Impact Health Outcomes Research Articles

Demographic characteristics associated with a penicillin allergy label during pregnancy

IntroductionPenicillins and other beta-lactam antibiotics are used in greater than one-third of pregnant women as treatment for Group B Streptococcus colonization and prophylaxis for Caesarean sections. Penicillin allergy labels have been associated with increased morbidity in the pregnant population, and penicillin allergy evaluation during pregnancy is now recognized as safe and effective. Yet, demographic characteristics associated with having a penicillin allergy label during pregnancy have not been studied. We aimed to evaluate factors associated with having a penicillin allergy label in a diverse population of pregnant patients.MethodsWe performed a retrospective observational study of pregnant patients who had an outpatient visit with Obstetrics and Gynecology and a delivery encounter from 1/1/2020 through 6/30/2022 using electronic health record data in a large health system. We used a multivariable logistic regression model to evaluate factors associated with having a penicillin allergy label.ResultsWe identified 10,969 pregnant women of whom 940 (8.6%) had a penicillin allergy label. In the multivariable analysis, having a penicillin allergy label was positively associated with age 32−34 years [odds ratio (OR) = 1.31 vs. 18−27 years, p = 0.02], 35−51 years (OR = 1.41 vs. 18−27 years, p = 0.002) and having rhinitis, asthma, or eczema (OR = 1.55 vs. none, p < 0.0005); and negatively associated with Black race (OR = 0.59 vs. White, p < 0.0005).DiscussionThis study found that Black race was associated with lower likelihood of penicillin allergy label, while older age and atopic conditions were associated with a higher likelihood. This finding may impact health outcomes and interventions related to penicillin allergy in pregnant women.

Examining health determinants and outcomes of older adults across Ghana's North-South divide.

Healthcare services and outcomes are often not evenly distributed across geographic regions. This study used the harmonized data from the Research on Early Life and Trends and Effects (RELATE) to compare the health outcomes of older adults across the North-South divide of Ghana and identify the factors underlying these differences. Although the literature indicates that the South has more health resources and better health indicators, the current study revealed that, for older adults, health outcome in the North was comparatively better than that in the South. The optimal health index scores show that older adults in the North are living at 86% of their optimal health compared with 82% in the South. Work-related physical activity and age substantially influenced optimal health in both regions. Additionally, healthcare use and gender were influential, particularly in the South. The results of the current study suggest that healthcare service availability can impact health outcomes, but so can behavioral and sociodemographic factors.

Association of Unmet Social Needs With Disease-Related Outcomes in Pediatric Patients With Sickle Cell Disease.

Social determinants of health (SDoH) are socioeconomic factors that influence health and well-being, though when unmetcan greatly contribute to health disparities. Individuals with sickle cell disease (SCD) are at increased risk of mortality, disability, and healthcare utilization. However, there are limited data linking specific social needs with disease outcomes in this population. Therefore, we sought to identify the unmet needs in one institution and their association with healthcare utilization. Children with SCD and their guardians answered demographic and SDoH questionnaires during routine Sickle Cell Clinic appointments. We defined an unmet social need as any positive answer to the SDoH questionnaire. Disease outcome variables were electronic health record (EHR)-documented emergency department (ED) visits, hospitalizations, clinic appointment attendance, and guardian-reported acute SCD events in the previous year. A total of 114 parent-guardian dyads participated, with 103 having complete data to analyze. In all, 52% of subjects reported at least one unmet social need with food insecurity (36%), trouble paying utility bills (28%), and unemployment (16%) being the most prevalent. Subjects with at least one unmet need had two times the rate of ED visits and/or hospitalizations and were 1.15 times more likely to have an SCD event in the past year. However, only the association with ED visits was statistically significant (p = 0.03). Over half of subjects reported at least one unmet need; the most common being reliable access to food, which has the potential to impact health outcomes of sickle cell patients. Furthermore, unmet social needs are linked to healthcare utilization and SCD-related complications, supporting routine screening for SDoH in this population.

