Health Outcomes Of Residents Research Articles

Connecting Past to Present: Does Historical Redlining Affect Current Life Expectancy?

Previous research has documented a strong relationship between currently living in the redlined zones of the 1930s and suffering from a higher prevalence of disease. However, little is known about the relationship between historical redlining, modern-day redlining, and current resident health outcomes. This paper aimed to simultaneously model the associations between both historical redlining and modern-day redlining on current health outcomes. In this paper, we used structural equation modeling to uncover relationships between current and historical redlining practices and modern-day life expectancy, exploring two levels of potential mediating factors: (1) racial segregation and structural racism; and (2) mediating health outcomes. We analyzed data from 11,661 census tracts throughout the United States using historical redlining data from 1940, modern redlining data from 2010 to 2017, racial segregation and structural racism indices from 2010 to 2019, health outcome data from 2021 to 2022, and life expectancy data from 2010 to 2015. Historical redlining was measured using Home Owners' Loan Corporation (HOLC) ratings, which ranged from 1.0 for favorable neighborhoods ("greenlined") to 4.0 for unfavorable ("redlined") neighborhoods. Modern-day redlining was measured using Home Mortgage Disclosure Act (HMDA) data, which were transformed into four quartiles, ranging from level 1 (low mortgage rejection rates) to level 4 (high mortgage rejection rates). We found a significant relationship between historic redlining and current life expectancy, with average life expectancy decreasing steadily from 80.7 years in HOLC 1 tracts to 75.7 years in HOLC 4 tracts, a differential of 5.0 years between the greenlined and redlined tracts. We also found a significant relationship between modern-day redlining and current life expectancy, with average life expectancy decreasing steadily from 79.9 years in HMDA 1 tracts to 73.5 years in HMDA 4 tracts, a differential of 6.4 years. In the structural equation model, historical redlining had a total effect of decreasing life expectancy by 1.18 years for each increase of one in the HOLC rating. Modern-day redlining had a total effect of decreasing life expectancy by 1.89 years for each increase of one in the HMDA quartile. This paper provides new evidence that the legacy of redlining is not relegated to the history books but rather is a present and pressing public health issue today.

Fatty Acids Composition of Pasture Grass, Yak Milk and Yak Ghee from the Four Altitudes of Qinghai-Tibet Plateau: A Predictive Modelling Approach to Evaluate the Correlation among Altitude, Pasture Grass, Yak Milk and Yak Ghee.

This study investigates the effect of altitude on the fatty acid composition of pasture grass, yak milk, and yak ghee on the Qinghai-Tibet Plateau, aiming to understand how environmental factors influence the nutritional quality of these products. Samples were collected from four different altitudes and analyzed for fatty acid profiles using gas chromatography. The analysis reveals that higher altitudes are associated with an increased prevalence of beneficial unsaturated fatty acids, such as oleic acid (C18:1) and linoleic acid (C18:2n6c). These findings highlight the significant influence of altitude on yak lipid metabolism, ultimately enhancing the nutritional value of dairy products. This adaptation not only supports the health and resilience of yaks, but also provides vital nutritional benefits to residents in high-altitude regions. The research underscores the importance of further investigations to optimize dairy production practices, ensuring improved food security and health outcomes for residents of the plateau.

Rural reticence to inform physicians of cannabis use.

Over 75% of Americans have legal access to medical cannabis, though physical access is not uniform and can be difficult for rural residents. Additionally, substantial stigma remains in using medical cannabis, particularly within the health care system. This article argues that rural Americans may be particularly affected by such stigma and may thus be more likely to not report cannabis use to health care providers. Data were obtained from 1,045 adult Pennsylvanians using a self-administered web panel omnibus survey. Rurality was determined by overlaying Zip Code Tabulation Areas with urban areas, as defined by the U.S. Census Bureau. Primary outcomes were prior use of cannabidiol (CBD) or marijuana and reporting of such use to medical professionals. Covariates utilized in logistic regressions included rurality, gender, age, race/ethnicity, political affiliation, political ideology, and veteran status. Living in an urban area was positively associated with disclosure of marijuana use to health care providers as compared to those in rural areas, although there were no differences found in CBD disclosure. Stigma surrounding marijuana usage may have a disproportionate impact on health outcomes for rural residents who use marijuana. Nonreporting prevents effective holistic medical care and can result in negative drug interactions and other side effects.

