Global Health Measures Research Articles

The Mental Health of Refugees and Forcibly Displaced People: A Narrative Review

BACKGROUND: One of the pressing global issues today is the matter of refugees and forcibly displaced people migration. Refugee or forcibly displaced status has a significant impact on a person's mental health, with a high risk of developing depression, anxiety, post-traumatic stress disorder and psychotic disorders. AIM: To conduct a literature review and evaluate the mental health status of refugees and forcibly displaced people due to military action METHODS: The search of literature was conducted without any restrictions on the publication date, with a focus on articles from the past two decades. The search was conducted in the Google Scholar and PubMed databases using the following keywords and phrases: “migration”, “migrants”, “refugees”, “forcibly displaced people”, “mental health”, “mental disorder”, “psychiatric disorders”. This analysis included studies that discussed and evaluated the social, psychological, and clinical aspects of migration. The review included original research and meta-analyses published in English, Russian, and Spanish. Descriptive analysis was applied to summarize the results. RESULTS: The literature review showed that global migration levels have reached a high point, and this trend continues due to the existing geopolitical conditions. Even limited and difficult-to-compare epidemiological data demonstrate that more than a quarter of migrants suffer from mental disorders. These primarily include depression, anxiety, and post-traumatic stress disorders. Apart from creating and exacerbating problems for the refugees and forcibly displaced people themselves, they also pose serious challenges to the social services and healthcare systems of refugee-hosting countries. The literature review demonstrated that forced displacement plays a role in the development of mental disorders, and also emphasizes the significance of several associated factors. CONCLUSION: This review emphasizes the urgent need for standardizing screening methods for refugees and forcibly displaced people, creating unified approaches to diagnostic evaluation, as well as specialized training for mental health professionals. Large-scale programs are needed to support and implement sustainable global mental health measures in the countries affected by hostilities.

Association that Neuroimaging and Clinical Measures Have with Change in Arm Impairment in a Phase 3 Stroke Recovery Trial.

Vagus nerve stimulation (VNS) paired with rehabilitation therapy improved motor status compared to rehabilitation alone in the phase III VNS-REHAB stroke trial, but treatment response was variable and not associated with any clinical measures acquired at baseline, such as age or side of paresis. We hypothesized that neuroimaging measures would be associated with treatment-related gains, examining performance of regional injury measures versus global brain health measures in parallel with clinical measures. Baseline magnetic resonance imaging (MRI) scans in the VNS-REHAB trial were used to derive regional injury measures (extent of injury to corticospinal tract, the primary regional measure; plus extent of injury to precentral gyrus and postcentral gyrus; lesion volume; and lesion topography) and global brain health measures (degree of white matter hyperintensities, the primary global brain measure; plus volumes of cerebrospinal fluid, cortical gray matter, white matter, each thalamus, and total brain). Eight clinical measures assessed at baseline were also evaluated (treatment group, age, race, gender, paretic side, pre-stroke dominant hand, time since stroke, and baseline Fugl-Meyer upper extremity score). Bivariate analyses compared each measure with the primary trial end point (change in Fugl-Meyer upper extremity score from baseline to end of 6 weeks of treatment) across all subjects, with secondary analyses examining trial groups separately. MRIs were available from 80 patients (age = 59.8 ± 9.5 years, 29 women). Across all patients, less white matter hyperintensities (r = -0.25, p = 0.028) at baseline was associated with larger Fugl-Meyer score change. In the VNS group, less white matter hyperintensities (r = -0.37, p = 0.018) and larger ipsilesional thalamus volume (r = 0.33, p = 0.046) were each associated with larger Fugl-Meyer score change. Analysis of covariance (ANCOVA) analyses tested the interaction that each baseline measure had with treatment group and found that the model examining white matter hyperintensities had a significant interaction term, indicating 2.3 less change in Fugl-Meyer Upper Extremity (FM-UE) points in the VNS group relative to the control group for each point increase in modified Fazekas scale. Neuroimaging measures are associated with extent of gains on the primary endpoint of a phase III stroke recovery trial. Among the neuroimaging measures examined, a measure of global brain health (extent of white matter hyperintensities) was better at explaining the change in arm impairment as compared with measures of regional injury; this was true when examining all study subjects as well as only those in the VNS group and is consistent with the global mechanism of action that VNS has throughout the cerebrum. Future studies can evaluate additional measures that further predict response to VNS therapy. The current findings suggest that individual patient neuroimaging results may be useful for a personalized medicine approach to stroke recovery therapeutics. ANN NEUROL 2024.

