Lack Of Health Insurance Research Articles

Predictors of mortality among children at a tertiary hospital in Tanzania: a cohort study

BackgroundTanzania is among the countries in sub-Saharan Africa with the highest under-five mortality rate. The leading causes of mortality among these children include vaccine-preventable infections. Strategies for reducing under-five mortality in hospital settings require a good knowledge of driving factors, which are largely unknown in Tanzania. This study was conducted at Muhimbili National Hospital to determine mortality and its predictors among under-five admitted in the general paediatric wards.MethodsWe conducted a prospective cohort study among children aged between 1 and 59 months admitted in the paediatric wards at Muhimbili National Hospital from 2nd October 2017 to 13th April 2018. We recruited eligible children consecutively and followed them up until discharge or death. We calculated the mortality rate as the incidence density rate and determined the causes and predictors of mortality. We analyzed data to identify and quantify predictors of deaths and used Kaplan-Meir and Cox regression analyses to determine predictors of survival. A P-value of < 0.05 was considered statistically significant.ResultsWe recruited 925 children aged 1–59 months with a median age of 13 and (IQR) of (20) months, females constituted 40.8%. The overall mortality rate was 12.2% (95% CI: 10.2%-14.5%). We found septicaemia (27%), malnutrition (12%), congenital heart disease (12%), pneumonia (11%), and Human Immunodeficiency Virus infection (9%) to be leading causes of mortality. More deaths were observed at night, during the first 24 h of admission, and on weekends. Independent factors for mortality were found to be low wealth quintiles (lowest quintile (AOR = 4.0; 95% CI: 1.19–13.51), second quintile (AOR = 5.2; 95% CI: 1.65–16.69) and middle quintile (AOR = 3.6; 95% CI: 1.14–11.33), unconsciousness on admission (AOR = 18; 95% CI: 6.70–56.82), inability to feed (AOR = 5.7; 95% CI: 1.97–16.51), lethargy (AOR = 4.9; 95% CI: 2.32–10.40), severe wasting (AOR = 4.5; 95% CI: 2.49–8.10), and respiratory distress (AOR = 2.6; 95% CI: 1.40–4.97).ConclusionA high mortality rate was noted in this study and low wealth quantile, low parental education, and lack of health insurance were associated with high mortality. Patients had the highest risk of mortality within 24 h of admission, therefore it is important to raise awareness among clinicians regarding the need for improvement in the monitoring of patients, especially within 24 h of admission.

Textbook oncological outcomes and prognosis after curative gastrectomy in advanced gastric cancer: A multicenter study

BackgroundThe impact of achieving textbook oncological outcome (TOO) as a multimodal therapy quality indicator on the prognosis of advanced gastric cancer (AGC) remains inadequately assessed. MethodsPatients with AGC who underwent curative gastrectomy between January 2010 and December 2017 at two East Asian medical centers were included. TOO was defined as achieving the textbook outcome (TO) and receiving neoadjuvant and/or adjuvant chemotherapy (NCT or ACT). Cox and logistic regression models were used to identify prognostic and non-TOO-associated risk factors. ResultsAmong 3626 patients, 57.6% achieved TOO (TOO group), exhibiting significantly better 5-year overall survival (OS) and disease-free survival (DFS) than the non-TOO group (both p < 0.05). Multivariate Cox regression identified TOO as an independent prognostic factor for 5-year OS (HR, 0.67; 95% CI, 0.61–0.74; p < 0.001) and DFS (HR, 0.73; 95% CI, 0.66–0.81; p < 0.001). Multivariate logistic regression showed that open gastrectomy, lack of health insurance, age ≥65 years, ASA score ≥ Ⅲ, and tumor size ≥50 mm are independent risk factors for non-achievement of TOO (all p < 0.05). On a sensitivity analysis of TOO's prognostic value using varying definitions of chemotherapy parameters, a stricter definition of chemotherapy resulted in a decrease in the TOO achievement rate from 57.6 to 22.3%. However, the associated reductions in the risk of death and recurrence fluctuated within the ranges of 33–39% and 28–37%, respectively. ConclusionsTOO is a reliable and stable metric for favorable prognosis in AGC. Optimizing the surgical approach and improving health insurance status may enhance TOO achievement.