Facilitators, barriers, and strategies for supporting shared decision-making with people with intellectual disability: A West Australian primary healthcare professional perspective

ABSTRACT Background Shared decision-making between patients and primary healthcare professionals positively impacts health outcomes. However, people with intellectual disability face additional barriers and require supported shared decision-making (SSDM) to participate. Little is known about how healthcare professionals use SSDM with this population. This paper explores the facilitators and barriers experienced, and strategies/resources employed by healthcare professionals working with people with intellectual disability. Method Ten purposively sampled primary healthcare professionals participated in semi-structured interviews. This descriptive qualitative study used content analysis. Findings were compared with a proposed model of factors influencing triadic (the person with intellectual disability, their caregiver and the healthcare professional) SSDM. Results Five factor categories emerged: previous training/experience; engagement and trust; effective collaboration with caregivers; organisational culture and contexts; and familiarity/confidence with communication support strategies and resources. Conclusions Healthcare professionals can leverage pre-existing skills and knowledge, but provision of targeted professional development may reduce anxiety and increase successful SSDM.

Gondoskodási tőke, egészség-egyenlőtlenségek - a gondoskodás fogalom szerepe az egészség társadalmi determinánsainak elemzésében

Care is a key concept in different interpretations of health, illness and cure, and it has a major influence on various fields of research in medical and health sociology. Nevertheless it has yet to evolve into a well-established conceptual framework in these areas. Therefore in this paper we explore how care as a social determinant of health impacts health outcomes, and how concepts of social determinants of care enhance our understanding of the underlying mechanisms and pathways. We place TEAM-ECD framework at the centre of our analysis, because care is conceived of neither as a factor of inequality its own right, nor as a source of health inequalities by other frameworks that are in use in this field. We aim to fill these gaps by incorporating few approaches of care inequalities into the above-mentioned framework for the social determinants of healthy early childhood development.

Air pollution mixture exposure during pregnancy and postpartum psychological functioning: racial/ethnic- and fetal sex-specific associations.

Prenatal air pollution (AP) exposure has been linked to postpartum psychological functioning, impacting health outcomes in both women and children. Extant studies primarily focused on individual pollutants. To assess the association between prenatal exposure to a mixture of seven AP components and postpartum psychological functioning using daily exposure data and data-driven statistical methods. Analyses included 981 women recruited at 24.0 ± 9.9 weeks gestation and followed longitudinally. We estimated prenatal daily exposure levels for constituents of fine particles [elemental carbon (EC), organic carbon (OC), nitrate (NO3-), sulfate (SO42-), ammonium (NH4+)], nitrogen dioxide (NO2), and ozone (O3) using validated global 3-D chemical-transport models and satellite-based hybrid models based on residential addresses. Edinburgh Postnatal Depression Scale (EPDS) was administered to participants to derive a total EPDS score and the subconstruct scores for anhedonia and depressive symptoms. A distributed lag model (DLM) was employed within Bayesian Kernel Machine Regression (BKMR) to develop time-weighted exposure profile for each pollutant. These exposures were then input into a Weighted Quantile Sum (WQS) regression to estimate an overall mixture effect, adjusted for maternal age, education, race/ethnicity, season of delivery, and delivery year. Effect modification by race/ethnicity and fetal sex was also examined. Women were primarily Hispanic (51%) and Black (32%) reporting ≤12 years of education (58%). Prenatal exposure to an AP mixture was significantly associated with increased anhedonia subscale z-scores, particularly in Hispanics (β = 0.07, 95%CI = 0.004-0.13, per unit increase in WQS index). It was also borderline associated with increased total EPDS (β = 0.11, 95%CI = 0.00-0.22) and depressive symptom subscale (β = 0.09, 95%CI = -0.02 to 0.19) z-scores, particularly among Hispanic women who gave birth to a male infant. Sulfate (SO42-), O3 and OC were major contributors to these associations. This study utilizes an advanced data-driven approach to examine the temporally- and mixture-weighted effects of prenatal air pollution exposure on postpartum psychological functioning. We found that exposure to a prenatal air pollution mixture predicted poorer postpartum psychological functioning, particularly anhedonia symptoms in Hispanic women. Findings underscore the importance of considering both exposure mixtures as well as potential modifying factors to better help identify particular pollutants that drive effects and susceptible populations, which can inform more effective intervention strategies.