Monkeypox 2024 outbreak: Fifty essential questions and answers.

As the world still vividly recalls the previous monkeypox (mpox) outbreak that impacted over 120 countries worldwide with more than 99,000 cases in 2022, we are now facing a second wave of infections from the monkeypox virus (MPXV), characterized by an exponential increase in cases. The current 2024 outbreak has already recorded more than 20,000 cases in Africa, marking a dramatic escalation compared to previous outbreaks. The predominance of the newly identified clade Ib variant, first detected in the Democratic Republic of the Congo (DRC) and now identified across multiple African nations and beyond, underscores its enhanced transmissibility and potential for international spread, evidenced by cases in Sweden and Thailand. The World Health Organization (WHO) declared on August 14, 2024, the current mpox outbreak a Public Health Emergency of International Concern (PHEIC), calling for heightened global public health measures. The ongoing pattern of unusual, frequent, and extensive outbreaks of mpox with potential global implications poses significant questions. This review addresses, in the format of 50 questions and answers, the 2024 mpox outbreak, detailing its characteristics, epidemiological data, and impact compared to previous outbreaks. It comprehensively explores critical questions related to MPXV virological characteristics, immunological response, clinical manifestations, epidemiology, diagnostics, and available treatments. The review also documents the significant and evolving challenges posed by the current mpox outbreak, highlighting its scale, spread, and public health response.

Validity of a single-item indicator of treatment side effect bother in patients with head and neck cancer.

Patients with head/neck squamous cell carcinomas (HNSCC) experience significant tumor- and treatment-related side effects. No efficient summary measure capturing the totality of side effect burdencurrently exists. We examined associations between a single patient-reported outcome (PRO) item evaluating side effect bother (FACT GP5, "I am bothered by side effects of treatment") with overall side effects in HNSCC. We performed a retrospective secondary analysis of development of the Functional Assessment of Cancer Therapy (FACT) Head/Neck Symptom Index (FHNSI-10), which included completing FACT-HN (including Head/Neck Cancer Subscale (HNCS) and Trial Outcome Index (TOI)) and the pain intensity numeric rating scale (NRS). We calculated Spearman's correlations between GP5 and these measures of patient-reported global health, head/neck side effects, and pain intensity NRS. A correlation of > 0.4 was considered sufficient evidence of association. Ninety-seven patients completed baseline and 85 completed 3-month follow-up surveys. GP5 was highly correlated with FACT-HN total score (baseline r = 0.66, 3months r = 0.67) and FHNSI-10 (baseline r = 0.63, 3months r = 0.65). GP5 correlated with multiple FACT-HN subscales including FACT-G, physical well-being, functional well-being, HNCS, and TOI (range baseline r = 0.53-0.77, range 3months r = 0.49-0.77). Worsening GP5 score was associated with worsening overall HNCS (p = 0.002), worsening FHNSI-10 score (p < 0.001), and worsening mean pain intensity (p < 0.001). GP5 exhibited validity within HNSCC, exhibiting substantial correlations with a number of HNSCC-related PRO measures including FACT-HN and FHNSI-10. Worsening GP5 was associated with worsening HNCS, FHNSI summary score, and pain intensity. GP5 has promise as a summary indicator of symptom and side effect bother in HNSCC.

Psychometric validation of the Patient-Reported Outcomes Measurement Information System Global Health Scale for people with multiple sclerosis.

The coronavirus disease 2019 pandemic and postpandemic era have significantly impacted the physical, mental, and social health (global health) of people with multiple sclerosis (MS). Extensive evidence highlights the positive relationships among global health, employment, and subjective well-being. For rehabilitation psychologists and health professionals serving individuals with MS, it is crucial to incorporate a global health measure into their assessment toolkit. The Patient-Reported Outcomes Measurement Information System Global Health (PROMIS©GH) Scale is widely used and validated for diverse patient populations worldwide. However, there is no study that validates the PROMIS©GH for people with MS. We conducted an exploratory factor analysis with a sample of U.S. adults with MS (N = 495) to examine the measurement structure of the PROMIS©GH. Exploratory factor analysis results indicated a two-factor measurement structure (physical health and mental-social health) that accounted for 67.80% of the total variance. All items loaded highly onto their respective factors (ranging from 0.59 to 0.93). The Cronbach's α of the two subscales was .85 and .86, which is high for very brief measures. The two factors were significantly and positively associated with employment, subjective well-being, resilience, core self-evaluations, and social support, and negatively associated with stress and depression in the theoretically expected directions, supporting its construct validity. The findings of this study indicated that PROMIS©GH is a psychometrically sound global health measure for people with MS and should be included as a health assessment tool for rehabilitation psychologists and health professionals who provide services to people with MS. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

