Health Information Research Articles

Repurposing as a Decommissioning Strategy for Complex Systems: A Systematic Review

Abstract Managing the waste of decommissioned complex systems (e.g., aircraft, wind turbines, etc.) is a growing issue. In this review, we investigate repurposing as a potential solution. The objectives are to identify strategies that can enable repurposing and identify the research gaps hindering those strategies. We analyzed 104 journal articles published in the last decade. We identified four proactive strategies that can be applied before the decommissioning stage and three reactive strategies that can be applied after the decommissioning stage. The proactive strategies are local ecosystem-focused repurposing, modular design, efficient disassembly methods, and component embedded design and health information. The reactive strategies are decision support methods for repurposable component selection, function and context based repurposing opportunities, and business models for repurposing. Six research gaps were identified, hindering the strategies due to the lack of support methods for repurposing, strategy scope limitations, and repurposing opportunity limitations. We identified that two repurposing examples were most commonly studied (wind turbine blades and electric vehicle batteries). Addressing the research gaps through design could uncover new repurposing opportunities. The resulting opportunities could follow similar processes addressed under the two well-researched examples, enabling repurposing as an advantageous and sustainable decommissioning strategy for complex systems. Keywords: circular economy, sustainability, decommissioning, complex systems, repurposing, literature review

Prevalence of and factors associated with overweight and obesity in patients with severe mental disorders in Shenzhen: results from the urban Chinese population.

To determine the prevalence of overweight and obesity in patients with severe mental disorders (SMD) and the factors associated with their socio-demographic and disease characteristics in a cross-sectional population-based study. This analysis examined the prevalence of overweight and obesity in 14 868 managed SMD patients in an urban area of Shenzhen city based on data from the health information monitoring system in 2021. Multivariate logistic regression were used to identify the factors associated with the prevalence of overweight and obesity in patients with SMD. China. 14 868 patients with SMD. The prevalence of overweight and obesity in patients with SMD in this study was 32·6 % and 16·1 %, respectively. In multivariate analysis, married status, Shenzhen household registration, management durations of 5-10 years and >10 years, participation in family physician services, taking clozapine or aripiprazole, FPG > 6·1 mmol/l, hypertension, TC ≥ 5·2 mmol/l, TG ≥ 1·7 mmol/l, and more frequent follow-ups in the past year were associated with higher odds of overweight and obesity. Compared to their respective reference categories, living with parents, spouse and children, taking risperidone, aripiprazole, amisulpride and perphenazine, FPG > 6·1 mmol/l, hypertension, TC ≥ 5·2 mmol/l, TG ≥ 1·7 mmol/l, and more frequent follow-ups in the past year were associated with higher odds of obesity. We observed a high prevalence of overweight and obesity in patients with SMD in this study. The findings highlight the need for integrated management of overweight and obesity risk factors among patients with SMD.

#TraumaTok—TikTok Videos Relating to Trauma: Content Analysis

Background Experiencing a traumatic event can significantly impact mental and emotional well-being. Social media platforms offer spaces for sharing stories, seeking support, and accessing psychoeducation. TikTok (ByteDance), a rapidly growing social media platform, is increasingly used for advice, validation, and information, although the content of this requires further study. Research is particularly needed to better understand TikTok content relating to trauma and the potential implications for young viewers, considering the distressing nature of the subject and the possibility of users experiencing vicarious trauma through exposure to these videos. Objective This study aims to explore the content of trauma-related videos on TikTok, focusing on hashtags related to trauma. Specifically, this study analyzes how TikTok videos present information, advice, stories, and support relating to trauma. Methods A quantitative cross-sectional descriptive content analysis was performed on TikTok in December 2022. A total of 5 hashtags related to trauma were selected: #trauma, #traumatized, #traumatok, #traumatic, and #traumabond, with the top 50 videos from each hashtag analyzed (total N=250 videos). A standardized codebook was developed inductively to analyze the content of the videos, while an existing generic codebook was used to collect the video features (eg, age of people in the video) and metadata (likes, comments, and shares) for each video. Results A total of 2 major content themes were identified, which were instructional videos (54/250, 21.6%) and videos disclosing personal stories (168/250, 67.3%). The videos garnered significant engagement, with a total of 296.6 million likes, 2.3 million comments, and 4.6 million shares, indicating that users find this content engaging and useful. Alarmingly, only 3.7% (9/250) of videos included a trigger warning, despite many featuring highly distressing stories that young people and those with trauma may be exposed to. Conclusions The study highlights the potential risks of vicarious trauma due to trauma dumping without trigger warnings on TikTok, and the need for further research to assess the accuracy of advice and information in these videos. However, it also underscores the platform’s potential to foster social connections, provide validation, and reduce stigma around mental health issues. Public health professionals should leverage social media to disseminate accurate mental health information, while promoting user education and content moderation to mitigate potential harms. People often use social media, such as TikTok to share advice, stories, and support around mental health, including their experiences with trauma. Out of 250 videos, most were either giving advice (54/250, 21.6%) or sharing personal experiences (168/250, 67.3%). The study found many videos lacked warnings about upsetting content, which could potentially harm young viewers or people suffering from trauma. While TikTok can help people feel connected and reduce the stigma around mental health, it is important to seek support from professionals when needed.

