT-2is (53.6%) was physician deemed the patient to be clinically stable (Table 2). Most physicians (93.5%) reported being satisfied with treatment for patients with HFrEF and most (80.3%) believed that their patients with HFrEF were fully compliant with their treatments. Most physicians (91.2%) stated that they based their treatment decisions on both clinical experience and laboratory tests, as opposed to laboratory tests/imaging only (9.8%) or personal judgement only (16.7%). Conclusions In this cohort of patients with HFrEF from the US, the most common primary reason physicians reported for their patients not receiving GDMT was that the patient was clinically stable. Patient medication costs, contraindications, and proven intolerance were each reported as primary reasons for non-treatment in only a small minority of cases. These data suggest a strong culture of clinical inertia and lack of therapeutic urgency as the dominant driver of large gaps in use of GDMT in the US.GDMT prescriptions in HFrEF (n = 323)Physician-reasons for no GDMT

A review of alternative proteins for vegan diets: Sources, physico-chemical properties, nutritional equivalency, and consumer acceptance

Alternate proteins are gaining popularity as a more sustainable and environmentally friendly alternative to animal-based proteins. These proteins are often considered healthier and are suitable for people following a vegetarian or vegan diet. Alternative proteins can be recovered from natural sources like legumes, grains, nuts, and seeds, while single cell proteins (mycoproteins), and algal proteins are being developed using cutting-edge technology to grow fungus, yeast and algal cells in a controlled environment, creating a more sustainable source of protein. Although, the demand for alternative protein products is increasing, there still happens to be a large gap in use among the general consumers mainly stemming from its lower bioavailability, lack of nutritional equivalency and reduced digestibility compared to animal proteins. The focus of the review is to emphasize on various sources and technologies for recovering alternative proteins for vegan diets. The review discusses physicochemical properties of alternative proteins and emphasise on the role of various processing technologies that can change the digestibility and bioavailability of these proteins. It further accentuates the nutritional equivalency and environmental sustainability of alternative protein against the conventional proteins from animals. The food laws surrounding alternative proteins as well as the commercial potential and consumer acceptance of alternative protein products are also highlighted. Finally, key challenges to improve the consumer acceptability and market value of plant-based proteins would be in achieving nutrient equivalency and enhance bioavailability and digestibility while maintaining the same physicochemical properties, taste, texture, as animal proteins, has also been highlighted.

BeTTer Outcomes Workgroup Health Quality Initiative to optimize bone health for prostate cancer patients in the British Columbia Cancer System.

Bone-targeted therapies (BTTs) are integral to the management of bone metastases in metastatic castration-resistant prostate cancer (mCRPC). BTTs vary considerably in referral and drug access pathways and optimal BTT use requires multi-specialty consultation and supervision. Health quality improvement (HQI) has become the predominant framework to improve patient care in multidisciplinary settings. HQI initiatives on use of BTT in mCRPC were developed and evaluated in five centers of a provincial cancer center network using Plan-Do-Study-Act (PDSA) methodology. Multidisciplinary teams (MDTs) completed a common quality assessment form and an HQI template and then implemented an HQI initiative. Feedback and findings were shared and discussed at regional events. It was subsequently determined whether to adopt, adapt, or abandon initiatives. Patterns of unmet needs varied across type of BTT. Gaps in use of radium-223 were mostly referral and education issues that could be directly addressed at the local level by participating clinician teams. Conversely, most supportive BTT gaps were related to coverage and resourcing support. HQI initiatives selected by each site consisted of implementation or expansion of local MDT meetings, referral documents, databases, and improvement charters. The main HQI initiative was completed in four sites and was adapted or adopted in three. Improvements in BTT use were observed in two of three centers with data on HQI process measures. Despite the overall heterogenous structure of the groups and metrics used, this study demonstrated that the PDSA framework provides the needed structure for improvements in BTT use in mCRPC across multiple sites.