Adaptive Governance: Empowering Data Sharing for Public Health Impact - Insights from North Carolina Department of Health and Human Services

Objective and ApproachAt the 2022 IPDLN Conference, we presented work led by the North Carolina Department of Health and Human Services (NCDHSS), in partnership with university-based researchers, to build legal and ethical processes for routine data sharing. This session provides significant updates on the methods, results, and implications of these efforts–namely, that NCDHHS implemented an enterprise-wide data governance process and a legal framework that has enabled timely, impactful use of cross-sector data. We relied on Participatory Action Research and Deliberative Dialogue methods to engage a diverse range of partners in a data landscape overview and the co-creation of new data sharing processes that better enables the enterprise to adapt to a changing world. ResultsFour key actions were taken as a result of the participatory research process: NCDHHS developed a data strategy, created a data sharing guidebook, staffed their Data Office, and implemented a new legal framework. In addition to describing how these actions support data use across a large US state health and human services agency, we provide three use cases demonstrating the impact of this work. ConclusionsEstablishing routine data sharing presents legal, technical, and cultural challenges, particularly in large agencies. Through a collaborative, participatory approach, the NCDHHS successfully established enterprise-wide data governance and a legal framework to support data-driven policymaking and, ultimately, improve health outcomes for residents. ImplicationsThis research presents a successful, actionable, and replicable framework for developing and implementing processes to support intradepartmental data access, linkage, and use.

Falls in focus: an analysis of the rate of falls in 25 Australian residential aged care facilities from 2019 to 2021, pre- and during COVID-19 lockdowns

IntroductionDuring 2020–2021 Australia maintained comparatively low rates of COVID-19 in the community and residential aged care facilities (RAC) due to stringent public health measures such as lockdowns. However, the public health measures implemented may have had unintended impacts on critical RAC resident health outcomes, such as falls, due to routine care disruptions and aged care resident isolation. We utilised a longitudinal data to assess the association between COVID-19 lockdowns and the rate of falls in RAC settings.MethodsA longitudinal cohort study was conduct using routinely collected data from 25 RAC facilities from one non-profit aged care provider in Sydney, Australia. The study included 2,996 long term residents between March 2019 and March 2021. The outcome measures were all falls, injurious falls, and falls assessed as requiring hospitalisation. Generalised estimating equations (GEE) were applied to determine the association between COVID-19 lockdown periods and fall-related outcomes while adjusting for confounders and seasonality.ResultsDuring the study period 11,658 falls were recorded. Residents frequently experienced at least one fall during the study period (median: 1, interquartile range: 0–4). During Lockdown 1 (March-June 2020) the rate of all falls increased 32% (IRR 1.32, 95% CI 1.19–1.46, p < 0.01) and the rate of injurious falls increased by 28% (IRR 1.28, 95% CI 1.12–1.46, p < 0.01) compared to pre-pandemic rates. The rate of falls assessed as requiring hospitalisation remained unchanged during Lockdown 1 (IRR 1.07, 95% CI 0.86–1.32, p = 0.519). During Lockdown 2 (Dec 2020-Jan 2021) the rate of all falls, injurious falls, and falls assessed as requiring hospitalisation did not change significantly compared to pre-pandemic rates.ConclusionThese findings suggest that the consequences of stringent COVID-19 restrictions, as seen in Lockdown 1, produced changes in residents’ care which contributed to more falls and associated harm. The subsequent lockdown, which were less restrictive and occurred after staff had gained experience, was associated with no significant increase in falls rate. The nature and extent of lockdowns implemented for infection control in RAC need to balance multiple potential adverse effects. Factors which facilitated resilience during this period require exploration in future research.