Cost-related medication nonadherence in adults with COPD in the United States 2013-2020.

Cost-related medication nonadherence (CRN) is associated with poor prognosis among patients with chronic obstructive pulmonary disease (COPD), a population that requires long-term treatment for secondary prevention. In this study, we aimed to estimate the prevalence and sociodemographic characteristics of CRN in individuals with COPD in the US. In a nationally representative survey of US adults in the National Health Interview Survey (2013-2020), we identified individuals aged ≥18 years with a self-reported history of COPD. Cross-sectional study. Of the 15,928 surveyed individuals, a weighted 18.56% (2.39 million) reported experiencing CRN, including 12.50% (1.61 million) missing doses, 13.30% (1.72 million) taking lower than prescribed doses, and 15.74% (2.03 million) delaying filling prescriptions to save costs. Factors including age < 65 years, female sex, low family income, lack of health insurance, and multimorbidity were associated with CRN. In the US, one in six adults with COPD reported CRN. The influencing factors of CRN are multifaceted and necessitating more rigorous research. Targeted interventions based on the identified influencing factors in this study are recommended to enhance medication adherence among COPD patients.

Exploring refugees' experience of accessing dental health services in host countries: a scoping review.

Refugees often face worse oral health outcomes, such as periodontal diseases and dental caries in host countries due to barriers including language and cultural differences, institutional discrimination, and restricted use of dental health services. This scoping review aims to map and summarise the available studies on refugees' experience of accessing dental health services in the host countries, to identify the main characteristics of the dental health services that refugees access and to explore the barriers and enablers to navigate the dental health service system in their host countries. The Joanna Briggs Institute (JBI) framework was adopted. PubMed, Scopus, Assia, CINAHL and Social Services Abstract were searched. A search strategy was developed using Medical Subject Headings (MeSH) terms and a combination of search operators and syntax used in MEDLINE were adopted for the remaining databases. Data were synthesised using thematic analysis. Fourteen articles were included. Most studies used qualitative methods and Australia seemed to be the country with the highest number of publications surrounding this topic. The included studies showed that refugees frequently encountered substantial obstacles when attempting to access dental services in host countries. Numerous barriers such as language barriers, cultural differences, and lack of health insurance or financial support hindered refugees' ability to access these services. Additionally, many refugees possessed limited knowledge of the dental care system in their new country. As a result of untreated dental problems, refugees suffered from pain and other health complications. This scoping review explored the challenges refugees have experienced in accessing dental health services in host countries, which included the key barriers such as affordability, accessibility, accommodation, availability, awareness, and acceptability. The scarcity of relevant research highlighted the need for a more comprehensive understanding of refugees' experiences accessing dental health services in host countries. Limited data were identified regarding evidence focusing on the characteristics of dental services accessed by refugees in host countries.

Social determinants of health and treatment center affiliation: analysis from the sickle cell disease implementation consortium registry

BackgroundAdults with sickle cell disease (SCD) suffer early mortality and high morbidity. Many are not affiliated with SCD centers, defined as no ambulatory visit with a SCD specialist in 2 years. Negative social determinants of health (SDOH) can impair access to care. Hypothesis: Negative SDOH are more likely to be experienced by unaffiliated adults than adults who regularly receive expert SCD care.MethodsCross-sectional analysis of the SCD Implementation Consortium (SCDIC) Registry, a convenience sample at 8 academic SCD centers in 2017–2019. A Distressed Communities Index (DCI) score was assigned to each registry member’s zip code. Insurance status and other barriers to care were self-reported. Most patients were enrolled in the clinic or hospital setting.ResultsThe SCDIC Registry enrolled 288 Unaffiliated and 2110 Affiliated SCD patients, ages 15-45y. The highest DCI quintile accounted for 39% of both Unaffiliated and Affiliated patients. Lack of health insurance was reported by 19% of Unaffiliated versus 7% of Affiliated patients. The most frequently selected barriers to care for both groups were “previous bad experience with the healthcare system” (40%) and “Worry about Cost” (17%). SCD co-morbidities had no straightforward trend of association with Unaffiliated status. The 8 sites’ results varied.ConclusionThe DCI economic measure of SDOH was not associated with Unaffiliated status of patients recruited in the health care delivery setting. SCDIC Registrants reside in more distressed communities than other Americans. Other SDOH themes of affordability and negative experiences might contribute to Unaffiliated status. Recruiting Unaffiliated SCD patients to care might benefit from systems adopting value-based patient-centered solutions.