‘Nyungu’: an indigenous healing practice for decolonising the global health measures of COVID-19 in Tanzania

During the COVID-19 outbreak – a paradigmatic global health challenge – multiple African countries, including Tanzania, mobilised indigenous forms of healing as both preventive and curative measures to curb the pandemic. However, despite this effort to curtail the crisis, the place of indigenous medical knowledge in decolonising global health interventions remains unexamined. Drawing on ethnographic fieldwork in Tanzania, as well as political speeches and newspaper sources, this paper examines how the government, under the late President John Pombe Magufuli, responded to the COVID-19 pandemic. The paper demonstrates that the late Magufuli’s approach to the pandemic, and especially the mobilisation of local practices of self-care like steaming with nyungu, stirred debates on decolonising global health and the role of African traditional medicines in the COVID-19 pandemic response. Building on scholarship regarding the efforts to promote indigenous healing knowledge in postcolonial states in Africa, I argue that colonial history and postcolonial political positionings towards this history were the ‘cause’ for Magufuli’s resistance towards global health interventions of COVID-19 in Tanzania. This draws our attention to the possibility of new thinking when it comes to how global health, colonialism, national politics, and local practices of self-care like nyungu, interact with one another in contemporary Tanzania.

Further Evidence of Feasibility, Validity, and Reliability of Quality of Life-Aged Care Consumers: Evidence From Home-Based Care Settings

ObjectivesThe Quality of Life-Aged Care Consumers (QOL-ACC) is an aged-care-specific preference-based instrument currently being rolled out in residential care across Australia as part of the aged care Quality Indicator program. This study aimed to provide a comprehensive assessment of the feasibility, reliability, and construct validity of the QOL-ACC in a large national sample of older adults receiving aged care services at home. MethodsOlder adults receiving in-home aged care services completed a survey including the QOL-ACC, Quality of Care Experience-ACC, adult social care outcome tool, EQ-5D-5L, and 2 global single item measures of health and quality of life. Feasibility was assessed by missing responses (≤5%) and ceiling/floor effects (≤15%). Construct validity was assessed by exploring the relationship between the QOL-ACC and other instruments (convergent validity) and its ability to discriminate varying levels of self-rated health and quality of life (known-group validity). ResultsA total of 802 respondents (mean age, 74.5 ± 6.3 years; 56.0% females) completed the survey. The QOL-ACC had no missing responses, no floor effects, and very low ceiling effect (3.5%) and demonstrated moderate correlation with adult social care outcome tool (r = 0.59, P < .001), EQ-5D-5L (r = 0.65, P < .001), EQ-VAS (r = 0.53, P < .001), and a lower correlation with the QCE-ACC (r = 0.41, P < .001). Respondents with poor self-rated health and quality of life had significantly lower preference-weighted scores on the QOL-ACC. ConclusionsThe QOL-ACC demonstrated adequate feasibility, reliability, and construct validity in a large population of older people accessing government-subsidized aged care services at home. Further studies will explore the responsiveness of the QOL-ACC to aged-care-specific interventions both in home and residential aged care settings.

Mental and Physical Health Comorbidities in Traumatic Brain Injury: A Non-TBI Controls Comparison