Caregiving in long-term care before and during the COVID-19 pandemic: a scoping review.

The COVID-19 pandemic magnified pre-existing socioeconomic, operational, and structural challenges in long-term care across the world. In Canada, the long-term care sector's dependence on caregivers as a supplement to care workers became apparent once restrictive visitation policies were employed. We conducted a scoping review to better understand the associations between caregiving and resident, formal and informal caregiver health in long-term care before and during the COVID-19 pandemic. A literature search was performed using MEDLINE, AgeLine, Google Advanced, ArXiv, PROSPERO, and OSF. Pairs of independent reviewers screened titles and abstracts followed by a review of full texts. Studies were included if they reported biological, psychological, or social health outcomes associated with caregiving (or lack thereof). After screening and reviewing 252 records identified by the search strategy, a total of 20 full-text records were eligible and included in this review. According to our results, research on caregiving increased during the pandemic, and researchers noted restrictive visitation policies had an adverse impact on health outcomes for residents and formal and informal caregivers. In comparison, caregiving in long-term care prior to the pandemic, and once visitation policies became less restrictive, led to mostly beneficial health outcomes. Caregiver interventions, for the most part, appear to promote better health outcomes for long-term care residents and formal and informal caregivers. Suggestions to better support caregiving in long-term care settings are offered.

Health insurance and subjective well-being: evidence from integrating medical insurance across urban and rural areas in China.

Health insurance coverage and the risk protection it provides may improve enrollees' subjective well-being (SWB), as demonstrated, e.g. by Oregon Medicaid's randomized expansion significantly improving enrollees' mental health and happiness. Yet little evidence from low- and middle-income countries documents the link between insurance coverage and SWB. We analyse individual-level data on a large natural experiment in China: the integration of the rural and urban resident health insurance programmes. This reform, expanded nationally since 2016, is recognized as a vital step towards attaining the goal of providing affordable and equitable basic healthcare in China, because integration raises the level of healthcare coverage for rural residents to that enjoyed by their urban counterparts. This study is the first to investigate the impact of urban-rural health insurance integration on the SWB of the Chinese population. Analysing 2011-18 data from the China Health and Retirement Longitudinal Study in a difference-in-difference framework with variation in the treatment timing, we find that the integration policy significantly improved the life satisfaction of rural residents, especially among low-income and elderly individuals. The positive impact of the integration on SWB appears to stem from the improvement of rural residents' mental health (decrease in depressive symptoms) and associated increases in some health behaviours, as well as a mild increase in outpatient care utilization and financial risk protection. There was no discernible impact of the integration on SWB among urban residents, suggesting that the reform reduced inequality in healthcare access and health outcomes for poorer rural residents without negative spillovers on their urban counterparts.

Adherence to the Atrial fibrillation Better Care pathway and the risk of adverse health outcomes in older care home residents with atrial fibrillation: a retrospective data linkage study 2003-18.

The Atrial fibrillation Better Care (ABC) pathway is the gold-standard approach to atrial fibrillation (AF) management, but the effect of implementation on health outcomes in care home residents is unknown. To examine associations between ABC pathway adherence and stroke, transient ischaemic attack, cardiovascular hospitalisation, major bleeding, mortality and a composite of all these outcomes in care home residents. A retrospective cohort study of older care home residents (≥65years) in Wales with AF was conducted between 1 January 2003 and 31 December 2018 using the Secure Anonymised Information Linkage Databank. Adherence to the ABC pathway was assessed at care home entry using pre-specified definitions. Cox proportional hazard and competing risk models were used to estimate the risk of health outcomes according to ABC adherence. From 14,493 residents (median [interquartile range] age 87.0 [82.6-91.2] years, 35.2% male) with AF, 5,531 (38.2%) were ABC pathway adherent. Pathway adherence was not significantly associated with risk of the composite outcome (adjusted hazard ratio, 95% confidence interval [CI]: 1.01 [0.97-1.05]). There was a significant independent association observed between ABC pathway adherence and a reduced risk of myocardial infarction (0.70 [0.50-0.98]), but a higher risk of haemorrhagic stroke (1.59 [1.06-2.39]). ABC pathway adherence was not significantly associated with any other individual health outcomes examined. An ABC adherent approach in care home residents was not consistently associated with improved health outcomes. Findings should be interpreted with caution owing to difficulties in defining pathway adherence using routinely collected data and an individualised approach is recommended.