Abstract P6-05-52: Addressing Healthcare Gaps and Disparities in Electronic Medical Record Messages: A Quality Improvement Project Among Breast Cancer Patients

Abstract Introduction: Despite evidence that utilization of Electronic Medical Record (EMR) messaging positively impacts patients with cancer, there is little research on who uses EMR messaging and for what purpose. Methods: Sociodemographic and MyChart usage data was collected from Epic to identify patterns of EMR messaging by patients at an academic breast center. Study eligibility included breast cancer patients who completed a visit and sent at least one message to a provider during the study period (May 2021- May 2022). Chi-square and t-tests were used to describe differences between users and non-users of EMR messaging. ANOVA and chi-square were used to describe differences between race/ethnicity. Analyses were performed in R version 4.2 and p&amp;lt; 0.05 was considered statistically significant. Results: A total of 4069 patients who had MyChart account activated were included in the analysis sample. Of those, 3575 (87.9%) were messaging users and 494 (12.1%) were non-users. The mean age of users was significantly lower compared to the non-users (57.7 vs 61.2, p&amp;lt; .001). There were statistically significant racial/ethnic differences (p&amp;lt; 0.001) by user status with 83.9% and 9.5% of users being non-Hispanic White (NHW) and non-Hispanic Black (NHB) respectively. Among non-users 69.6% were NHW and 21.1% were NHB. There were also significant differences in preferred language (p&amp;lt; 0.001) and payor (p&amp;lt; 0.001) by user status. 99.2% of users were English speaking and 96.8% of non-users were non-English speaking. 54% and 38%, and 6.5% of users had Managed care, Medicare, and Medicaid respectively as their payor. Whereas 36.9%, 51%, and 10.5% of non-users had Managed care, Medicare, and Medicaid respectively. Lastly, there were statistically significant racial/ethnic differences in the types of messages sent among EMR users. Conclusions: There are significant differences in race/ethnicity among EMR users and non-users, and racial/ethnic differences in the types of messages sent among EMR messaging users. We believe that these differences may be in part due to disparities in access or comfort in using EMR. Future directions include conducting interviews with minority patients who are users and non-users of EMR messaging to identify barriers and gaps in use. Table 1. Patient Characteristics. Characteristics of users and non-users of EMR messaging. Chi-square and T-test for significance were performed to assess the difference between groups. P&amp;lt; .05 was considered significant. Table 2. Message Type by Race/Ethnicity. Types of message sent by race/ethnicity. ANOVA and chi-square were used to describe differences between race/ethnicity and type of message sent. P&amp;lt; .05 was considered significant. Citation Format: Meghan Conroy, Miracle Powell, Sneha Nagavally, Aprill Dawson, Anna Beckius, Heun Min, Maressa Sweeney, Elizabeth Weil, Angela Hallbach, Lubna N. Chaudhary, Yee Chung Cheng, Jutta Deiinger, John Burfeind, Janet Retseck, Tamiah Wright, John Charlson, Sailaja Kamaraju. Addressing Healthcare Gaps and Disparities in Electronic Medical Record Messages: A Quality Improvement Project Among Breast Cancer Patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-52.

Ideational factors and their association with insecticide treated net use in Magoe District, Mozambique

BackgroundInsecticide treated bed nets (ITN) are considered a core malaria vector control tool by the WHO and are the main contributor to the large decline in malaria burden in sub-Saharan Africa over the past 20 years, but they are less effective if they are not broadly and regularly used. ITN use may depend on factors including temperature, relative humidity, mosquito density, seasonality, as well as ideational or psychosocial factors including perceptions of nets and perceptions of net use behaviours.MethodsA cross–sectional household survey was conducted as part of a planned randomized controlled trial in Magoe District, Mozambique. Interviewers captured data on general malaria and ITN perceptions including ideational factors related to perceived ITN response efficacy, self-efficacy to use an ITN, and community norms around ITN using a standardized questionnaire. Only households with sufficient ITNs present for all children to sleep under (at least one ITN for every two children under the age of five years) were eligible for inclusion in the study. Additional questions were added about seasonality and frequency of ITN use.ResultsOne-thousand six hundred sixteen mother–child dyads were interviewed. Responses indicated gaps in use of existing nets and net use was largely independent of ideational factors related to ITNs. Self-reported ITN use varied little by season nor meaningfully when different methods were used to solicit responses on net use behaviour. Mothers’ perceived response efficacy of ITNS was negatively associated with net use (high perceived response efficacy reduced the log-odds of net use by 0.27 (95% CI − 0.04 to − 0.51), implying that stronger beliefs in the effectiveness of ITNs might result in reduced net use among their children.ConclusionsIn this context, ITN use among children was not clearly related to mothers’ ideational factors measured in the study. Scales used in solicitation of ideation around ITN use and beliefs need careful design and testing across a broader range of populations in order to identify ideational factors related to ITN use among those with access.