Mapping urban health policies: A scoping review of environmental, behavioural and socioeconomic determinants of health

Researchers have consistently shown that determinants of health—factors beyond healthcare, including the built environment and socioeconomic conditions— significantly impact health outcomes. This understanding has led to a growing trend in recent decades towards policy discourse that links determinants of health with health outcomes. However, the scientific community's access to these policies in a structured and systematised manner remains limited. The importance of this gap cannot be overstated, as information about which determinants of health are discussed and prioritised in policy agendas is spread across various documents from different organisations, making it difficult to address relevant policy questions promptly. A scoping review of urban health policies was conducted following JBI guidelines to bridge this gap. The aim was to create a structured framework that outlines the environmental, behavioural, and socioeconomic determinants of health included in policy agendas, as well as how they are understood and prioritised, their relationships with each other and with health outcomes, and how they vary across different geographic and governance levels. Using content analysis methods, 128 policy documents from intergovernmental, national, regional, and local governance levels were analysed, covering the World and European region and the cities of London, Lisbon, and Copenhagen from 2010 to 2022. The review identified 83 determinants of health employed in policy discourse, categorising them into nine priority themes: healthy diet; drug, alcohol, and tobacco; social cohesion; physical activity; safety; active travel; natural and open spaces; environmental exposures; and basic services. These determinants of health were organised in a structured framework to illustrate their perceived relationships with each other, the priority themes, and health outcomes, as well as their prioritisation in policy discourse based on their frequency of use in urban health policy. This review represents the first comprehensive scope of how determinants of health are employed in policy discourse. The resulting conceptual framework offers a remarkably comprehensive mapping of the systemic relations between determinants of health and health outcomes, which forms a valuable tool for guiding research and practice on the policy-suggested complex multivariate causal pathways between variables. This framework provides a foundation for systematically exploring previously challenging questions, such as how research evidence is being translated into policy discourse and which aspects of this discourse are being implemented into action. Moreover, the scoping review and content analysis protocol can be replicated in other geographic regions, providing insights into potential outcome variations.

Socioeconomic determinants of malaria and hepatitis infections: insights from the Federal Medical Center, Makurdi, North Central, Nigeria

BackgroundMalaria and hepatitis are prevalent public health issues in Nigeria, significantly impacting health outcomes. Given the importance of the Federal Medical Center, Makurdi, as a key healthcare provider in the region, it is crucial to understand the prevalence and factors associated with these diseases within this setting. This study is designed to address this need, aiming to evaluate the prevalence and risk factors of malaria and hepatitis B and C among patients at the Federal Medical Center, Makurdi.MethodologyA cross-sectional study design was employed, involving the meticulous analysis of patient records and diagnostic data from the Federal Medical Center, Makurdi. Data on malaria and hepatitis B and C prevalence were collected from laboratory reports and patient interviews. Socioeconomic information, including income, education level, and healthcare access, was also gathered. Statistical analyses were performed with utmost care to identify associations between disease prevalence and risk factors.ResultsThe study examined 248 patients at the Federal Medical Centre, Makurdi, assessing malaria, Hepatitis B surface antigen (HBsAg), and Hepatitis C virus (HCV). Malaria prevalence was 52.4%, with higher rates in males (57.7%) than females (47.2%). HBsAg prevalence was 6.9%, and HCV was 4.8%, with no significant differences by sex or marital status. Income level impacted HCV rates, with middle-income individuals showing higher prevalence (21.4%). Malaria was most common in the 26–40 age group (35.4%).DiscussionThe findings underscore the need for targeted public health interventions. Enhanced access to preventive measures, such as insecticide-treated nets and safer blood transfusion practices, and educational disease prevention programs, are essential. Addressing socioeconomic disparities is crucial for effective disease control.ConclusionTo mitigate the burden of malaria and hepatitis B and C at the Federal Medical Center, Makurdi, a multifaceted approach is required. Improving preventive measures, healthcare access, and addressing socioeconomic determinants will reduce disease prevalence and improve patient outcomes.

Trajectories of antidepressant use after tamoxifen initiation among young and middle-aged women with breast cancer.