ObjectiveTo examine whether aging with a TBI was associated with a greater burden of health-related comorbidities compared with a non-TBI control cohort and examine the associations between comorbidity burden, emotional outcomes, and health-related quality of life (HRQoL) after TBI across ages. DesignCross-sectional. SettingResearch center or telephone. ParticipantsThe study included 559 participants (NTBI=291, NControls=268). Participants with TBI were recruited during inpatient rehabilitation and had sustained a moderate-severe TBI 1-33 years previously. Non-TBI controls were a convenience sample recruited through advertisements in the community. InterventionsNot applicable. Main Outcome MeasuresThe number of cardiovascular, general physical health, and mental health comorbidities was compared between cohorts and age strata using Poisson regression. The relationships between comorbidities, age, emotional outcomes (Generalized Anxiety Disorder Scale-7, Patient Health Questionnaire-9), and HRQoL (PROMIS Global Health Measure) were examined with linear regression. Distinct subgroups of comorbidities were identified using latent class analysis. Associations between comorbidity classes with demographic and outcome variables were evaluated using multinomial logistic and linear regressions, respectively. ResultsTBI participants had a significantly higher comorbidity burden than controls, primarily driven by elevated rates of mental health disorders (RR=2.71, 95% confidence interval [1.37, 5.35]). Cardiovascular and physical health comorbidities were not elevated in the TBI group compared with controls. Both cohorts had 3 similar comorbidity subgroups, suggesting consistent patterns of co-occurring health conditions regardless of TBI exposure. Physical and mental health comorbidities were associated with elevated depression and anxiety symptoms and diminished HRQoL after TBI compared with controls. ConclusionTBI was associated with greater mental, but not physical, health comorbidities in the decades after injury. However, physical and mental health comorbidities significantly affected emotional and HRQoL status after TBI, underscoring a greater need for long-term support for individuals with TBI coping with both physical and mental health comorbidities.

Overview of Emerging Viruses, Other Viruses and Great Pandemic of the 21st Century

The 21st century witnessed the emergence of pivotal viral outbreaks, shaping global health and demanding robust responses. Severe Acute Respiratory Syndrome (SARS), Influenza H1N1 pdm 2009 (swine flu), Middle East Respiratory Syndrome (MERS), and the unprecedented COVID-19 pandemic reshaped public health strategies, emphasizing international collaboration and preparedness. Alongside these major pandemics, viruses like Ebola, Zika, Chikungunya, and Dengue garnered attention due to their significant impacts. Each virus posed unique challenges, affecting diverse regions and populations globally. Understanding their origins, transmission, symptoms, impacts, and control measures has been crucial. These outbreaks underscored the necessity for proactive global health measures, highlighting the interconnectedness of healthcare systems and the imperative for coordinated responses to mitigate the effects of emerging infectious diseases, shaping a new paradigm for future preparedness and response strategies.

May Artificial Intelligence take health and sustainability on a honeymoon? Towards green technologies for multidimensional health and environmental justice

ABSTRACT The application of Artificial Intelligence (AI) in healthcare and epidemiology undoubtedly has many benefits for the population. However, due to its environmental impact, the use of AI can produce social inequalities and long-term environmental damages that may not be thoroughly contemplated. In this paper, we propose to consider the impacts of AI applications in medical care from the One Health paradigm and long-term global health. From health and environmental justice, rather than settling for a short and fleeting green honeymoon between health and sustainability caused by AI, it should aim for a lasting marriage. To this end, we conclude by proposing that, in the upcoming years, it could be valuable and necessary to promote more interconnected health, call for environmental cost transparency, and increase green responsibility. Highlights Using AI in medicine and epidemiology has some benefits in the short term. AI usage may cause social inequalities and environmental damage in the long term. Health justice should be rethought from the One Health perspective. Going beyond anthropocentric and myopic cost–benefit analysis would expand health justice to include an environmental dimension. Greening AI would help to reconcile public and global health measures.

Assessing the interchangeability of linked scores in multivariable statistical analyses.

Using the lens of classical test theory, we examine a linkage's generalizability with respect to use in multivariable analyses, including multiple regression and structural equation modeling, rather than comparison of established subpopulations as is most common in the literature. To aid in this evaluation, we present a structural-equation-modeling based statistical method to examine the suitability of a given linkage for use cases involving continuous and categorical variables external to the linkage itself. Using the PROMIS® Parent Proxy and Early Childhood Global Health measures, we show that, although a high correlation between the scores (here, r = .829) may imply a general suitability for linking, a more detailed investigation of content, measurement structure, and results of the proposed methodology reveal important differences between the measures which can compromise interchangeability in certain use cases. In addition to the statistical quality of a linkage, users of linking methodology should also assess the question of whether the linkage is appropriate to apply to particular use cases of interest.