Abstract 12786: Contemporary Outpatient Management of Patients With and Without Worsening Heart Failure With Reduced Ejection Fraction Within A Single Integrated System: Results From Electronic Medical Record Data in the CHART-HF Study

Background: Patients with HFrEF and worsening HF events (WHFE) have substantial disease burden and poor outcomes. CHART-HF aims to characterize real-world clinical characteristics, longitudinal treatment use, and therapeutic decision-making among patients with HFrEF with vs without WHFE. Methods: Retrospective analysis of EMR data of 1000 adult patients with HF (with LVEF &lt;45%) from a single integrated health system with 2 mutually exclusive cohorts was conducted. The WHFE cohort included patients with a WHFE (i.e., hospitalization or receipt of IV diuretics) between 2017-2019 followed by an index outpatient cardiology visit ≤6 months. The control cohort included patients with no WHFE in a given year between 2017-2019. Index visit was defined as the last outpatient cardiology visit in the given year. Treatment use followed for 12 months. Results: Patients with WHFE were slightly older (68.6 vs. 68.0 years), had more females (28.8 vs. 24.4%) and had more comorbidities such as hypertension, atrial fibrillation, COPD, diabetes mellitus and chronic kidney disease compared with control patients (p&gt;0.05). On index date, 81% of WHFE cohort patients were on beta blocker (BB), 55% on ACEI/ARB/ARNI, and 18% on MRA ( Figure, Panel A ) while 75%, 66%, and 22%, respectively, in the control cohort ( Figure, Panel B ). In both the WHFE and control cohorts, use of BB and ACEI/ARB/ARNI decreased while patients without any GDMT increased in the 12 months. The most frequent reason for not changing GDMT was “clinically stable and/or adequate symptom control” ( Figure, Panel C ). The median time to next HF hospitalization or death was 30 and 136 weeks from index date in WHFE and control cohort, respectively (p&lt;0.001). Conclusion: Among US patients with HFrEF, there remain major gaps in use of GDMT and these gaps persist during longitudinal outpatient follow-up. These longitudinal gaps in GDMT are particularly large among the high-risk subset of patients with a recent WHFE.

TREATING CHILDREN IN FOSTER CARE: TRENDS, OVERSIGHT, QUALITY IMPROVEMENT, AND FUTURE DIRECTIONS

Data on very young publicly insured children can inform prescription drug use patterns and the impact of oversight programs. Children in foster care are a particularly vulnerable population as a result of trauma exposure and challenges to access to care. Medicaid claims data show that children in foster care experience higher rates of psychotropic medication use compared to their Medicaid-enrolled peers, and case review data show gaps in use of evidence-based therapies and monitoring response to psychotropic medications.

Implementation of insecticide-treated malaria bed nets in Tanzania: a systematic review

Background Malaria is a significant cause of morbidity, mortality, and economic burden among the Tanzanian population. An effective form of personal protection against malaria is the insecticide-treated bed net (ITN). Although Tanzania has made great efforts to implement ITNs in the general population, gaps in use, access, coverage, and ownership remain. We conducted a systematic review of the available data on the barriers and facilitators to the implementation of ITNs in Tanzania. Methods A comprehensive search was conducted in four databases: OVID Medline, OVID Embase, EBSCO CINAHL, and Web of Science. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to present the review and analysis. Eligible studies were appraised to determine the quality of evidence. Various content data were extracted, including study locations, years of publication, study objectives, and barriers and facilitators to ITNs. The Consolidated Framework for Implementation Research (CFIR) facilitated a thematic analysis of the barriers and facilitators. Results Seven mixed-methods and three qualitative studies met this review’s inclusion criteria. Seven regions and ten districts within Tanzania were represented in this review, most notably the Morogoro region and its respective districts, Kilombero and Ulanga. Study dates ranged from 1995 to 2020. Facilitators of ITN implementation included cost, voucher schemes, involving locals, planning for distribution, and social marketing and communication campaigns. Similarly, barriers to ITN implementation included cost, knowledge and beliefs, a poorly developed private sector, and inadequate distribution methods. Conclusions A systematic review of studies on the implementation of ITNs in Tanzania highlights vital areas in the development of successful implementation that include: (i) the cost of ITNs, (ii) knowledge and beliefs about ITNs among potential users, and (iii) planning for the execution of ITN distribution programs. ITN implementation can be enhanced if national stakeholders invest further in processes that promote ITN procurement, such as voucher schemes, providing education sessions, integrating distribution methods that cater to locals’ preferences, and initiating the promotion of ITN months in advance of their distribution. Registration PROSPERO (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=222128)

Understanding perinatal patient’s health preferences and patient-provider relationships to prevent congenital syphilis in California and Louisiana