Bridging the Gap: Addressing Immigrant Health Through Community-initiated Screening Events

Abstract: Background: In areas of new-immigrant population growth, medical and social infrastructure may be lagging behind the needs of those who do not identify with the majority culture or language. Subsequently, information regarding this population's health status and access to care is limited. Montana's Hispanic population is one such group. Despite its low total population, the state has experienced unprecedented growth in the number of Spanish-speaking individuals and families over the last decade. Objectives: We utilized a community based participatory research framework to emphasize equal partnership between lay community members and researchers to ensure adherence to community priorities and strengthen trust between the two parties allowing for future collaboration. Based on community request, we designed four health screening events to provide needed health prevention services to the Hispanic community. Methods: Through collaboration with a Community Advisory Board, we created four health screening events to provide basic primary care services, including height and weight, blood pressure, diabetes, and mental health screenings. We partnered with a team of dental hygienists to provide oral preventive health. We conducted a cost-effectiveness analysis, comparing our approach to traditional health services. Study variables were analyzed using analysis of variance to examine differences in health outcomes between health screening events. Results: We screened 140 persons and found that 85.7% lacked health insurance and 80.7% lacked a usual source of care. We also found overweight and obesity in 47.1% and 27.1%, respectively, and hypertension in 63.6%. Services provided by the health screening events were up to $239 less expensive than comparable services provided at local health centers. Conclusions: Working directly with the community, we designed and implemented health prevention events which served to meet a growing need and to identify and address health concerns among the Hispanic immigrant community.

Emerging Adult Mental Health During COVID: Exploring Relationships Between Discrete and Cumulative Individual and Contextual Stressors and Well-Being

PurposeIndicators of poor mental health increased during the COVID-19 pandemic among emerging adults aged 18–24 years, a group already at elevated risk. This study explores associations between contextual and personal stressors with symptoms of emerging adults’ anxiety and depression, assessing both multidimensional and distinct measures of stress. MethodsUsing Census Household Pulse Surveys from emerging adults aged 18 to 24 years (N = 71,885) and administrative data from April 23, 2020 to March 29, 2021, we estimated logistic regression models adjusted for state and wave fixed effects. ResultsRates of elevated anxiety and depressive symptoms rose dramatically among emerging adults during the first year of the COVID-19 pandemic. Results indicate that potential contextual stressors—state COVID-19 rates and state COVID-19 mitigation policies limiting social interactions (stay-at-home orders, restaurant closures, large gathering restrictions, and mask mandates)—were not significantly associated with symptoms. In contrast, personal economic stressors (nonemployment, household income loss, food insecurity, housing insecurity, lacking health insurance) and disruptions to education were associated significantly with elevated anxiety and depressive symptoms, with greater numbers of stressors associated with worse well-being. DiscussionEmerging adults reported persistently high levels of elevated anxiety and depressive symptoms during the first year of the pandemic, outcomes associated not with COVID-19 rates or mitigation policies, but with economic inequities, and other personal stressors heightened by the pandemic. Providing targeted support for young adults, including ensuring access to mental health supports, health care, and economic relief, is critical.

Exploring the Link: Health Insurance Coverage and Historical Substance Use Patterns Among U.S. Adults-A NHANES-Based Analysis.