COVID-19 AND PSYCHOTROPIC DRUG USE IN ASSISTED LIVING RESIDENTS: VARIATION BY WAVE AND SETTING TYPE

Abstract The onset of COVID-19 was associated with significant, albeit modest, increases in the use of psychotropics and opioids in nursing home residents. Little research exists on whether similar trends occurred among older residents of publicly funded assisted living (AL) homes, a growing and poorly investigated setting. We examined the impact of pandemic wave (1 to 4) and setting type (dementia designated spaces [AL-D] vs other [AL-O]) on prevalent antipsychotic, antidepressant, benzodiazepine, opioid and anticonvulsant use in AL residents from Alberta, Canada. Using linked population-based clinical and health administrative databases, we conducted a repeated cross-sectional study of quarterly medication prevalence from January 2018 to December 2021. Log-binomial GEE models estimated prevalence ratios (PR) for 4 waves (vs 2018-19 historical months) and setting (AL-D vs AL-O) and period-setting interactions. On March 1, 2020, there were 2,874 AL-D and 6,611 AL-O residents in our cohorts (mean age 82.4 vs 79.9 years and 93.5% vs 42.6% with dementia, respectively). Antipsychotic prevalence increased during waves 2-4 for both settings but this increase was significantly greater for AL-D than AL-O in later waves (e.g., AL-D: PR 1.21, 95%CI 1.14-1.27; AL-O: 1.12 (1.07-1.17) for March-May 2021 vs 2018-19). For both settings, there was a significant but modest increase in antidepressants but a decrease in benzodiazepines during several waves. No pandemic effect was observed for opioids in either setting. The AL resident and home characteristics associated with these medication trends, concerns about medication risks (particularly for dementia care settings), and consequent health outcomes for residents require further study.

CULTURALLY SENSITIVE STRATEGIES TO RECRUIT FOREIGN EDUCATED NURSES FOR US LONG-TERM CARE RESEARCH

Abstract Long-term care (LTC) facilities experience chronic nursing staff instability which negatively impacts resident health outcomes. Recruiting Foreign Educated Nurses (FENs) is one strategy to stabilize the nursing workforce but most studies on FENs, use secondary data from: American Community Survey and the National Sample Survey of Registered Nurses. Few empirical studies have examined FEN experiences, employment outcomes, and impact on US LTC facilities. Since LTC facilities are dependent on FENs to meet minimum staffing requirements, additional research is needed to better understand FEN workforce issues in LTC, how to improve its sustainability, and the links to resident outcomes. Mistrust of researchers, however, may make FENs hard to reach. Therefore, conducting primary research on FENs in LTC requires culturally sensitive and community-engaged recruitment strategies. Drawing from existing literature and lessons learned from primary research conducted with FENs working in LTC facilities in the southeastern US, we will review best practices for recruitment so researchers can understand the cultural and structural issues that may affect research conduct in facilities where FENs are employed and their recruitment as participants. Developing relationships with FEN leaders as well as the Nigerian, Jamaican, Filipino, and/or Asian nurses associations can facilitate access to the population. Key stakeholder relationships also include the American Nurses Association, State Boards of Nursing, and Commission on Graduates of Foreign Nursing Schools as they can facilitate entrée into data sources and networks for recruitment. Understanding recruitment strategies will strengthen research that deepens our understanding of workforce issues among FENs in LTC.