Antidepressant treatment patterns may change after women with breast cancer (BC) initiate tamoxifen, potentially impacting health outcomes. We characterized trajectories of antidepressant use after initiating tamoxifen among young and middle-aged women with BC, identifying risk factors for trajectory group membership. A retrospective cohort included women 18-64years-old with BC and antidepressant treatment history who received a new tamoxifen dispensing (index date). We measured longitudinal antidepressant use post-index date as 12, monthly, proportion of days covered (PDC) measurements in a 25% random sample of IQVIA PharMetrics® Plus for Academics US claims, 2006-2022. Group-based trajectory models identified latent subgroups of antidepressant use by testing 2-6-group representations; the best model fit determined by the lowest Bayesian Information Criterion, clinical interpretability, and each subgroup comprising ≥ 5% of the cohort. Using multinomial logistic regression, baseline covariates including demographics, depression status and the CYP2D6-inhibitory strength of antidepressants were evaluated as risk factors for the trajectory of antidepressant use after tamoxifen initiation. Our sample of 851 women followed four distinct antidepressant adherence trajectories after tamoxifen initiation: 12% exhibited immediately decreasing use [mean PDC (sd) 8% (± 7)]; 7% exhibited delayed decreasing use [41% (± 14)]; 20% exhibited dynamic-moderate use [54% (± 15)]; and 60% exhibited consistently high use [91% (+ 7)]. Age, depression, and treatment with non CYP2D6-inhibiting antidepressants were associated with women's trajectory of antidepressant use after initiating tamoxifen. Nearly 40% of women were nonadherent to antidepressants after tamoxifen initiation. Future research should explore cancer-related and mental health implications of this nonadherence.

Abstract 4135127: Traveling more than a 20-mile radius to a Heart Failure Center can affect the quality of Heart Failure Care.

Introduction: We recognized the profound importance of access to care among patients with heart failure (HF). The geographical location of HF centers may significantly impact health outcomes, especially for those with limited transportation. This social determinant of health (SDOH) aspect is critical in bridging the gap in achieving HF care. Hypothesis/Methods: This was a single-center observational study conducted at a tertiary heart failure center in central Pennsylvania. We assessed the impact of travel distance by comparing patients who travel within a 20-mile radius to those who travel beyond a 20-mile radius. A total of 322 patients were referred to the HF clinic and enrolled in a guideline-directed medical therapy (GDMT) optimization program. Data collected included distance to Hershey Medical Center (HMC), health insurance coverage, HF etiology, onset, and echocardiogram. The distance was calculated based on the patient’s zip code. Results: Among patients enrolled in the HF-GDMT program, 194 travel within 20 miles, and 128 travel beyond a 20-mile radius to HMC. The mean travel distance to HMC was 9.1 miles (within) and 40.9 miles beyond 20 miles. The majority of patients were 81.3% white, 67% male, and the average age was 64. Most patients had heart failure with reduced ejection fraction (HFrEF) at 92.9%, 63% nonischemic, and 57.5% new onset. The comorbidities in both groups were similar, including hypertension, hyperlipidemia, and coronary artery disease (CAD). When comparing both groups, those who traveled beyond the 20-mile radius to HMC had more chronic HF at 55.5% vs. 34% in patients who traveled within the 20-mile radius. Upon enrollment, most patients were on suboptimal doses of either 1 or 2 of the four pillars of GDMT for HFrEF. Conclusions: The findings of this study revealed that patients with HF who travel beyond a 20-mile radius to HMC are more likely to have chronic HF, suggesting a delay in seeking care. A delay in referral may affect the timely initiation of appropriate GDMT and will likely lead to worse health outcomes. This underscores the urgent need for interventions to address barriers like transportation to improve HF care, offering a potential avenue for better patient outcomes.

Racial disparity in mortality from tuberculosis in the US between states with and without a history of Jim-Crow laws: an analysis of the Global Burden of Disease (GBD) and risk factors study, 1990 to 2019.