This study analyzed the NHANES database (2016-2018), investigating substance use patterns among 6,108 U.S. adults (18-64 years), with a focus on health insurance, race/ethnicity, age, gender, and socioeconomic status. Among participants, 1,063 reported a history of substance use. A key finding was the correlation between health insurance coverage and substance use history; notably, 80% of those with a history of substance use were insured. Non-Hispanic Whites represented a significant proportion (76%) of substance users, exceeding their population representation. Age and gender differences were prominent, with older adults (50-64 years) comprising 41% of substance users, and males accounting for 61%. The study's reliance on self-reported substance use history from NHANES may introduce measurement bias. Such bias necessitates careful interpretation of the data, considering variations across demographic and socioeconomic variables. Logistic regression analysis revealed that lacking health insurance increased the odds of a history of substance use (OR = 1.43, p < .01). The interaction between insurance coverage and race/ethnicity was not significant. These findings underscore the multifaceted nature of substance use, highlighting the need for comprehensive public health strategies to address the diverse factors influencing substance use behaviors.

COVID-19 vaccination, infection, and symptoms among cancer survivors in the United States.

The experiences of cancer survivors with the COVID-19 pandemic in the United States during 2021 and 2022, when vaccinations became widely available, are largely undocumented. Using nationally representative survey data in 2021 and 2022, we found that compared with adults without a cancer history, cancer survivors were more likely to have at least 2 COVID-19 vaccines (2021: 66.6% vs 62.3%, P = .003; 2022: 77.0% vs 72.4%, P < .001) and as likely to have a COVID-19 infection history (2021: 14.1% vs 14.2%, P = .93; 2022: 39.9% vs 39.3%, P = .55) but, once infected, were more likely to develop moderate to severe symptoms (2021: 62.5% vs 54.2%, P = .02; 54.5% vs 61.3%; P = .13). Among cancer survivors, younger age, lower educational attainment, lack of health insurance, and more comorbidities were statistically significantly associated with lower vaccination rates (P < .001). Among infected cancer survivors, being female and younger were associated with higher likelihood of developing moderate to severe symptoms (P < .001). Our findings suggest tailored efforts to prevent and control COVID-19 infections for cancer survivors.

Access to healthcare and depression severity in vulnerable groups the US: NHANES 2013–2018

BackgroundAccess to healthcare is essential for managing chronic diseases, yet it often poses a barrier, contributing to a significant burden of conditions like depression. This study aimed to investigate the association between healthcare access and depression severity in contemporary free-living adults in the US, with a focus on identifying vulnerable populations. MethodData from the National Health and Nutrition Examination Survey cycles 2013–2018 were utilized, involving 13,689 participants aged 20 years or older. Multivariable multinomial logistic regression models were conducted, adjusting for various confounding variables. ResultsApproximately 17 % of US adults lacked access to healthcare, while 24 % experienced varying levels of depression severity, with 8 % having moderate-to-severe depression. More males faced challenges accessing healthcare, while more females reported diverse levels of depression. Both healthcare access and depression severity were associated with low educational attainment, low familial income, lacking spousal support, lacking health insurance coverage, and worse self-reported overall health. We found a higher vulnerability to moderate-to-severe depression among females (OR (95 % CI): 1.20 (0.91, 1.59)), individuals identifying as the Other ethnic group (1.69 (1.02, 2.79)), and those living without a spouse (1.57 (1.10, 2.26)). LimitationsOur cross-sectional study cannot establish causality, and potential biases related to self-reported data exist. ConclusionsAccess to healthcare emerged as a crucial predictor of moderate-to-severe depression among females, individuals of the Other ethnic group, and those without a spouse. Longitudinal research is needed to confirm and enhance our understanding of factors that shape the relationship between healthcare access and depression in free-living US adults.

Small for Gestational Age Newborns in French Guiana: The Importance of Health Insurance for Prevention.