Mapping of the PROMIS global health measure to the PROPr in the United States

BackgroundThe Patient-Reported Outcomes Measurement and Information System (PROMIS®) global health items (global-10) yield physical and mental health scale scores and the PROMIS-Preference (PROPr) scoring system estimated from PROMIS domain scores (e.g., PROMIS-29 + 2) produces a single score anchored by 0 (dead or as bad as being dead) to 1 (full health). A link between the PROMIS global-10 and the PROPr is needed.MethodsThe PROMIS-29 + 2 and the PROMIS global-10 were administered to 4102 adults in the Ipsos KnowledgePanel in 2022. The median age was 52 (range 18–94), 50% were female, 70% were non-Hispanic White, and 64% were married or living with a partner. The highest level of education completed for 26% of the sample was a high school degree or general education diploma and 44% worked full-time. We estimated correlations of the PROPr with the PROMIS global health items and the global physical and mental health scales. We examined the adjusted R2 and estimated correlations between predicted and observed PROPr scores.ResultsProduct-moment correlations between the PROMIS global health items and the PROPr ranged from 0.50 to 0.63. The PROMIS global physical health and mental health scale scores correlated 0.74 and 0.60, respectively, with the PROPr. The adjusted R2 in the regression of the PROPr on the PROMIS global health items was 64%. The equated PROPr preference scores correlated (product-moment) 0.80 (n = 4043; p < 0.0001) with the observed PROPr preference scores, and the intra-class correlation (two-way random effects model) was 0.80. The normalized mean absolute error (NMAE) was 0.45 (SD = 0.43). The adjusted R2 in the OLS regression of the PROPr on the PROMIS global health scales was 59%. The equated PROPr preference scores correlated (product-moment) was 0.77 (n = 4046; p < 0.0001) with the observed PROPr preference scores, and the intra-class correlation was 0.77. The NMAE was 0.49 (SD = 0.45).ConclusionsRegression equations provide a reasonably accurate estimate of the PROPr preference-based score from the PROMIS global health items or scales for group-level comparisons. These estimates facilitate cost-effectiveness research and meta-analyses. The estimated PROPr scores are not accurate enough for individual-level applications. Future evaluations of the prediction equations are needed.

Evolving trends in neuropsychological profiles of post COVID-19 condition: A 1-year follow-up in individuals with cognitive complaints.

Cognitive difficulties are reported as lasting sequelae within post COVID-19 condition. However, the chronicity of these difficulties and related factors of fatigue, mood, and perceived health have yet to be fully determined. To address this, the current longitudinal study aimed to clarify the trends of cognitive test performance and cognitive domain impairment following COVID-19 onset, and whether hospitalization influences outcomes. 57 participants who reported subjective cognitive difficulties after confirmed COVID-19 infection were assessed at baseline (~6 months post COVID-19) and follow-up (~15 months later) visits. Assessments included measures across multiple cognitive domains and self-report questionnaires of fatigue, mood, and overall health. Analyses were conducted in three stages: at the test score level (raw and adjusted scores), at the cognitive domain level, and stratified by hospitalization status during infection. Results at the test-score level indicate that cognitive performance remains relatively stable across assessments at the group level, with no significant improvements in any adjusted test scores at follow-up. Cognitive domain analyses indicate significant reductions in attention and executive functioning impairment, while memory impairment is slower to resolve. On self-report measures, there was a significant improvement in overall health ratings at follow-up. Finally, those hospitalized during infection performed worse on timed cognitive measures across visits and accounted for a larger proportion of cases with short-term and working memory impairment at follow-up. Overall, our findings indicate that cognitive difficulties persist both at test score and cognitive domain levels in many cases of post COVID-19 condition, but evidence suggests some improvement in global measures of attention, executive functioning and overall self-rated health. Furthermore, an effect of hospitalization on cognitive symptoms post COVID-19 may be more discernible over time.

Side effects of AZD 1222 COVISHIELD vaccine among front-line health care workers in a tertiary care hospital: A descriptive cross-sectional study

Introduction: Coronavirus disease vaccination has been accepted as a global health measure to prevent severity,transmission and mortality. Vaccine frequently cause adverse effects which is supposed to be due to protective immune response induced by the vaccine. The study aimed to find out the prevalence of side effects of first dose of AZD 1222 COVISHIELD vaccine among front line health care workers receiving vaccination in a tertiary care hospital. Methods: This was a descriptive cross-sectional study among front line health workers who received the first dose of COVISHIELD vaccine. The study was conducted from February 2021 to March 2021 in a tertiary care hospital after receiving ethical approval from the Institutional Review Committee. Convenience sampling was used for data collection and data was analyzed using SPSS version 17 was used for analysis. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Among 629 participants, 344(54.7%) participants reported one or other side effects following vaccination. The major side effects reported were fever 152(19.6%), myalgia 144(22.9%), pain at injection site 123(19.6%), headache 75(11.9%) and in one reactivation of Herpes Zoster. Conclusions: After the first dose of COVISHIELD vaccine, mild symptoms were seen which resolved within few days. Some cases of reactivation of Herpes Zoster was found. The adverse effects were seen more in patients who had history of COVID-19 infection.