BackgroundCongenital syphilis (CS) has reemerged as a global maternal and child health crisis. Kern County, California and East Baton Rouge Parish, Louisiana are among the highest CS morbidity regions in the United States. We previously reported on social-ecological and structural barriers to prenatal care and maternal syphilis testing and treatment in these two regions. The aim of this study was to examine perinatal patient’s health preferences and perceptions of patient-provider relationships in the prenatal care clinic setting.MethodsBetween May 2018 and January 2019 we conducted 20 in-depth qualitative interviews with prenatal providers and 8 focus group discussions with pregnant and postpartum individuals in Kern County and East Baton Rouge Parish. We applied an adapted health services framework to analyze participants’ understanding of health disparities and vulnerable populations; perinatal patient’s health and prenatal care preferences; and participants’ perspectives of clinical encounters in the context of prenatal care and maternal syphilis testing and treatment.ResultsSite-specific determinants of syphilis infection emerged but participants from both locations felt CS prevention efforts should be prioritized among youth, racial/ethnic minority populations, people experiencing socioeconomic limitations and people with other commonly occurring health conditions. Although perinatal patients expressed clear health preferences, they reported inconsistent receipt of respectful, patient-centered care. Inconsistencies were connected with limited ethnic and cultural competence among providers, and implicit, negative attitudes toward patients using substances, experiencing homelessness, or engaging in sex work. Providers clearly aimed to offer high quality prenatal care. However, some clinic and health systems level factors were thought to reduce positive and communicative patient-provider relationships, contributing to gaps in use of prenatal care and syphilis testing and treatment.ConclusionsOur findings suggest that interventions tailored to address setting-specific determinants (including clinic and health system factors) of disparities in CS risk could improve pregnant people’s access to prenatal care and ensure they and their sex partners receive timely syphilis screening and treatment. We recommend all prenatal care providers receive training on how to identify and mitigate implicit biases and provide competent and compassionate patient-centered care.

Physical therapy for temporomandibular disorders: evidence-based improvements and enhancements for diagnosis and management

: The most common oral and maxillofacial disorders treated by physical therapists are temporomandibular disorders (TMD), and rehabilitation strategies continue to evolve with advancements in research and technology. While physical therapy is an evidence-supported approach to the management of TMD, difficulties with referral to and access to appropriately trained physical therapists can create disparity in care for patients. Lack of interdisciplinary collaboration and practice is an ongoing issue, particularly among dentists and physical therapists and this can translate to less than optimal care for individuals with TMD. While dentists and physical therapists may utilize similar diagnostic criteria, implementation gaps in use of consistent diagnostic criteria still exist across both professions. Additionally, possibilities exist for the future expansion of such criteria to recognize the contribution of structures and comorbidities outside of the masticatory system such as the cervical spine and central nervous system changes that can promote the persistence of pain in some individuals with TMD. Pain neuroscience education, epigenetics, and other rehabilitation tools such as virtual reality may allow physical therapists to address the central nervous system changes associated with pain persistence and a fear of movement seen in some individuals with TMD. Applying biomechanical knowledge gained from real-time ultrasound muscle imaging and musculoskeletal modeling will enhance diagnostic management and post-surgical rehabilitation approaches. The purpose of this review paper is to describe novel evidence-based rehabilitative tools or concepts that can be used to improve the diagnosis and management of individuals with TMD. Continued growth and development in research and clinical practice related to TMD will ultimately lead to improved care for individuals with TMD, both conservatively and post-surgically.

Understanding the immigrant-native gap in childcare use: An empirical exploration for 21 European countries

In this contribution, we examine whether and why there is a gap in the use of formal childcare services between immigrant and native families across 21 European countries. We focus on three sets of potential determinants: (1) social class, education and labour market position; (2) immigrant-specific factors such as norms in the region of origin, citizenship acquisition and length of stay in the country of residence; and (3) contextual factors such structural constraints impeding access to childcare and traditional norms on motherhood in the region of origin. Drawing on data from the 2010 ad hoc module of the EU Labour Force Survey, we find evidence for an immigrant-native gap in formal childcare use. Adjusted for social class position, education and maternal employment, immigrant families are less likely to use childcare compared to native families across European countries. However, there are important cross-country differences in the size of this gap. The study also provides evidence for immigrant-specific explanations: acquiring citizenship and staying longer in the country of residence increases the probability to use childcare, while the strength of traditional norms in the region of origin reduces the probability to use childcare. Finally, we find that structural barriers to childcare use negatively affect childcare use for both native and immigrant families. Removing barriers to childcare use in terms of availability and affordability will benefit everyone.

Patients and physicians' attitudes change on fecal microbiota transplantation for inflammatory bowel disease over the past 3 years.