Re-Examine: The Power of China’s New Rural Pension Scheme

Drawing upon data from the China Family Panel Studies (CFPS) and the China Health and Retirement Longitudinal Study (CHARLS), this paper employs a Difference in Differences (DID) approach to investigate the varying impacts of the New Rural Pension Scheme (NRPS) across different regions in China. The empirical results reveal that the NRPS has generally improved the health outcomes of residents. Notably, the benefits of the NRPS are more pronounced in rural and economically advanced areas, while its effects are not statistically significant in less developed and urban regions. This analysis elucidates the underlying reasons for these regional disparities, attesting to the pension policy’s efficacy and advancing the scholarly conversation on pension policy research.

Systematic Review on the Positive Mental Health Impact of Older Adults Participation in Horticultural Activities in Long Term Care Facilities

The present research study focuses on exploring the effects of horticultural activities on the health outcomes of residents of long-term care facilities (LTCFs). The study utilizes evidence-based nursing and a systematic literature review. A search for relevant articles was conducted on databases such as PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane. Randomized controlled trials in English and Chinese were included in the analysis, with two researchers independently evaluating the selected articles. The synthesis of results revealed that horticultural activities for residents of LTCFs had positive effects on physical aspects, such as increasing physical agility and aerobic endurance. Moreover, they had positive influences including happiness, positive mental health. In terms of social aspects, horticultural activities for older adults helped reduce aggressive behaviors, promoted goal-oriented living, and enhanced quality of life. Evidence of the impact of horticultural activities on the positive mental health of residents of LTCFs is relatively scarce compared to community-dwelling older adults, where psychological states are often studied in negative contexts. It has been suggested that LTCFs should integrate horticultural activities into their regular programs to foster positive mental health outcomes. Horticultural activities show promise in promoting positive mental health among residents of LTCFs and warrant further exploration.

A Scoping Review of the Costs, Consequences, and Wider Impacts of Residential Care Home Closures in a UK Context

Background. Between 2015 and 2020, 1,578 care homes in the UK closed, displacing nearly 50,000 older and disabled people with very significant care and support needs. It is widely thought that relocation can have a significant impact on the health and well-being of older people. Yet, evidence is limited due to sensitivity and logistical difficulties with data collection. This study aimed to review the published literature in order to (i) identify evidence on the costs, consequences, and wider impacts of care home closures, for older people, family members, care home staff, and local authorities and (ii) understand the causes of and processes surrounding the closure of residential care homes in the UK. Methods. Eight electronic databases (Medline, Embase, Web of Science, Scopus, ASSIA, HMIC, AgeInfo, and SPP) were searched from 1st January 2000 to 9th February 2023; Google and Google Scholar were searched for guidance/policy documents from the grey literature. Data on the objectives, methods, and main results were extracted, and the findings were narratively reported. Results. Eighteen records, comprising guidance documents and academic publications (quantitative, qualitative, and mixed-method approaches), met the inclusion criteria. We found a lack of good quality evidence on costs of closure and no consideration of outcomes for staff. Studies reporting on outcomes for residents suggest there may not be any long-term adverse effects on their health, in contrast to often-expressed views that care home closures result in harm. Conclusion. Future research should consider the stress and anxiety experienced by staff and families as relevant outcomes and show caution with respect to the use of proxy reporting of resident health outcomes. Given that a sizable portion of the costs associated with care home closure falls on local authorities, an evidence-based approach to closures that includes an assessment of cost-effectiveness will help to improve future outcomes and guide the most efficient use of limited public resources.