Objectives: Small for gestational age (SGA) newborns have a higher risk of poor outcomes. French Guiana (FG) is a territory in South America with poor living conditions. The objectives of this study were to describe risk factors associated with SGA newborns in FG. Methods: We used the birth cohort that compiles data from all pregnancies that ended in FG from 2013 to 2021. We analysed data of newborns born after 22weeks of gestation and/or weighing more than 500g and their mothers. Results: 67,962 newborns were included. SGA newborns represented 11.7% of all newborns. Lack of health insurance was associated with SGA newborns (p < 0.001) whereas no difference was found between different types of health insurance and the proportion of SGA newborns (p = 0.86). Mothers aged less than 20years (aOR = 1.65 [1.55-1.77]), from Haiti (aOR = 1.24 [1.11-1.39]) or Guyana (aOR = 1.30 [1.01-1.68]) and lack of health insurance (aOR = 1.24 [1.10-1.40]) were associated with SGA newborns. Conclusion: Immigration and precariousness appear to be determinants of SGA newborns in FG. Other studies are needed to refine these results.

Birth cohort-specific consideration in an Emergency Department Hepatitis C Testing Programme: A description of age-related characteristics and outcomes.

The emergency department (ED) has increasingly become an important public health partner in non-targeted hepatitis C virus (HCV) testing and referral to care efforts. HCV has traditionally been an infection associated with the Baby Boomer generation; however, recent exacerbation of the opioid epidemic has resulted in a growing number of younger cohorts, namely Millennials, also impacted by HCV. Examination of this age-related demographic shift, including subsequent linkage success and linkage barriers, from the perspective of an ED-based testing and linkage programme may have implications for future population and health systems interventions. A retrospective descriptive chart review was performed, inclusive of data from August 2015 through December 2020. We compared the quantity of positive HCV screening antibody (Ab) and confirmatory (RNA) tests and further considered linkage rates and correlative demographics (e.g. gender, race). Patient barriers to HCV care linkage (e.g. substance misuse, lack of health insurance, homelessness) were also evaluated. The data set was disaggregated by birth cohort to include Silent Generation (SG) (1928-45), Baby Boomer (BB) (1946-64), Generation X (Gen X) (1965-80), Millennial (1981-96) and Generation Z (1997-2012). Descriptive statistics and chi-square analysis were performed. Overall, 83,817 patients were tested for HCV (50.6% of eligible); 6187 (7.4%) were HCV Ab positive, and 2665 were HCV RNA positive (3.2%). RNA-positive individuals were more likely to be white (70.4%) and male (67.7%); generational distribution was similar (BB 33.3%, Gen X 32.0% and Millennials 32.7%). Amongst Ab-positive patients, white (45.5%), male (47.2%) and Millennial (49.7%) individuals were most likely to be RNA-positive. Overall, 28.1% of the RNA-positive cohort successfully linked to care; linkage to care rates were significantly higher in older generations (38.1% in BB vs. 17.8% in Millennials) (p < .00001). Over 90% were identified as having at least one linkage to care barrier. Younger generations (Gen X and Millennials) were disproportionately impacted by linkage barriers, including incarceration, lack of health insurance, history of mental health and substance use disorders, as well as history of or active injection drug use (IDU) (p < .00001). Older generations (SG and BB) were more likely to be impacted by competing medical comorbidities (p < .00001). The ED population represents a particularly vulnerable, at-risk cohort with a high prevalence of HCV and linkage to care barriers. While past HCV-specific recommendations and interventions have focused on Baby Boomers, this data suggests that younger generations, including Gen X and Millennials, are increasingly affected by HCV and face disparate social risk and social need factors which impede definitive care linkage and treatment.