While TB-related mortality in the US declined four-fold from 1990 to 2019, country-level estimates of TB burden obscure within-state racial heterogeneity and changes in TB burden over time. In sixteen US Southern States and Washington DC, the effects of health inequities engendered by Jim-Crow laws enacted from the late 1800s to the 1960s have not been evaluated for TB-related mortality. We, therefore, sought to compare TB mortality rates and annualized rate of change (AROC) between 1990 and 2019 in former Jim-Crow vs. non-Jim-Crow states to help guide response efforts and inform resource prioritization to improve racial equity. We evaluated whether TB-related mortality varied over time, from 1990 to 2019, between states that have a history of enacting Jim-Crow laws vs. states with no such history using estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). TB mortality per 100,000 population and bootstrap 95% uncertainty intervals (UIs) were modeled using the Cause of Death Ensemble model (CODEm) framework with varying combinations of predictive covariates. For changes over time, we present age-standardized AROC as the percent difference in the natural logarithm of the rate in 1990 and 2019 divided by 30 (i.e., 100*[ln(2019 Rate/1990 Rate)/(30)) and the corresponding 95% UIs. TB-related mortality in all US states declined between 1990 and 2019. From 1990 to 2019, most former Jim-Crow states had higher mortality rates than states that did not enact Jim-Crow laws. The most significant decline in TB mortality was in Washington DC, with a six-fold decline from 2.69 (2.46-2.96) per 100,000 population in 1990 to 0.45(0.37-0.55) in 2019, corresponding to an AROC of -0.83% (-0.86;-0.79). The lowest decline was in Iowa, from 0.30 (0.27-0.33) to 0.09 (0.07-0.11) (AROC: -0.70% (-0.76; -0.63)). Eleven of the 16 states and Washington DC in the third tertile of TB mortality rate in 1990 (range 0.81-2.69) had a history of Jim-Crow laws, whereas none of the 17 states in the first tertile (range 0.30-0.51) had such history. Conversely, mortality decreased relatively slowly in former Jim-Crow states than in non-Jim-Crow states. Even though the 1964 Civil Rights Act dismantled Jim-Crow statutes, racial inequities in TB burden experienced by past generations may still be felt in subsequent generations. Understanding the role of structural racism at the intersection of science and medicine shows the complex ways historical laws, such as Jim-Crow laws, continue to negatively impact health outcomes and warn of future dangers, such as COVID-19, to avoid.

Unincorporation in counties as a political determinant of health: An exploration of five states

Local government policies and practices shape the context of the places that can alter a population's life chances through socioeconomic factors, built environments, and healthcare access. County governments, one of the most ubiquitous U.S. political structures, impact health outcomes within their jurisdiction through multiple policy levers and pathways. By identifying which political determinants within counties are associated with variation in life expectancy and premature death, we can better intervene on modifiable factors. One overlooked political determinant from public health studies is the county's responsibility as the primary local government for approximately a third of the U.S. population and 93% of land in unincorporated areas. To conduct an ecological study and assess associations between county population health and county responsibility for unincorporated areas and populations, we created and tested two county indicators of unincorporation. Multilevel multivariable regression results showed that larger proportions of unincorporated land within a county are associated with lower average county life expectancy. More testing of the measurement is needed to understand the relationship between unincorporation, county government, and population health outcomes.

Accuracy is inaccurate: Why a focus on diagnostic accuracy for medical chatbot AIs will not lead to improved health outcomes.

Since its launch in November 2022, ChatGPT has become a global phenomenon, sparking widespread public interest in chatbot artificial intelligences (AIs) generally. While not approved for medical use, it is capable of passing all three United States medical licensing exams and offers diagnostic accuracy comparable to a human doctor. It seems inevitable that it, and tools like it, are and will be used by the general public to provide medical diagnostic information or treatment plans. Before we are taken in by the promise of a golden age for chatbot medical AIs, it would be wise to consider the implications of using these tools as either supplements to, or substitutes for, human doctors. With the rise of publicly available chatbot AIs, there has been a keen focus on research into the diagnostic accuracy of these tools. This, however, has left a notable gap in our understanding of the implications for health outcomes of these tools. Diagnosis accuracy is only part of good health care. For example, crucial to positive health outcomes is the doctor-patient relationship. This paper challenges the recent focus on diagnostic accuracy by drawing attention to the causal relationship between doctor-patient relationships and health outcomes arguing that chatbot AIs may even hinder outcomes in numerous ways including subtracting the elements of perception and observation that are crucial to clinical consultations. The paper offers brief suggestions to improve chatbot medical AIs so as to positively impact health outcomes.