Racial and Demographic Disparities in Susceptibility to Health Misinformation on Social Media: National Survey-Based Analysis.

Social media platforms have transformed the dissemination of health information, allowing for rapid and widespread sharing of content. However, alongside valuable medical knowledge, these platforms have also become channels for the spread of health misinformation, including false claims and misleading advice, which can lead to significant public health risks. Susceptibility to health misinformation varies and is influenced by individuals' cultural, social, and personal backgrounds, further complicating efforts to combat its spread. This study aimed to examine the extent to which individuals report encountering health-related misinformation on social media and to assess how racial, ethnic, and sociodemographic factors influence susceptibility to such misinformation. Data from the Health Information National Trends Survey (HINTS; Cycle 6), conducted by the National Cancer Institute with 5041 US adults between March and November 2022, was used to explore associations between racial and sociodemographic factors (age, gender, race/ethnicity, annual household income, marital status, and location) and susceptibility variables, including encounters with misleading health information on social media, difficulty in assessing information truthfulness, discussions with health providers, and making health decisions based on such information. Over 35.61% (1740/4959) of respondents reported encountering "a lot" of misleading health information on social media, with an additional 45% (2256/4959) reporting seeing "some" amount of health misinformation. Racial disparities were evident in comparison with Whites, with non-Hispanic Black (odds ratio [OR] 0.45, 95% CI 0.33-0.6, P<.01) and Hispanic (OR 0.54, 95% CI 0.41-0.71, P<.01) individuals reporting lower odds of finding deceptive information, while Hispanic (OR 1.68, 95% CI 1.48-1.98, P<.05) and non-Hispanic Asian (OR 1.96, 95% CI 1.21-3.18, P<.01) individuals exhibited higher odds in having difficulties in assessing the veracity of health information found on social media. Hispanic and Asian individuals were more likely to discuss with providers and make health decisions based on social media information. Older adults aged ≥75 years exhibited challenges in assessing health information on social media (OR 0.63, 95% CI 0.43-0.93, P<.01), while younger adults (18-34) showed increased vulnerability to health misinformation. In addition, income levels were linked to higher exposure to health misinformation on social media: individuals with annual household incomes between US $50,000 and US $75,000 (OR 1.74, 95% CI 1.14-2.68, P<.01), and greater than US $75,000 (OR 1.78, 95% CI 1.20-2.66, P<.01) exhibited greater odds, revealing complexities in decision-making and information access. This study highlights the pervasive presence of health misinformation on social media, revealing vulnerabilities across racial, age, and income groups, underscoring the need for tailored interventions.

Developing remote patient monitoring infrastructure using commercially available cloud platforms

Wearable sensor devices for continuous patient monitoring produce a large volume of data, necessitating scalable infrastructures for efficient data processing, management and security, especially concerning Patient Health Information (PHI). Adherence to the Health Insurance Portability and Accountability Act (HIPAA), a legislation that mandates developers and healthcare providers to uphold a set of standards for safeguarding patients’ health information and privacy, further complicates the development of remote patient monitoring within healthcare ecosystems. This paper presents an Internet of Things (IoT) architecture designed for the healthcare sector, utilizing commercial cloud platforms like Microsoft Azure and Amazon Web Services (AWS) to develop HIPAA-compliant health monitoring systems. By leveraging cloud functionalities such as scalability, security, and load balancing, the architecture simplifies the creation of infrastructures adhering to HIPAA standards. The study includes a cost analysis of Azure and AWS infrastructures and evaluates data processing speeds and database query latencies, offering insights into their performance for healthcare applications.