Factors Affecting Food-Related Activity Performance in Low-Income Older Adults

In an effort to reduce food access issues for older adults, the United States Department of Agriculture’s (USDA) Commodity Supplemental Food Program (CSFP) provides monthly food assistance specifically for low-income older adults through local food banks. The purpose of this study was to explore factors that influence an older adult’s performance in food-related activities. Older adults eligible to receive a monthly senior food box from community food distribution sites were recruited to complete a survey. The survey included home information, Patient-Reported Outcomes Measurement Information Systems (PROMIS®) v1.1 Global Health measure, individualized supplemental food utilization profile (FP), and a kitchen inventory. Descriptive and statistical analyses were performed. From December 2021 until March 2023, n = 200 participants were recruited and n = 36 took the survey for an 18% completion rate with a mean age of 71 years old; 61% were female and 36% were male. Of the participants who took the survey, 64% ( n = 23) acknowledged having at least one chronic disease and 89% ( n = 32) indicated they prepared meals for themselves. The OPMF revealed grocery shopping, cooking, and eating as “extremely important” and directly related to their performance and satisfaction. The FP rate revealed that 61% ( n = 22) of participants always use 100% of their food box by the end of each month. While the participants in this study report having at least one chronic disease, most are functional and independent when it comes to food-related activities, and most report that they have the tools to manage and use their food resources.

Role of Menstrual Bleeding Assessments in Sickle Cell Clinics in Improving Quality of Care for Women- a Multicenter Approach

Introduction: Reproductive health education is lacking among individuals with sickle cell disease (SCD) despite many females reporting increased pain during menstruation. Research suggests that SCD-related pain associated with menstruation may be regulated with the use of hormonal therapy. Yet, education about safe and available contraceptive therapies is often lacking during routine sickle cell visits, leading to increased pain-related healthcare utilization and suboptimal management of menses and contraception. In this prospective cross-sectional study, we hypothesized that menstrual bleeding assessments, in the form of surveys conducted during sickle cell clinic visits would prompt timely identification and management of menstruation complications in females with SCD. Methods: The study was primarily conducted by members of the Foundation for Women &amp; Girls with Blood Disorders' Women &amp; Girls SCD Learning Action Network (WGSCD LAN) and Pacific Sickle Cell Regional Collaborative (PSCRC). The menstrual bleeding assessment consisted of 4 surveys; a patient survey and provider survey both created by the WGSCD LAN, a validated menstrual bleeding questionnaire (MBQ) and a validated measure of global health from the Patient Reported Outcomes Measurement Information System (PROMIS). The patient survey included questions about the patients' experience with sickle cell pain in relation to menstruation, medications being used, their education, access to, and utilization of reproductive health services. The provider survey was completed after the provider reviewed the patient MBQ and surveys and included questions about the providers' access to reproductive health services, the patients' medical data, and the providers' plans of care for that patient. Sickle cell centers across the U.S. were recruited to participate through the WGSCD LAN and the PSCRC. Consented females who reached menarche for &amp;gt;12 months, had menses in the past 12 months, and were not pregnant or breastfeeding were requested to complete the patient, MBQ and PROMIS surveys by their sickle cell providers. For every patient survey filled, provider surveys were encouraged but not required. Results: After IRB approval at 9 U.S. sickle cell centers, 6 institutions enrolled 56 females with SCD for the MBQs and patient surveys, with 45 (80%) provider surveys and 32 (57%) short PROMIS surveys completed. Most patients had hemoglobin SS disease (71%). Thirty-six (64%) females were ≥ 18 years old (range 18-48 years), and 20 (36%) were 13-17 years old. Mean MBQ score for adults with SCD was 17.3 (SD 9.6) (mean validated score 10.8,SD 8.8) and for adolescents with SCD was 16.1 (SD 7.5) (mean validated score 19.6, SD 7.6). Thirty-five (63%) females reported sickle cell pain with menstrual cycles. Despite this, only 7 females (12.5%) reported using one or more hormonal therapies in the 3 months prior, including oral contraceptives (n= 4), Depo injections (n =5), and/or an intrauterine device (IUD) (n =1). Only one female reported using condoms. Most sickle cell providers (38/45) were not prescribing hormonal therapies to their patients, however, all providers reported having access to reproductive health specialists in their institutions. Seven females reported not having heard of hormonal therapy, including 3 females &amp;gt;18 years of age. NSAID use of ≥5 days in a 2-week period was reported by 22% of females (12/54). In the PROMIS survey, only 28% females reported very good to excellent physical health and only 47% reported very good to excellent mental health. After review of MBQ, PROMIS and patient surveys, provider surveys (n = 32) noted intent to or provision of one or more of these services: verbal education about hormonal therapy by 25 (66%) providers, referral to a reproductive health specialist by 14 providers (37%), work-up for iron deficiency by 6 providers (22.2%), and work up for bleeding disorders by 4 providers (14.8%). Conclusion: Patient reportedsickle cell pain with menstruation is quite prevalent, but hormonal therapy use is minimal despite availability of reproductive health specialists in most U.S. sickle cell centers. Menstrual bleeding assessments in the sickle cell clinic can facilitate a dialogue and recognition of reproductive health concerns among females with SCD and enhance medical attention and care from hematologists and reproductive health specialists in collaborative models of care.