The effects of special nursing units in nursing homes on healthcare utilization and cost: A case-control study using propensity score matching

BackgroundMost nursing homes in South Korea lack professional nursing services, resulting in transporting residents to hospitals for mild health problems and nursing treatment needs. While the number of nursing homes has increased, the number of registered nurses working in nursing homes has declined. In 2019, the Korean Ministry of Health and Welfare and the National Health Insurance Service launched the Special Nursing Units in Nursing Homes, a pilot nurse-led model, to resolve the lack of health and nursing services in nursing homes by mandating registered nurses' minimum staffing levels and protecting their scope of practice. ObjectiveThis study explored the effects of the Special Nursing Units model in Nursing Homes on healthcare utilization and cost among nursing home residents. DesignA comparative effectiveness research design using propensity score matching. Setting(s)Eighteen nursing homes were selected based on the region and number of beds. ParticipantsThere were 323 matched-pairs of residents from the case and control groups. MethodsNursing homes with more than 30 beds were recruited nationwide, with 18 nursing homes being selected based on the region and number of beds. The case group included 323 older adults receiving professional nursing services by registered nurses under the Special Nursing Units model in Nursing Homes for more than six months consecutively in 18 nursing homes between April and December 2019. We matched control participants using propensity score matching with health insurance and long-term care data. We analyzed the differences in healthcare utilization and cost changes between the case and control groups using generalized estimating equations. ResultsThe groups were not statistically different in baseline demographic or health-related characteristics. There were 26 (8.1%) and 30 (9.3%) deaths in the case and control groups, respectively, during the six months of the model, which was not statistically different (p = .576). The case group showed statistically significant decreases in healthcare utilization and costs, including hospitalization frequency (p = .008), length of stay (p = .002), and hospitalization costs (p = .003); outpatient visit frequency (p = .003) and costs (p < .001); and home healthcare frequency (p < .001) and cost (p < .001) than the control group. ConclusionsProfessional nursing services by registered nurses under the Special Nursing Units model in Nursing Homes decreased healthcare utilization and costs. A nurse-led model in nursing homes, which includes mandating the minimum staffing levels of registered nurses and protecting their scope of practice, promises to improve resident health outcomes.

Trend analysis of malaria in urban settings in Ethiopia from 2014 to 2019

BackgroundUrbanization generally improves health outcomes of residents and is one of the potential factors that might contribute to reducing malaria transmission. However, the expansion of Anopheles stephensi, an urban malaria vector, poses a threat for malaria control and elimination efforts in Africa. In this paper, malaria trends in urban settings in Ethiopia from 2014 to 2019 are reported with a focus on towns and cities where An. stephensi surveys were conducted.MethodsA retrospective study was conducted to determine malaria trends in urban districts using passive surveillance data collected at health facilities from 2014 to 2019. Data from 25 towns surveyed for An. stephensi were used in malaria trend analysis. Robust linear models were used to identify outliers and impute missing and anomalous data. The seasonal Mann-Kendal test was used to test for monotonic increasing or decreasing trends.ResultsA total of 9,468,970 malaria cases were reported between 2014 and 2019 through the Public Health Emergency Management (PHEM) system. Of these, 1.45 million (15.3%) cases were reported from urban settings. The incidence of malaria declined by 62% between 2014 and 2018. In 2019, the incidence increased to 15 per 1000 population from 11 to 1000 in 2018. Both confirmed (microscopy or RDT) Plasmodium falciparum (67%) and Plasmodium vivax (28%) were reported with a higher proportion of P. vivax infections in urban areas. In 2019, An. stephensi was detected in 17 towns where more than 19,804 malaria cases were reported, with most of the cases (56%) being P. falciparum. Trend analysis revealed that malaria cases increased in five towns in Afar and Somali administrative regions, decreased in nine towns, and had no obvious trend in the remaining three towns.ConclusionThe contribution of malaria in urban settings is not negligible in Ethiopia. With the rapid expansion of An. stephensi in the country, the receptivity is likely to be higher for malaria. Although the evidence presented in this study does not demonstrate a direct linkage between An. stephensi detection and an increase in urban malaria throughout the country, An. stephensi might contribute to an increase in malaria unless control measures are implemented as soon as possible. Targeted surveillance and effective response are needed to assess the contribution of this vector to malaria transmission and curb potential outbreaks.