Implementation of an outpatient clinical pharmacy service at an adult cystic fibrosis center

BackgroundHigh treatment burden can adversely impact health outcomes in people with cystic fibrosis (PwCF). There is a continued need for medication adherence education and further research to evaluate impact of cystic fibrosis (CF) pharmacist interventions in an ambulatory care setting. ObjectivesTo evaluate whether pharmacist integration into an outpatient adult CF clinic can positively impact patient satisfaction and medication adherence through various pharmacist-based interventions. MethodsAt a single urban medical center, a clinical pharmacist on an adult CF care team conducted comprehensive counseling sessions with PwCF. During these visits, types of pharmacist interventions were documented. Patients were provided a baseline and postcounseling survey to assess satisfaction with the pharmacist visit. Adherence to cystic fibrosis transmembrane regulator (CFTR) modulator and mucolytics were tracked 12 months before and 12 months after the counseling session. ResultsA total of 723 pharmacist interventions were performed throughout 100 pharmacist visits in 100 PwCF. Most common interventions were inhaler technique education (17%), drug interaction identification (12%), provision of drug education material (12%), and medication refills (12%). Prior to any intervention, 97% of patients felt they could benefit from a pharmacist visit. Postcounseling survey results demonstrated that 98% of patients found pharmacist counseling to be beneficial. Medication adherence rate prior to pharmacy intervention was 81.9% for CFTR modulators and 62.5% for mucolytics, and 86.9% (P = 0.143) and 63.6% (P = 0.773), respectively, after pharmacist intervention. ConclusionIntegration of a clinical pharmacist within the CF clinic can help improve satisfaction and understanding of medication use among PwCF. Nearly all PwCF favorably perceived pharmacist counseling. We report that various pharmacist interventions including optimizing medication use knowledge, reinforcing adherence strategies, and streamlining timely access to treatment can contribute to enhanced care of PwCF.

11.D. Scientific session: Participatory approaches and co-creation in complex interventions to reduce inequity in health

Abstract Health disparities are linked to social inequalities, necessitating health researchers to address the health gaps that exist between different social groups, particularly in the realm of health interventions. This workshop delves into the significance of co-creation processes and participatory approaches in complex health interventions to reduce social inequities in health outcomes. Through empirical cases illustrating co-creation processes in intervention research, the workshop aims to enlighten the audience on the continuum of participatory approaches. The MRC/NIH framework of complex interventions highlights the importance of engagement with relevant stakeholders throughout the research phases to enhance the likelihood of developing or identifying interventions that can positively impact health outcomes. However, the extent and nature of stakeholder involvement may vary depending on the specific context and stage of the research. While stakeholder involvement has been a longstanding focus, the concept of co-creation, where stakeholders actively participate in the entire process of intervention development, implementation, and evaluation, has emerged more recently. This shift from creating interventions for the target population to collaborating with them in the intervention’s creation has led to the emergence of more inclusive health interventions that are contextually relevant and tailored to the local settings where they are intended to create change. Yet, introducing participatory approaches in intervention research may raise new questions about decision-making and power dynamics. While interventions led solely by experts and researchers may overlook the empowerment and capacity-building potential among stakeholders and intervention sites, co-creation processes have the capacity to empower stakeholders and address health inequities effectively. However, challenges persist in ensuring equal collaboration between researchers and participants, especially in disadvantaged groups. This workshop aims to prompt reflection on ethical issues arising from traditional health intervention approaches and approaches to ensure participants’ ownership of interventions when they are adapted in new contexts. Moreover, this workshop will discuss the design of participatory interventions: What methods can we use to co-create? What stakeholders to involve? At what stages of the intervention should co-creation occur? The workshop program begins with an introductory presentation of participatory approaches and co-creation in health intervention research, with examples from a school-based intervention. Next, three empirical cases of co-creation processes introduced in interventions in different contexts are presented. Finally, the audience is invited to a take part in a discussion focusing on how participatory approaches among disadvantaged populations can potentially contribute to reduced social inequity in health. Key messages • The involvement of stakeholders in the development, implementation and evaluation of health interventions can take many forms, and what is meaningful for the specific context needs to be considered. • Co-creation approaches in health interventions empower participants and address unequal power dynamics between those who deliver and those who receive health interventions.