Incorporating routine mental health assessment into survivorship.

350 Background: Cancer survivors experience higher rates of mental health (MH) symptoms including anxiety and depression compared to the general population. To address this in our longitudinal survivorship clinic, the Patient-Reported Outcome Measurement Information System (PROMIS) Global health measure is routinely administered and reviewed at point-of-care with psychosocial status incorporated in survivorship care (SC) plans. The uncertainly and social isolation that occurred during the COVID-19 pandemic increased the risk of adverse MH outcomes. This study examines PROMIS Global MH subscale scores and discussions of MH prior to, during and following the pandemic. Methods: Patients who had at least one SC visit and a completed PROMIS-Global measure within 22 months prior to and after the Massachusetts COVID-19 state of emergency (SoE) (March 20, 2020-June 15, 2021) were evaluated. MH subscale scores were calculated using scoring algorithms. A paired t-test was used to compare scores from each time period. Patient characteristics were summarized from the clinic’s database. Clinician notes were analyzed to determine if MH discussions occurred. Results: All 41 patients had been diagnosed during childhood, adolescence, or young adulthood (median age of 12 years, range 0-36), with a median current age of 31 years (range 19-54). 61% were diagnosed with leukemia or lymphoma, 66% were female, 80% were White. Patients had been in the clinic from 0-7 years, with 15% of the initial visits occurring within the pre-SOE period. At time of entry into clinic 73% had a known late effect, 32% had a comorbidity and 29% had a known MH disorder. At some point in their SC, 41% of patients had been encouraged to pursue MH care. During the SoE, those with MH concerns were triaged for outreach; 78% of patients received virtual and/or in-person visits; PROMIS was not collected during virtual visits. Mean PROMIS-Global MH subscale scores were not statistically different by time period: 49.9 mean (9.3SD) pre vs 48.3 mean (10.1SD) post SoE (p=0.10) and did not differ from population norms. MH discussions occurred prior to (54%), during (53%) and following (49%) the SoE. Conclusions: Despite the additional barriers to providing care brought on by the pandemic, the MH tools in place supported quick identification of patients at risk and ongoing MH discussions. Consistent inclusion of MH assessment into SC should be encouraged as part of ongoing quality care, not only in response to the pandemic.

Contributions ofdeclining mortality, overall andfrom HIV, TB andmalaria, to reduced health inequality andinequity across countries.