BackgroundIn the past 3 years, increasing data and experience has become available regarding fecal microbiota transplantation (FMT) for the treatment of inflammatory bowel disease (IBD). However, how this increase in knowledge has impacted the attitudes of patients and physicians is largely unknown. This study aimed to investigate the change of patients’ and physicians’ attitudes towards FMT for IBD treatment.MethodsQuestionnaires for patient and physician attitude on FMT for IBD were pilot-tested and developed. Patients and physicians from the same groups completed the questionnaires in 2016 and 2019, separately. The attitudes towards efficacy, adverse events, and methodological features of FMT in 2016 were compared with those in 2019.ResultsA total of 1,255 questionnaires from 486 patients and 769 physicians were collected. Over the 3 years, an increased number of patients had heard of FMT and had similarly positive opinions towards using FMT for IBD therapy. Additionally, patients retained the tendency to overestimate the efficacy. The physicians’ perceptions became closer to the findings reported in recent studies in 2019 compared with 2016. However, only a minority of patients and physicians understood the frequency required of FMT courses for induction of clinical remission. In particular, both patients and physicians underestimated the risk of mild adverse events and IBD flare.ConclusionsPatients are receptive towards FMT as therapy for IBD but opportunity remains to improve understanding of benefit and potential risks. Physicians also demonstrated knowledge gaps in use of this therapy. Aligning patient preference and physician knowledge gap will lead to better education and facilitate the development of decision-making guidelines.

Feasibility study of a health coaching intervention to improve contraceptive continuation in adolescent and young adult women in Philadelphia, Pennsylvania.

Few interventions to improve contraceptive continuation are tailored to meet the developmental needs of young women under age 25 years. The Health Coaching for Contraceptive Continuation (HC3) intervention was designed to address this gap. In this special report, we describe the rationale for using health coaching, conceptual framework, intervention processes, and findings from a single-arm feasibility study of the intervention protocol. Health coaching is a person-centered behavioral change approach organized around five main strategies: providing education relevant to health goals, building health self-management skills, offering patient-centered counseling, identifying barriers to adherence, and fostering personal accountability for achieving health goals. We used these strategies to affect theory-driven mediators delineated in the Integrative Model of Behavioral Prediction (intentions, knowledge, attitudes, perceived social norms, and self-efficacy) and clinical mediators posited to change through program participation (shared contraceptive decision-making, method satisfaction, quality of life, distress tolerance, experiential avoidance, patient-coach alliance, and expectations of treatment effect). Experienced sexual health educators completed a manualized, 4-week health training program adapted from the National Society of Health Coaches. Between March and December 2017, we recruited a convenience sample of sexually-active women ages 14-21 years who initiated a new contraceptive in the prior 14 days from three urban pediatric clinics in Philadelphia, Pennsylvania. At baseline, participants completed a socio-demographic questionnaire, contraceptive needs assessment interview, and prioritized reproductive topics to learn more about. We synthesized these data into a coaching plan that guided the monthly coaching sessions which occurred for 6 months following contraceptive initiation. We assessed method adherence and continuation with monthly follow-up questionnaires and corroborated the findings through electronic medical record and pharmacy refill data review. Exit interviews assessed program acceptability. Feasibility outcomes measured throughout the protocol administration included recruitment and retention success. We used descriptive statistics to assess baseline and follow up questionnaire measures and audio-recorded and transcribed exit interviews verbatim. Two independent coders used deductive and inductive content analysis coding approaches to identify themes related to program acceptability. Of 92 women approached for the longitudinal intervention, 33 enrolled. Participants' mean age was 17.4 ± 2.1 years. Most were Black (n=24), in high school (n=23), and single/never-married (n=31). Twenty-one completed ≥4 coaching sessions. Among the 23 for whom 6-month contraceptive continuation could be determined, 20 continued their baseline method, 2 switched methods without a gap in use, and 1 discontinued contraceptive use. Five were lost to follow up after enrollment; continuation status was indeterminant for the remaining five. Among the 22 who completed exit interviews, all expressed high program acceptability citing that it provided knowledge-based benefits, nonknowledge-based benefits, and an opportunity to develop a positive, supportive relationship with a reproductive health expert. Participants provided feedback on logistical aspects of the program they enjoyed and made suggestions for improvements prior to embarking on a larger efficacy trial. Health coaching is a new approach for promoting contraceptive continuation in young women. The conceptual framework, program structure, and feasibility findings demonstrate strong support for the program among participants. Subsequent research must explore program effects on contraceptive continuation and prevention of unintended pregnancy.