Psychological distress in Aotearoa New Zealand adults with type 1 diabetes.

The psychological burden of type 1 diabetes (T1D) can negatively impact health outcomes. This study evaluates the prevalence of low mood (WHO-5), disordered eating (DEPS-R), diabetes distress (PAID) and fear of hypoglycaemia (HFS-II), in a sample of 250 New Zealand adults (8.4% Māori/91.6% non-Māori; 43.6% female/56.4% male) with T1D using validated tools. Māori and female patients indicated low mood, with lower median WHO-5 scores than non-Māori (p = 0.027) and males (p = 0.002). Māori were more likely to score in the clinical range on the WHO-5, DEPS-R, PAID and HFS-II (all p < 0.05). HbA1c was correlated with emotional well-being (rs = -0.189), diabetes distress (rs = 0.223) and disordered eating (rs = 0.389; all p < 0.001) whilst DEPS-R correlated with age (rs = -0.232) and BMI (rs = 0.343; both p ≤ 0.001). Thus, diabetes-related psychological distress is common in New Zealand adults with T1D, particularly for Māori, females and those with elevated HbA1c levels.

Toward diversification of acute stressors and precision stress research: A stage 2 Registered Report validating a reward-salient stress task in emerging adults.

Stress is one of, if not the, most ubiquitously studied risk factor across the health sciences. This is unlikely to change given that the primary drivers of mortality and disability are chronic, stress-mediated illnesses (often highly comorbid with psychopathology). We argue that an important limitation of stress research is the consistency with which the Trier Social Stress Test is used when the research questions are not specific to social stress. We advocate for precision stress research using qualitatively different stressors to facilitate exploration of how different types of stressors might differentially impact health outcomes, including psychopathology. This registered report validates a reward-salient stress task (a modified Anger Incentive Delay Task) in a sample of 101 emerging adults, over half of whom reported clinically relevant anxiety, hypo/mania, depression, and/or suicidal ideation, who participated in a study between 2020 and 2022. This task involves teaching participants a game where they can win money. Part way through, the "goal frustration" condition changes the rules such that correct responses to trials with anticipatory stimuli indicating the possibility to win money actually lose money on 56% of trials despite visual feedback indicating that responses were successful. Results consistently indicated that the Anger Incentive Delay Task successfully reduced positive emotions and motivation and increased negative emotions. The magnitude of these responses was predicted by individual differences in reward and punishment sensitivity. Given the breadth of psychopathologies that share both (a) stress and (b) reward and punishment sensitivity as risk factors, a reward-salient acute stress task is an important tool for precision psychopathology research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Association between dietary inflammatory index and all-cause mortality in US adults with dermatitis: a population-based cohort study.

While dermatitis management is primarily symptomatic, the role of diet in symptom exacerbation and improvement is increasingly recognized. The dietary inflammatory index (DII), a quantitative assessment tool for dietary inflammatory potential, has been associated with various chronic diseases but remains understudied in dermatitis. This cohort study investigated the association between DII scores and all-cause mortality among patients with dermatitis. The study included 1,074 patients with dermatitis and complete dietary intake records from the National Health and Nutrition Examination Survey (NHANES) 1999-2004. The DII scores were calculated using two 24-h dietary recalls and dietary supplement intakes and the consumption of 28 foods with known pro- or anti-inflammatory properties. All-cause mortality information was from the National Death Index, censored on December 31, 2019. Multivariable Cox hazards regression models, restricted cubic spline (RCS) models, and subgroup analyses were employed to evaluate the association of DII with all-cause mortality, adjusting for potential confounders. The 1,074 patients were divided into DII tertiles (T1: n = 358, median age 40 years, DII -3.91, 0.06; T2: n = 296, median age 40 years, DII 0.06, 1.88; T3: n = 237, median age 39 years, DII 1.88, 4.39). The study revealed a positive correlation between higher DII scores and increased all-cause mortality risk among patients with dermatitis (fully-adjusted model, HR = 1.13, 95% CI 1.02, 1.27, p = 0.026). This association was more pronounced in adults over 45 years, with the highest DII tertile indicating a 2.42-fold increased mortality risk (95% CI 1.15, 5.07, p = 0.019) compared with the lowest tertile. The RCS model confirmed a linear dose-response trend (p for non-linear = 0.183), validating the relationship. Elevated DII scores are associated with an increased risk of all-cause mortality in patients with dermatitis, suggesting that the dietary inflammatory potential may impact health outcomes in this population. The findings underscore the importance of dietary interventions in dermatitis management, especially for middle-aged and older adults. Future research with larger cohorts and a longer follow-up is warranted to validate the findings.