The objective to reduce global health inequalities and inequities is integral to the global development agenda, from the Universal Declaration of Human Rights to the sustainable development goals and the ongoing response to coronavirus disease. Yet, summary measures of global health gains or of the cost-effectiveness of global health programmes barely capture how well they improve the lives of the most disadvantaged populations. This paper instead explores the distribution of global health gains across countries and the implications for health inequality and inequity (here referring to health disadvantages that reinforce economic disadvantage, and vice versa) across countries. Specifically, it studies the distribution of gains in life expectancy across countries (overall and owing to reduced mortality from HIV, TB and malaria), using the Gini index and a concentration index ranking countries by gross domestic product (GDP) per capita as indicators of health inequality and inequity. By these counts, global inequality in life expectancy across countries declined by one-third between 2002 and 2019. Reduced mortality from HIV, TB and malaria accounted for one-half of this decline. Fifteen countries in sub-Saharan Africa, containing 5% of the global population, accounted for 40% of the global decline in inequality, with nearly six-tenth of this contribution coming from HIV, TB and malaria. Inequity in life expectancy across countries declined by nearly 37%, with a contribution from HIV, TB and malaria of 39% of this gain. Our findings show how simple indicators on the distribution of health gains across countries usefully complement aggregate measures of global health gains and underscore their positive contribution to the global development agenda.

Global health measures from a National Down Syndrome Registry.

People with Down syndrome (DS) have a unique medical profile which may impact views of health. We aimed to study the use of global health measures for DS in a national cohort. We prospectively surveyed parents of individuals with DS from the DS-Connect® registry with validated Patient Reported Outcomes Measurement Information System (PROMIS)® instruments of global health. Analyses included use of scoring manuals and the PROMIS® scoring service, descriptive statistics, and t-tests. We received completed surveys from 223 parents of individuals with DS; previously published limitations of the instrument in this population were shown again. T-scores differed from the available comparative standardized scores to these measures from PROMIS® reference population on Fatigue (p < 0.001) and Global Health (p < 0.001), but not on Pain Interference (p = 0.41).

An appraisal of peer-reviewed published literature on Influenza, 2000-2021 from countries in South-East Asia Region.

Influenza poses a major public health challenge in South-East Asia Region (SEAR). To address the challenge, there is a need to generate contextual evidence that could inform policy makers and program managers for response preparedness and impact mitigation. The World Health Organization has identified priority areas across five streams for research evidence generation at a global level (WHO Public Health Research Agenda). Stream 1 focuses on research for reducing the risk of emergence, Stream 2 on limiting the spread, Stream 3 on minimizing the impact, Stream 4 on optimizing the treatment and Stream 5 on promoting public health tools and technologies for Influenza. However, evidence generation from SEAR has been arguably low and needs a relook for alignment with priorities. This study aimed to undertake a bibliometric analysis of medical literature on Influenza over the past 21 years to identify gaps in research evidence and for identifying major areas for focusing with a view to provide recommendations to member states and SEAR office for prioritizing avenues for future research. We searched Scopus, PubMed, Embase, and Cochrane databases in August 2021. We identified studies on influenza published from the 11 countries in WHO SEAR in the date range of 1 January 2000-31 December 2021. Data was retrieved, tagged and analyzed based on the WHO priority streams for Influenza, member states, study design and type of research. Bibliometric analysis was done on Vosviewer. We included a total of 1,641 articles (Stream 1: n = 307; Stream 2: n = 516; Stream 3: n = 470; Stream 4: n = 309; Stream 5: n = 227). Maximum number of publications were seen in Stream 2, i.e., limiting the spread of pandemic, zoonotic, and seasonal epidemic influenza which majorly included transmission, spread of virus at global and local levels and public health measures to limit the transmission. The highest number of publications was from India (n = 524) followed by Thailand (n = 407), Indonesia (n = 214) and Bangladesh (n = 158). Bhutan (n = 10), Maldives (n = 1), Democratic People's Republic of Korea (n = 1), and Timor-Leste (n = 3) had the least contribution in Influenza research. The top-most journal was PloS One which had the maximum number of influenza articles (n = 94) published from SEAR countries. Research that generated actionable evidence, i.e., implementation and intervention related topics were less common. Similarly, research on pharmaceutical interventions and on innovations was low. SEAR member states had inconsistent output across the five priority research streams, and there was a much higher scope and need for collaborative research. Basic science research showed declining trends and needed reprioritization. While a priority research agenda has been set for influenza at the global level through the WHO Global Influenza Program since 2009, and subsequently revisited in 2011 and again in 2016-2017, a structured contextualized approach to guide actionable evidence generation activities in SEAR has been lacking. In the backset of the Global Influenza Strategy 2019-2030 and the COVID-19 pandemic, attuning research endeavors in SEAR could help in improved pandemic influenza preparedness planning. There is a need to prioritize contextually relevant research themes within priority streams. Member states must inculcate a culture of within and inter-country collaboration to produce evidence that has regional as well as global value.