Disparities in Cervical Cancer Knowledge and Trust in Information Sources Among Diverse American Women.

Cervical cancer rates have declined due to prevention and screening, but disparities remain. This study examines how trust and preference in information sources affect knowledge and behaviors, alongside demographic differences to identify health disparities. This study used Health Information National Trends Survey data and employed weighted chi-square tests and multivariate logistic regression to analyze associations between knowledge, behaviors, and demographic differences. The results revealed significant disparities in HPV awareness, with lower awareness among Black (OR, 0.521), Hispanic (OR, 0.398), and Asian (OR, 0.138) women compared to Whites. Age and education also played roles, as older and less-educated women were less informed. Trust in doctors was crucial; women with low trust in doctors (aOR, 0.499; 95% CI, 0.252-0.989) had lower odds of having heard of HPV. Preference for written materials as a primary information source (aOR, 0.312; 95% CI, 0.122-0.793) also correlated with lower HPV awareness compared to preferring information from doctors. Furthermore, women with low trust in charity organizations (aOR, 0.647; 95% CI, 0.461-0.909) were less likely to believe HPV causes cervical cancer, while those who preferred the internet as an information source (aOR, 1.544; 95% CI, 1.026-2.324) had higher odds of having heard of HPV compared to those preferring doctors. Minority populations, older women, and those with lower education levels had significantly lower HPV knowledge. These findings highlight the need for tailored communication, community outreach, policy initiatives, culturally sensitive approaches, digital health interventions, and strategies promoting patient-provider trust to address these disparities.

Effects and Mechanisms of TikTok on Self-Rated Health of Older Adults in China During the COVID-19 Pandemic: A Mediation Analysis

Background/Objectives: During the COVID-19 pandemic, TikTok emerged as a significant app for entertainment and information acquisition for the general public, gradually extending its reach to the older population. Digital technology, exemplified by TikTok, has become an indispensable part of older adults’ lives. However, while prior studies have extensively focused on the impact of internet use on older adults’ health, research on the impact of TikTok during the COVID-19 pandemic remains insufficient. Methods: Utilizing data from the China Family Panel Studies (CFPS) 2020, this study explored the impact of TikTok use on older adults’ self-rated health and its underlying mechanisms through multiple regression and mediation analysis. Results: The study found that (1) TikTok use had a significant positive effect on the self-rated health of older adults; (2) while TikTok use increased the exercise frequency of older adults, exercise frequency did not affect their self-rated health; and (3) TikTok use boosted older adults’ protein intake, contributing substantially to their self-rated health, accounting for 38.7% of the total effect. Conclusions: It is advisable to actively promote the popularity of short video apps such as TikTok among older adults, as they serve as an effective tool for disseminating health information and encouraging healthier lifestyles and behaviors.

Patient Health Record Protection Beyond the Health Insurance Portability and Accountability Act: Mixed Methods Study