Improving Access to Eye Care Through Community Health Screenings Using Artificial Intelligence

ABSTRACT Purpose To the best of our knowledge, implementation of artificial intelligence (AI)-based vision screening in community health fair settings has not been previously studied. This prospective cohort study explored the incorporation of AI in a community health fair setting to improve access to eyecare. Methods Vision screening was implemented during a community health fair event using an AI-based non-mydriatic fundus camera. In addition, a questionnaire was provided to survey the various barriers to eyecare and assess eye health literacy. Results A total of 53 individuals were screened at this event. Notably, about 88% of participants had follow-up appointments scheduled accordingly with an approximate 62% attendance rate. The most reported barrier to eyecare was lack of health insurance followed by transportation. Conclusion The addition of AI-based vision screening in community health fairs may ultimately help improve access to eye care.

Barriers and facilitators to utilizing HIV prevention and treatment services among migrant youth globally: A scoping review.

Both migrants and young people experience disproportionately high rates of HIV acquisition and poor access to HIV prevention and treatment services. To develop effective interventions and reach epidemic control, it is necessary to understand the barriers and facilitators to accessing HIV services among migrant youth. We conducted a scoping review to identify these factors for migrant youth ages 15-24, globally. We conducted a PRISMA-concordant scoping review using keyword searches in PUBMED and Web of Science for peer-reviewed primary literature published between January 2012 and October 2022. We included studies that investigated barriers and facilitators to accessing services for migrant youth participants. We used the Socio-Ecological Model as an analytical framework. The 20 studies meeting the inclusion criteria spanned 10 countries, of which 80% (n = 16) were low- and middle-income countries. Study methods included were quantitative (40%), qualitative (55%), and mixed methods (5%). Six studies included refugee youth (30%), 6 included migrant worker youth (30%), 3 included immigrant youth (15%), 2 included rural migrant youth (10%), and 1 included immigrants and refugees. The remainder represented unspecified migrant youth populations (10%). At the individual level, education level and fear of infection acted as barriers and facilitators to HIV services. At the relationship level, social support and power in relationships acted as barriers and facilitators to HIV services. At the community level, barriers to HIV services included discrimination and stigma, while community and religious outreach efforts facilitated access to HIV services. At the structural level, barriers to HIV services included stigmatizing social norms, lack of health insurance, and legal barriers. Migrant youth face significant, unique barriers to accessing HIV services. However, facilitators exist that can be leveraged to enable access. Future implementation science research, enabling policies, and adapted programmatic interventions should prioritize migrant youth as a distinctive sub-population to receive targeted HIV services.

Measure Twice, Change Once: Using Simulation to Support Change Management in Rural Healthcare Delivery.

Barriers to adequate healthcare in rural areas remain a grand challenge for local healthcare systems. In addition to patients' travel burdens, lack of health insurance, and lower health literacy, rural healthcare systems also experience significant resource shortages, as well as issues with recruitment and retention of healthcare providers, particularly specialists. These factors combined result in complex change management-focused challenges for rural healthcare systems. Change management initiatives are often resource intensive, and in rural health organizations already strapped for resources, it may be particularly risky to embark on change initiatives. One way to address these change management concerns is by leveraging socio-technical simulation models to estimate techno-economic feasibility (e.g., is it technologically feasible, and is it economical?) as well as socio-utility feasibility (e.g., how will the changes be utilized?). We present a framework for how healthcare systems can integrate modeling and simulation techniques from systems engineering into a change management process. Modeling and simulation are particularly useful for investigating the amount of uncertainty about potential outcomes, guiding decision-making that considers different scenarios, and validating theories to determine if they accurately reflect real-life processes. The results of these simulations can be integrated into critical change management recommendations related to developing readiness for change and addressing resistance to change. As part of our integration, we present a case study showcasing how simulation modeling has been used to determine feasibility and potential resistance to change considerations for implementing a mobile radiation oncology unit. Recommendations and implications are discussed.

Lived experiences of people living with HIV and hypertension or diabetes access to care in Ethiopia: a phenomenological study

BackgroundPeople living with HIV (PLWH) are more likely to develop hypertension and diabetes than people without HIV. Previous studies have shown that HIV stigma, discrimination and exclusion make it difficult...