The ACTIVATE Digital Health Pilot Program for Diabetes and Hypertension in an Underserved and Rural Community.

Community health centers and patients in rural and agricultural communities struggle to address diabetes and hypertension in the face of health disparities and technology barriers. The stark reality of these digital health disparities were highlighted during the coronavirus disease 2019 pandemic. The objective of the ACTIVATE (Accountability, Coordination, and Telehealth in the Valley to Achieve Transformation and Equity) project was to codesign a platform for remote patient monitoring and program for chronic illness management that would address these disparities and offer a solution that fit the needs and context of the community. ACTIVATE was a digital health intervention implemented in three phases: community codesign, feasibility assessment, and a pilot phase. Pre- and postintervention outcomes included regularly collected hemoglobin A1c (A1c) for participants with diabetes and blood pressure for those with hypertension. Participants were adult patients with uncontrolled diabetes and/or hypertension (n = 50). Most were White and Hispanic or Latino (84%) with Spanish as a primary language (69%), and the mean age was 55. There was substantial adoption and use of the technology: over 10,000 glucose and blood pressure measures were transmitted using connected remote monitoring devices over a 6-month period. Participants with diabetes achieved a mean reduction in A1c of 3.28 percentage points (standard deviation [SD]: 2.81) at 3 months and 4.19 percentage points (SD: 2.69) at 6 months. The vast majority of patients achieved an A1c in the target range for control (7.0-8.0%). Participants with hypertension achieved reductions in systolic blood pressure of 14.81 mm Hg (SD: 21.40) at 3 months and 13.55 mm Hg (SD: 23.31) at 6 months, with smaller reductions in diastolic blood pressure. The majority of participants also reached target blood pressure (less than 130/80). The ACTIVATE pilot demonstrated that a codesigned solution for remote patient monitoring and chronic illness management delivered by community health centers can overcome digital divide barriers and show positive health outcomes for rural and agricultural residents.

Clinical and Subjective Oral Health Status of Care Home Residents in Europe: A Systematic Review.

Several studies demonstrated the poor oral health of care home residents in Europe but there is no systematic overview of the relevant literature. The objective of this study was to systematically review the evidence on the clinical and subjective oral health outcomes of care home residents in Europe. The study design is a systematic review. All included publications presented data on clinical and/or subjective oral health outcomes in care home residents in Europe with no restrictions for language or study design. MEDLINE, Embase, and CINAHL were searched, including publications from January 2010 onward. Data extraction and quality assessment (Qualsyst tool) was performed by 2 researchers independently. Findings were synthesized narratively, lack in data homogeneity restricted the relevance of a meta-analysis. Eighty-three papers from 18 countries were included in the systematic review, with a sample size ranging from 39 to 92,827 participants. Their mean age was older than 80years. The residents had few natural teeth, with fewer than a third a functional natural dentition. Removable dentures were present in half to 80% of residents. A high prevalence of dental caries was reported. Oral hygiene was insufficient, for both natural teeth and removable dentures. Few residents had a healthy periodontium. Clinical treatment needs were found in most residents. Perceived treatment needs were high with at least one-third of care home residents reporting a need for care due to poor oral health. A fifth to half of the residents reported negative impacts of their oral condition on their everyday lives. This systematic review clearly highlights the poor oral health and high burden of oral conditions among care home residents across Europe, irrespective of country or health care system. There is need for substantial policy actions to improve oral health in care homes.

Perinatal Health Outcomes Across Rural and Nonrural Counties Within a Single Health System Catchment.