Background The security and privacy of health care information are crucial for maintaining the societal value of health care as a public good. However, governance over electronic health care data has proven inefficient, despite robust enforcement efforts. Both federal (HIPAA [Health Insurance Portability and Accountability Act]) and state regulations, along with the ombudsman rule, have not effectively reduced the frequency or impact of data breaches in the US health care system. While legal frameworks have bolstered data security, recent years have seen a concerning increase in breach incidents. This paper investigates common breach types and proposes best practices derived from the data as potential solutions. Objective The primary aim of this study is to analyze health care and hospital breach data, comparing it against HIPAA compliance levels across states (spatial analysis) and the impact of the Omnibus Rule over time (temporal analysis). The goal is to establish guidelines for best practices in handling sensitive information within hospitals and clinical environments. Methods The study used data from the Department of Health and Human Services on reported breaches, assessing the severity and impact of each breach type. We then analyzed secondary data to examine whether HIPAA’s storage and retention rule amendments have influenced security and privacy incidents across all 50 states. Finally, we conducted a qualitative analysis of textual data from vulnerability and breach reports to identify actionable best practices for health care settings. Results Our findings indicate that hacking or IT incidents have the most significant impact on the number of individuals affected, highlighting this as a primary breach category. The overall difference-in-differences trend reveals no significant reduction in breach rates (P=.50), despite state-level regulations exceeding HIPAA requirements and the introduction of the ombudsman rule. This persistence in breach trends implies that even strengthened protections and additional guidelines have not effectively curbed the rising number of affected individuals. Through qualitative analysis, we identified 15 unique values and associated best practices from industry standards. Conclusions Combining quantitative and qualitative insights, we propose the “SecureSphere framework” to enhance data security in health care institutions. This framework presents key security values structured in concentric circles: core values at the center and peripheral values around them. The core values include employee management, policy, procedures, and IT management. Peripheral values encompass the remaining security attributes that support these core elements. This structured approach provides a comprehensive security strategy for protecting patient health information and is designed to help health care organizations develop sustainable practices for data security.

The mediating role of healthy behaviors and self-perceived health in the relationship between eating behaviors and comorbidity in adults.

There is limited information on how healthy behaviors and individual health perceptions mediate the relationship between eating behaviors and noncommunicable diseases in adults. This study aimed to evaluate the mediating role of these factors in the relationship between eating behaviors and comorbidity in U.S. adults. A cross-sectional predictive study using data from 5,247 adults from the Health Information National Trends Survey (HINTS) 5, cycle 3 (2019) was conducted. Structural equation modeling (SEM) was used to assess the mediating effect. The model showed good fit (χ2/df = 1.22, CFI = 971, TLI = 959, RMSEA = 0.050, SRMR = 0.036). It was found that self-perceived health totally mediated the relationship between eating behaviors and comorbidities (β = - 0.026, p < .001). Additionally, healthy behaviors and self-perceived health together mediated the relationship between eating behaviors and comorbidities (β = - 0.025, p < .001). A direct relationship was also observed between healthy behaviors and comorbidities, mediated by self-perceived health (β = - 0.103, p < .001). The study concludes that eating behaviors are significantly related to comorbidities through the mediation of healthy behaviors and self-perceived health.

Ask Your Relative: A mixed method analysis of the Sexual Health and Healthy Relationship Q&As submitted by American Indian Alaska Native young adults.

Disparities in sexual health outcomes persist among American Indian and Alaska Native (AIAN) youth due to intersectional challenges accessing youth-friendly health services. AIAN youth have an increased prevalence of STIs and teen pregnancy. To address disparities in sexual health outcomes, the Ask Auntie/Ask Your Relative (AYR) Q&A service has been used by AIAN youth and young adults for over seven years as a trusted resource for information on sensitive health topics. There is a continued need to better understand the health-seeking behaviors of AIAN youth, especially those related to healthy relationships and sexual health, to improve the alignment of health resources to their needs. This mixed-method study began with two phases. Phase 1 involved an analysis of all AYR data using Google Analytics and basic frequency counts. Phase 2 reviewed all questions and answers related to sexual health and healthy relationships (N = 240) using thematic analysis, NVivo 12.0, and intersectionality, guided by the social determinants of health. All AYR answers were coded based on type, name/location, number of times viewed, and examples. The final step of the analytic process was to utilize an intersectional approach and socioecological model (Individual, Community, Tribe/Nation, and World) to create a visual model with results. Phase 1-Since We R Native began tracking AYR data, the service has been utilized by 2.37M users, with 1.16M unique pageviews. The average time on the page was 4min and 46s. The number of AYR questions submitted varied by year, and were most frequent in 2016, then decreased in subsequent years. In Phase 2, the main themes identified in AYR questions were (1) Reaching Out for Help, (2) Identity and Physical Development, and (3) Healthy Relationships. Analysis of the Q&A answers identified 244 resources, and of these, 100 were Native-specific. The context-specific resources represented 21 uniquely coded health topics, ranging from women's health to behavioral health. The broad range of healthy relationship and sexual health questions submitted to the AYR service reflects the types of health information that AIAN young adults want to know about. Resources provided in response to their questions connected Q&A viewers to a wide variety of organizations and programs designed to support AIAN young adults in their health and wellness journey. Findings from this study may be useful for creating additional culturally tailored resources.