Immunogenicity of 2-Dose HPV Vaccine Series for Postpartum Women

Postpartum human papillomavirus (HPV) vaccination is a promising strategy to increase HPV vaccination uptake in the US, particularly for reaching vaccine-naive women and those who lack health insurance beyond the pregnancy period. However, completion of the 3-dose vaccine regimen is challenging. To evaluate the immunogenicity of a 2-dose postpartum HPV vaccination regimen (0 and 6 months) and assess whether it is noninferior to a 3-dose postpartum HPV vaccination regimen (0, 1-2, and 6 months) administered to historical controls. A noninferiority, open-label, nonrandomized immunogenicity trial was conducted from August 4, 2020, to June 23, 2022, of postpartum patients aged 15 to 45 years who delivered at 2 hospitals in Baltimore, Maryland. Historical controls were adolescents and young women aged 16 to 26 years. Two doses of the nonavalent HPV vaccine administered 6 months apart. The primary outcome was noninferiority (90% CI, lower bound >0.67) of the geometric mean titer (GMT) ratio for HPV-16 among postpartum women compared with historical controls. Secondary outcomes were noninferiority of GMT ratios for the other 8 HPV types and percentage seroconversion for each HPV type. As a noninferiority trial, the primary analysis used the per-protocol analysis. Of 225 enrolled participants, the mean (SD) age at baseline was 29.9 (6.8) years, and 171 (76.0%) were HPV-16 seronegative at baseline. Of these 171 participants, 129 (75.4%) received a second vaccine dose and completed the subsequent 4-week serologic measurements. Relative to historical controls, the HPV-16 GMT ratio was 2.29 (90% CI, 2.03-2.58). At month 7, HPV-16 GMT was higher after the 2-dose regimen (7213.1 mMU/mL [90% CI, 6245.0-8331.4 mMU/mL]) than among historic controls after the 3-dose regimen (3154.0 mMU/mL [90% CI, 2860.2-3478.0 mMU/mL]). Similarly, the lower bound of the 90% CI of the GMT ratio was above 1 for the 8 HPV types 6, 11, 18, 31, 33, 45, 52, and 58. A total of 118 of 134 women (88.1%) seroconverted for HPV-16 after the first dose; 4 weeks after the second dose, the seroconversion rate was 99% or greater for all HPV types. This study suggests that immunogenicity of a 2-dose HPV vaccination regimen given 6 months apart among postpartum women was noninferior to a 3-dose regimen among young historical controls. Most women seroconverted after the first dose of the 2-dose regimen. These results demonstrate that postpartum vaccination using a reduced schedule may be a promising strategy to increase HPV vaccine series completion. ClinicalTrials.gov Identifier: NCT04274153.

The role of neighborhood deprivation in the cervicovaginal microbiota

BackgroundLactobacillus-deficient cervicovaginal microbiota is associated with spontaneous preterm birth and is more common among Black individuals. Persistent racial segregation in the United States has led to differential neighborhood exposures by race that can affect pregnancy outcomes. The extent to which neighborhood exposures may explain racial differences in the cervicovaginal microbiota is unknown. ObjectiveWe sought to determine if neighborhood deprivation, defined as material community deprivation, is associated with a Lactobacillus-deficient cervicovaginal microbiota in a prospective cohort of pregnant individuals. Our hypothesis is that racial differences in neighborhood deprivation may explain the higher prevalence of Lactobacillus-deficient cervicovaginal microbiota in Black birthing people. Design/MethodsWe analyzed data from Motherhood & Microbiome, a prospective pregnancy cohort enrolled from prenatal clinics in a single hospital system 2013-2016 in which a Lactobacillus-deficient cervicovaginal microbiota was previously shown to be associated with spontaneous preterm birth. We geocoded addresses to obtain census tract neighborhood deprivation data from the Brokamp Nationwide Community Deprivation Index that uses weighted proportions of poverty, income, public assistance, lack of health insurance, and vacant housing. Generalized linear mixed models quantified associations of deprivation with the cervicovaginal microbiota accounting for geographical clustering by census tract and potential confounders. Due to different distributions of neighborhood deprivation and the cervicovaginal microbiota, we performed race-stratified models. Mediation analyses quantified the extent to which deprivation may contribute to racial differences in the cervicovaginal microbiota. ResultsHigher neighborhood deprivation was associated with a Lactobacillus-deficient cervicovaginal microbiota. Per standard deviation increment of deprivation, participants had 28% higher adjusted odds (aOR 1.28, 95% CI: 1.04-1.58) of a Lactobacillus-deficient microbiota. Black participants had higher odds of a Lactobacillus-deficient microbiota than White participants (aOR 4.00, 95% CI: 2.05, 8.26), and mediation analysis revealed that deprivation accounted for 22% (P=0.046) of that disparity. ConclusionNeighborhood deprivation was associated a Lactobacillus-deficient cervicovaginal microbiota and may partially explain Black-White disparities in the cervicovaginal microbiota. Mechanistic studies to explore how environmental exposures modify the cervicovaginal microbiota are warranted to identify novel opportunities for future interventional strategies to prevent preterm birth. As these findings demonstrate a potential biologic impact from neighborhood conditions, policies that drive urban planning should be explored to improve pregnancy outcomes.