Perinatal health outcomes are influenced by a variety of socioeconomic, behavioral, and economic factors that reduce access to health services. Despite these observations, rural communities continue to face barriers, including a lack of resources and the fragmentation of health services. To evaluate patterns in health outcomes, health behaviors, socioeconomic vulnerability, and sociodemographic characteristics across rural and nonrural counties within a single health system catchment area. Socioeconomic vulnerability metrics, health care access as determined by licensed provider metrics, and behavioral data were obtained from FlHealthCHARTS.gov and the County Health Rankings. County-level birth and health data were obtained from the Florida Department of Health. The University of Florida Health Perinatal Catchment Area (UFHPCA) was defined as all Florida counties where ≥5% of all infants were delivered at Shands Hospital between June 2011 and April 2017. The UFHPCA included 3 nonrural and 10 rural counties that represented more than 64,000 deliveries. Nearly 1 in 3 infants resided in a rural county, and 7 out of 13 counties did not have a licensed obstetrician gynecologist. Maternal smoking rates (range 6.8%-24.8%) were above the statewide rate (6.2%). Except for Alachua County, breastfeeding initiation rates (range 54.9%-81.4%) and access to household computing devices (range 72.8%-86.4%) were below the statewide rate (82.9% and 87.9%, respectively). Finally, we found that childhood poverty rates (range 16.3%-36.9%) were above the statewide rate (18.5%). Furthermore, risk ratios suggested negative health outcomes for residents of counties within the UFHPCA for each measure, except for infant mortality and maternal deaths, which lacked sample sizes to adequately test. The health burden of the UFHPCA is characterized by rural counties with increased maternal death, neonatal death, and preterm birth, as well as adverse health behaviors that included increased smoking during pregnancy and lower levels of breastfeeding relative to nonrural counties. Understanding perinatal health outcomes across a single health system has potential to not only estimate community needs but also facilitate planning of health care initiatives and interventions in rural and low-resource communities.

Power, place, and access: Why history is at the center of black D.C. residents of wards 7 and 8 decisions to receive the COVID-19 vaccine

Vaccines have played an essential role in curbing case and mortality rates due to SARS-CoV-2 in the United Sates. Still, many communities display high rates of unwillingness or inability to get a COVID-19 vaccine, limiting overall vaccination efforts and contributing to viral spread. Black Americans have expressed skepticism towards vaccines because of limited access to the technology, mistrust in its safety and efficacy, and a lack of confidence in the healthcare authorities that distribute it. This article investigates how Black residents of Wards 7 and 8 in Washington, D.C. thought about COVID-19 vaccination and why or why not they decided to vaccinate. These Wards’ vaccination rates were markedly lower than those from Wards 1–6, which have substantially higher populations of White residents, affluence, access, and resources. This study involved 31 interviews with Ward 7 and 8 residents recruited through snowball sampling. We found that residents navigated the dual perceived risks of coronavirus infection and vaccination through three key frames: their relationship to their place or location, their desires to maintain autonomy over their health, and their abilities to access COVID-19 vaccines. This case study advances knowledge of vaccine utilization among marginalized communities, and how this phenomenon varies depending on local social, cultural, and political dynamics. Moreover, this research has implications for vaccine rollout efforts and the D.C. health system, as it reveals gaps in confidence and care that undermine health outcomes for Black residents.

More private than public: the choice neighborhoods initiative as another tool for state-led gentrification in the Sun Valley neighborhood of Denver CO

ABSTRACT Through the Choice Neighborhoods Initiative (CNI), private investors and developers replace distressed US public housing with new mixed-income and mixed-use developments. Although these projects promote community involvement and are purported to prioritize community input and to benefit residents, private investors have disproportionate power and often modify redevelopment to favor the market-rate units while receiving tax incentives, extremely low-cost and long-term land-leases, and government funds for demolition, construction, maintenance, and management. Through a CNI program in Denver (US) we identify and examine the hardships experienced by its residents. CNI transitioned residents toward modern living amenities and mixed-income arrangements but with a loss of community and negatively impacted residents’ mental and physical health. Our initial findings highlight how this regeneration process can lead to degeneration, displacement, fragmented communities, and poor health outcomes for residents. Federal and local agencies should commit to programs that ensures collaborative community-centred planning from beginning to end.