Feature Selection and Machine Learning Approaches in Prediction of Current E-Cigarette Use Among U.S. Adults in 2022

Feature selection is essentially the process of picking informative and relevant features from a larger collection of features. Few studies have focused on predictors for current e-cigarette use among U.S. adults using feature selection and machine learning (ML) approaches. This study aimed to perform feature selection and develop ML approaches in prediction of current e-cigarette use using the 2022 Health Information National Trends Survey (HINTS 6). The Boruta algorithm and the least absolute shrinkage and selection operator (LASSO) were used to perform feature selection of 71 variables. The random oversampling example (ROSE) method was utilized to deal with imbalance data. Five ML tools including support vector machines (SVMs), logistic regression (LR), random forest (RF), gradient boosting machine (GBM), and extreme gradient boosting (XGBoost) were applied to develop ML models. The overall prevalence of current e-cigarette use was 4.3%. Using the overlapped 15 variables selected by Boruta and LASSO, the RF algorithm provided the best classifier with an accuracy of 0.992, sensitivity of 0.985, F1 score of 0.991, and AUC of 0.999. Weighted logistic regression further confirmed that age, education level, smoking status, belief in the harm of e-cigarette use, binge drinking, belief in alcohol increasing cancer, and the Patient Health Questionnaire-4 (PHQ4) score were associated with e-cigarette use. This study confirmed the strength of ML techniques in survey data, and the findings will guide inquiry into behaviors and mentalities of substance users.

Data management practice of health extension workers and associated factors in Central Gondar Zone, northwest Ethiopia

IntroductionGenerating quality data for decision-making at all levels of a health system is a global imperative. The assessment of the Ethiopian National Health Information System revealed that health information system resources, data management, dissemination, and their use were rated as “not adequate” among the six major components of the health system. Health extension workers are the frontline health workforce where baseline health data are generated in the Ethiopian health system. However, the data collected, compiled, and reported by health extension workers are unreliable and of low quality. Despite huge problems in data management practices, there is a lack of sound evidence on how to overcome these health data management challenges, particularly among health extension workers. Thus, this study aimed to assess data management practices and their associated factors among health extension workers in the Central Gondar Zone.MethodAn institution-based cross-sectional study was conducted among 383 health extension workers. A simple random sampling method was used to select districts, all health extension workers were surveyed in the selected districts, and a structured self-administered questionnaire was used for data collection. The data was entered using EpiData version 4.6 and analyzed using STATA, version 16. Bivariable and multivariable binary logistic regression analyses were executed. An odds ratio with a 95% confidence interval and a p-value of &amp;lt;0.05 was calculated to determine the strength of the association and to evaluate statistical significance, respectively.ResultsOf the 383 health extension workers enrolled, all responded to the questionnaire with a response rate of 100%. Furthermore, 54.7% of the respondents had good data management practices. In the multivariable logistic regression analysis, being a married woman, having good data management knowledge, having a good attitude toward data management, having 1–5 years of working experience, and having a salary ranging from 5,358 to 8,013 Ethiopian Birr were the factors significantly associated with good data management practices among health extension workers. The overall data management practice was poor with only five health extension workers out of ten having good data management practices.

Epidemiology of Emergency Department Visits for Children With Clinically Significant Cardiovascular Disease.