Community perspectives on the use of extension offices for behavioral health

Rural communities experience more systemic health disparities than urban communities, particularly around behavioral health. Disparities include a lack of providers, few hospitals, lack of health insurance, stigma, and limited public transportation. This study explored the potential use of Cooperative Extension offices to serve as “hubs” for behavioral health services. We conducted six focus groups (n = 52) in rural communities with high rates of opioid use and misuse. Community stakeholders were asked about the potential benefits and barriers to using Cooperative Extension as a behavioral health hub and what role Extension can play in behavioral health. We identified four major themes related to the extension being used to address behavioral health: the organization is trusted, the organization could provide many services, potential structural and social barriers need to be addressed, and resources are necessary for success. The study found that Extension is trusted, lacks the stigma of a traditional behavioral health setting, and could provide prevention and/or recovery education and a connector to support services. However, Extension is not currently seen as a resource for behavioral health and may have structural barriers and create stigma by providing services. To address these barriers, it was suggested Extension partner with other organizations to extend the reach of existing resources (telehealth and support groups) while focusing on both prevention education and relationship building. Moving forward, participating counties will leverage their partners into a community advisory group to define next steps, develop processes and protocols and begin advertising services/resources, and provide continual feedback on how needs are being met and recommended improvements.

Lived Experiences of Hospitalized Patients With Coronavirus Disease at Tibebe Ghion Comprehensive Specialized Hospital, Bahir Dar, North West Ethiopia, A Phenomenological Study.

Hospitalized patients with coronavirus disease experienced different challenges at treatment centers; however, there is no evidence in Ethiopia on patients' experiences at COVID-19 treatment centers. Therefore, the aim of this study was to explore the lived experiences of hospitalized patients with coronavirus disease at Tibebe Ghion Comprehensive Specialized Hospital, Bahir Dar, Ethiopia, in 2021. A qualitative phenomenological study design with a heterogeneous purposive sampling technique was used. Fifteen hospitalized patients participated from March 15 to April 1, 2021. The information was gathered through an in-depth interview technique with an audio recorder. Thematic analysis was used to analyze the data using Atlas Ti version 7.09 software. Hospitalized patients with the coronavirus disease had a variety of experiences with various phenomena. Lived experiences were identified with 2 major themes: the psychoemotional theme has 2 subthemes (psychological and emotional experience), and the context-related experience has 5 subthemes (socioeconomic, patient-health care provider, health facility-related, exposure prevention, and governmental-related factors). The study identified 2 major themes: 7 subthemes and 10 categories. Study participants faced different challenges, mainly hopelessness, anxiety, a lack of caregiver, isolation, a shortage of medications, poor communication between the patient and health care provider, and a lack of health insurance. Therefore, we recommend giving psychological support, improving communication between patients and health care professionals, and ensuring health insurance.