Association between lifetime criminal legal involvement and acute healthcare utilization in middle-aged and older US adults, 2015-2019.

Five decades into the era of mass incarceration, a growing number of older adults have experienced criminal legal involvement (CLI) in their lifetime. Studies have shown that prior incarceration is associated with substantial disease burden, but little is known about the distinct needs and utilization patterns of middle-aged and older adults with lifetime CLI compared to those without. Using a nationally representative data set, we tested the association between lifetime CLI exposure and use of acute care services among middle-aged and older adults. Our sample included 44,007 US adults (25,074 middle-aged-50-64 years; 18,709 older- ≥65 years) who participated in the National Survey of Drug Use and Health (2015-2019). The data is publicly available. Our independent variable was lifetime CLI. Using separate negative binomial regression models for middle-aged and older adults, we tested the association between lifetime CLI and acute healthcare utilization (ED visits and nights spent inpatient) controlling for relevant sociodemographic covariates. For middle-aged respondents, 19.1% reported lifetime CLI; for older adults, the rate of exposure was 9.6%. In multivariate models, CLI was associated with increased ED visits in middle-aged adults (IRR 1.18, 95% CI 1.06-1.31) but not older adults (IRR 0.99, 95% CI 0.85-1.16). CLI was associated with increased nights hospitalized in both groups (middle-aged: IRR 1.33, 95% CI 1.08-1.62; older adults: IRR 1.26, 95% CI 1.01, 1.57). Middle-aged and older adults with lifetime CLI experience higher rates of acute care utilization than their peers with no lifetime CLI, even after adjustment for confounders. As the cohort of adults from the era of mass incarceration ages, understanding the mechanisms by which lifetime CLI impacts health outcomes is crucial in designing interventions to improve outcomes and reduce unnecessary acute healthcare utilization.

Eating traditional foods enhances diet quality among First Nations in Canada: an analysis using the Healthy Eating Food Index-2019 (HEFI-2019) and the Canadian Healthy Eating Index 2007 (C-HEI 2007).

Understanding the dietary patterns of First Nations is crucial for addressing health disparities and promoting well-being. Historical assaults (colonization and loss of control over their lands) have strongly altered dietary practices and impacted health outcomes for generations. Canada conducts regular surveys to assess the extent to which individuals adhere to dietary guidelines. However, Indigenous peoples living on reserves are excluded from these surveys. This study aims to assess the diet quality of First Nations adults using the Healthy Eating Food Index-2019 (HEFI-2019) and the Canadian Healthy Eating Index 2007 (C-HEI 2007) and identify their influencing factors. Data were collected from adults (19 years and older) across ninety-two First Nations communities throughout Canada. Participants provided information on sociodemographic factors and dietary intake using structured questionnaires and 24 h dietary recalls. Statistical analyses included mean scores and regression models to assess associations between dietary indices and influencing factors. The mean HEFI-2019 and C-HEI 2007 scores among First Nations adults were 35/80 and 49/100, respectively, indicating suboptimal adherence to dietary guidelines compared to the Canadian population. Factors such as region, age, sex, education level, number of working people in the household, smoking status, and traditional food intake significantly influenced diet quality. This study underscores the importance of understanding and improving the diet quality of First Nations adults as measured by HEFI-2019 and C-HEI 2007 scores. While acknowledging the low adherence to dietary guidelines, particularly in younger age groups, the study highlights the positive influence of traditional foods on diet quality within Indigenous communities.