The aim of the study is to determine the epidemiology, cost, and factors associated with hospital admission, deterioration if hospitalized, and mortality for children with a history of clinically significant cardiovascular disease (CVD) presenting to pediatric emergency departments (EDs). Using the Pediatric Health Information System, we performed a retrospective analysis of ED encounters of children ≤17 years old with clinically significant CVD between 2016 and 2021. Patients were included if they had a cardiovascular complex chronic condition, defined by ICD diagnosis, and procedure codes. We assessed the primary diagnosis, admission rate, ICU transfer rate (as a marker of disease progression), mortality, resource utilization, and costs. We conducted multivariable analyses to identify risk factors for admission, ICU transfer, and mortality. There were 201,551 ED visits (mean 33,592 ± 3354 per year) among 129,938 children with clinically significant CVD. Most ED encounters had a primary diagnosis of a circulatory (21.1%) or respiratory (19.7%) illness. Seventy-six percent of visits had at least one blood test or imaging study conducted. The overall admission rate was 59.7%, with 28.7% admitted to the ICU, and 6.2% transferred to the ICU after the first 24 hours. The median costs for encounters resulting in admission were $13,605 in US 2023 dollars. In multivariable analyses, younger age, a greater number of noncardiac complex chronic conditions, and CVD type were associated with increased odds of admission, ICU transfer after 24 hours, and mortality (all P < 0.05). ED visits for children with clinically significant CVD lead to substantial resource utilization, including frequent hospitalization, ICU level of care, and costs. This baseline data aids in the development of prospective studies to inform the appropriate ED management for children with clinically significant CVD.

Information seeking behaviour of informal caregivers at the premier tertiary teaching hospital in Nigeria

This study was conducted to examine the information behaviour of informal caregivers in a university college hospital in Ibadan, Nigeria. Informal caregivers in the teaching hospitals constitute critical pubic health care players whose information behaviours have not been studied. Data was collected from 208 caregivers using a questionnaire that consisted of structured and open-ended questions. The study found that healthcare providers were the primary source of health for caregivers, with 34.1% actively seeking information from them. The caregivers seldom utilised sources like the internet, community organizations, books, family, and friends. The preference for healthcare providers as sources is due to their accessibility and ability to provide prompt and accurate answers. Caregivers have diverse information needs, including medication-related information, first aid techniques, nutrition, exercise, mental health, and lifestyle choices. They seek this knowledge to make informed decisions that improve their loved ones’ well-being. The study also revealed that caregivers heavily rely on information technology for health information due to its accessibility and reliability. The study highlights the need for ongoing training and proactive information sharing by healthcare providers to better support informal caregivers in Nigeria, emphasizing the importance of integrated support systems within healthcare facilities. To meet diverse information needs, healthcare institutions should diversify dissemination strategies, including culturally sensitive materials and digital literacy programs, while developing tailored mobile applications and online support communities for caregivers. Policymakers must focus on creating supportive healthcare policies, funding caregiver programs, and expanding insurance coverage to alleviate financial burdens, ensuring that caregivers have access to necessary resources and information.

Sociodemographic predictors of imaging utilization in children with right lower quadrant pain.

Inequities in health care access lead to inequities in outcome. In recent years, health outcome disparities have been documented in children with acute appendicitis and sociodemographic predictors of imaging utilization have not been adequately assessed. The purpose of our study is to assess sociodemographic predictors for the diagnostic imaging of children with right lower quadrant (RLQ) pain. Our hypothesis is that disparities exist in imaging utilization. Our nationwide retrospective cohort study of the Pediatric Health Information System (PHIS) database queried emergency department encounters for children aged 0-18years presenting with RLQ pain (ICD code CM R10.31) between January 2018 and September 2023. Primary exposures included neighborhood-level sociodemographic metrics as measured by Child Opportunity Index, race/ethnicity, and insurance status. Outcomes included no diagnostic imaging, diagnostic imaging with radiography alone, ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). Multivariable logistic regression analyses assessed modality usage with respect to the primary exposures after controlling for demographic (age, gender) and additional (hospital geographic region, time of imaging) covariates. To avoid the perpetuation of bias, reference categories were determined by the lowest numerical value for each covariate. In total, 100,161 patient encounters met inclusion criteria (mean patient age 11.2years ± 3.9; 59.3%, n = 59,416 females). Imaging utilized was US (78.0%; n = 78,115), CT (16.4%, n = 16,405), no imaging (13.9%, n = 13,894), radiography alone (4.4%, n = 4,429), and MRI (3.1%, n = 3,148). The most predictive factors for no imaging were moderate, low, and very low Child Opportunity Index (aOR 1.25, 1.17, and 1.18 [95% CI 1.10-1.33] compared to very high Child Opportunity Index); Black race/ethnicity (aOR 1.26 [95% CI 1.11-1.44] compared to White or Asian race/ethnicity); and public or other insurance (aOR 1.23 and 1.32 [95% CI 1.18-1.41] compared to commercial insurance). The most predictive factors for radiography alone were Black race/ethnicity (aOR 1.30 [95% CI 1.17-1.45] compared to Hispanic race/ethnicity) and public or other insurance (aOR 1.26 [95% CI 1.11-1.44] compared to commercial). The most predictive factors for US were very-high Child Opportunity Index (aOR 1.16 [95% CI 1.09-1.22] compared to very low Child Opportunity Index); Asian, NH-White, or Hispanic race/ethnicity (aOR 1.33, 1.31, 1.30 [95% CI 1.18-1.40] compared to Black race/ethnicity); and commercial insurance (aOR 1.20 [95% CI 1.16-1.25] compared to public insurance). The most predictive factor for CT was White race/ethnicity (aOR 1.26 [95% CI 1.11-1.43] compared with Asian race/ethnicity) and the most predictive factor for MRI was Hispanic race/ethnicity (aOR 1.49 [95% CI 1.17-1.61] compared with Black race/ethnicity). The greatest predictor of cross-sectional imaging was a hospital's region, with CT most likely in southern hospitals (aOR 4.09 [95% CI 2.17-7.70] compared with northeast hospitals). Patient Child Opportunity Index did not predict the likelihood of cross-sectional imaging with CT or MRI in tertiary pediatric centers. Sociodemographic disparities exist in the imaging of children presenting to tertiary pediatric hospitals with RLQ pain. Future studies are needed to analyze the causes of such disparities both on hospital and departmental levels.

Prevalence and Influence Factors of Cognitive Frailty in the Older Adult Patients Undergoing Maintenance Haemodialysis: A Multi-Centre Cross-Sectional Study.

To examine the prevalence of factors of cognitive frailty in patients undergoing maintenance haemodialysis (MHD). A cross-sectional study. From September 2023 to January 2024, 1023 patients undergoing MHD were recruited from 11 hospitals in Chengdu, China, using convenience sampling. The participants' sociodemographic and lifestyle factors, health information and laboratory indicators were assessed using a general information questionnaire. Cognitive frailty was assessed using the Fried Frailty Phenotype and Montreal Cognitive Assessment Scales. Multivariate logistic regression was used to examine the associations between cognitive frailty and sociodemographic and clinical characteristics. Independent variables for the multivariate logistic regression model encompassing age, sex, educational level, marital status, visual impairment, hearing impairment, falls within a year, depression, weight, height, Malnutrition-inflammation score and serum albumin, sodium, phosphorus, total cholesterol and creatinine levels. Among 1023 participants with a mean age of 69.52 years, 300 (29.3%) had cognitive frailty, with a predominance of older patients. Regression analysis showed that advanced age, low literacy and low serum creatinine, sodium and total cholesterol levels were positively correlated with cognitive frailty. Furthermore, 17.1% of the participants experienced depression, a risk factor for cognitive frailty, and malnutrition was an independent risk factor for cognitive frailty. Older adult patients undergoing (MHD) are at an increased risk of developing cognitive frailty. The aetiology of cognitive frailty in this cohort was multifactorial. Targeted interventions should be designed and implemented based on these factors, prioritising nutritional guidance and mood management to prevent or reverse cognitive frailty. The study adhered to the STROBE checklist. Older adult patients undergoing MHD are at increased risk of developing cognitive frailty. Cognitive frailty screening must be incorporated into the routine assessment of older patients undergoing MHD. No patient or public contribution.

Interventions for improving health literacy among older people: a systematic review

BackgroundHealth literacy(HL) is defined as the degree to which individuals have the capacity to obtain process and understand basic health information and services required for making appropriate health decisions. Effective interventions to improve older people’s HL have become increasingly important. The purpose of this study is to conduct a review of interventions aimed at enhancing the HL of older people.MethodologyRelevant information was gathered from various databases including PubMed, Scopus, Cochrane Library, Science Direct, and Web of Science. Additionally, a manual search of related journals and Google Scholar, a search of the reference lists of selected articles, and a search of unpublished sources were also conducted up to 30 August 2024. Reporting quality assessment was performed using CONSORT: 2010, JBI Critical Appraisal Checklist for Quasi-Experimental Studies, and “Quality Assessment Criteria for Survey Research Reports”.ResultsA total of 21 articles were included in this study. The interventions conducted in high-income countries were found to be more effective compared to those conducted in middle and low-income countries. Furthermore, interventions carried out at the community level were more effective than those performed in nursing homes. Educational interventions were more effective than lifestyle modification interventions, and interventions carried out in a single dimension were more effective than multidimensional interventions. Additionally, interventions that utilized technology were found to be more effective.ConclusionBased on the findings, community-based interventions that encompass a one-dimensional approach, incorporating the use of technology and considering the duration of the intervention, are more recommended.

“That’s not how abortions happen”: a qualitative study exploring how young adults navigate abortion misinformation in the post-Roe era

BackgroundMisinformation about abortion is widespread and was exacerbated by the overturn of Roe v Wade. Young adults are among those facing the most direct impacts of new abortion restrictions and...

Pediatric Hospital Utilization During Medical Stabilization for Patients With Eating Disorders.

Few studies have examined pediatric hospital utilization across the spectrum of eating disorder (ED) diagnoses among hospitalized patients. We describe sociodemographic and clinical characteristics, hospital utilization, and enteral tube feeding and examine factors associated with hospital utilization among patients with EDs. Using data from the Pediatric Health Information System, we included patients aged 4 to 20 years with primary ED diagnoses hospitalized from 2018 to 2022. We examined sociodemographic factors, length of stay, costs, and enteral tube feeding by ED diagnosis. Adjusted regression models compared hospital utilization by diagnosis, adjusting for sociodemographic and clinical factors. Among N = 10 279 hospitalizations from 49 hospitals, anorexia nervosa (AN) was most common (70.9%), followed by avoidant restrictive food intake disorder (ARFID) (15.6%). Mean age was 15.1 years (SD = 2.5), and most were female (86.6%), of white non-Hispanic race (70.9%), with private insurance (70.1%), with 63.9% occurring after the coronavirus disease 2019 pandemic onset. Median (interquartile range) length of stay was 8.0 days (7.0), and hospital costs were $18 099 ($15 592). A total of 18.8% received enteral tube feeding, with significant hospital variation. In adjusted models, compared with AN, ARFID, binge disorders, and unspecified feeding and ED had shorter stays, whereas hospital costs were lower for binge disorders, and enteral feeding was more likely for ARFID. Our findings indicate long and costly hospitalizations, especially for AN, with implications for hospital and treatment capacity, highlighting the need for earlier diagnosis and treatment to prevent the need for hospitalization.

Telehealth utilization among patients with chronic disease: Insights from the 2022 Health Information National Trends Survey.

Telehealth has been effectively used for managing chronic disease conditions; however, utilization patterns vary across populations. This study aims to examine the prevalence of telehealth utilization, the associated factors of telehealth modality (e.g., audio, video) among patients with chronic diseases, and the role of health literacy. Participants with at least one diagnosed chronic disease from the 2022 Health Information National Trends Survey (HINTS 6) data (n=3686) were analyzed. Differences in participant characteristics between telehealth users and non-users were compared using χ² statistics. Multinomial logistic regression models were employed to investigate factors associated with telehealth modality. About 52% of participants reported using telehealth in the past 12 months, with 34.7% using audio-only modality. Telehealth use was highest among participants with depression (61.6%) and lowest among those with high blood pressure (47.6%). Participants over 75 years old (OR, 3.11 [95% CI, 1.99-4.85]; P < 0.001) were more likely to use audio-only modality compared to the youngest group (18-34 years). Respondents with a higher educational level (bachelor's degree: OR, 0.77 [95% CI, 0.59-1.00], P = 0.049; post-baccalaureate degree: OR, 0.60 [95% CI, 0.43-0.82]; P < 0.001) and higher health literacy (OR, 0.81 [95% CI, 0.66-0.99]; P =0.04) were more likely to use audio-video modality compared to their counterparts. Telehealth use varied across demographics and chronic diseases, revealing significant disparities. Elderly individuals, those with lower socioeconomic status, and those with lower health literacy tended to use the audio-only modality. Providing support for digital platforms and health literacy can empower patients with chronic diseases to effectively use telehealth for self-management.