Health Care Research Articles

Addressing Social and Structural Determinants of Health in the Delivery of Reproductive Health Care: ACOG Committee Statement No. 11.

Social and structural determinants of health include historical, social, political, and economic forces, many of which are rooted in racism and inequality, that shape the relationship between environmental conditions and individual health. Unmet social needs can increase the risk of many conditions treated by obstetrician-gynecologists (ob-gyns), including, but not limited to, preterm birth, unintended pregnancy, infertility, cervical cancer, breast cancer, and maternal mortality. An individual health care professional's biases (whether overt or unconscious) affect delivery of care and may exacerbate and reinforce health disparities through inequitable treatment. Obstetrician-gynecologists and other health care professionals should seek to understand patients' health care decision making not simply as patients' individual-level behavior, but rather as the result of intersecting sociopolitical conditions, structural inequities, and social needs that create and maintain inequalities in health and health care. Recognizing the importance of social and structural determinants of health can help ob-gyns and other health care professionals to better understand patients, effectively communicate about health-related conditions and behavior, and contribute to improved health outcomes, including patients' experience of care and their trust in the health care system.

Health care resource use in preschool children with cerebral palsy.

To estimate the burden of disease and evaluate which factors affect health care resource use (HCRU) in young children with cerebral palsy (CP). Data were collected as part of a prospective, longitudinal cohort study of children with CP born in Queensland, Australia between 2006 and 2009. HCRU questionnaires were administered at six time points. Data on resource use, socio-demographics, and disease severity were collected. Costs were sourced from Medicare, the Australian National Hospital Cost Data Collection, and market prices. A generalized linear model was used to identify factors influencing CP-related costs. A total of 794 questionnaires were completed by 222 participants (mean = 3.6 per participant). Physiotherapy (94%, n = 208) was the most widely accessed allied health care therapy; almost half of the participants (45%; 354 of 794) reported one or more hospital admissions. From the health care funder perspective, a child with CP costs on average A$24 950 per annum (A$12 475 per 6 months). Higher costs were associated with increased motor impairment (Gross Motor Function Classification System, p < 0.001) and increased comorbidities (p = 0.012). HCRU in preschool children with CP can be analysed according to disease severity. Both increased motor impairments and increased comorbidities were associated with higher health care costs. Children with a higher number of comorbidities had higher health care costs, and more specifically, higher hospitalization costs. No significant change in costs was found over time as children aged from 18 months to 5 years.

A New Test for Evaluating the Psychological Impact of COVID-19 in Nurses

Introduction During the COVID-19 pandemic, many health care workers were involved and suffered significant physical and psychological strain, and nursing was one of the main players. Clearly and objectively establishing the psychological impact on nurses during the pandemic is necessary for long-term recovery and to be prepared for new outbreaks in the future. Aim The aims of this study were to evaluate the perceived impact on nurses at risk of psychological stress at work during a major health care crisis and determine the psychological impact and its influencing factors. Methods An online questionnaire was designed and distributed between April 9 and April 19, 2020, in Spain. The comprehensive self-conducted questionnaire included demographic information and the Psychological Stress and Adaptation at work Score. For the analysis, descriptive statistics, logistic regressions, and receiver operating characteristic curves were determined. Results A total of 825 nurses (33% working in intensive care units and emergency departments) answered the questionnaire. A logistic regression analysis revealed that nurses with higher psychological stress scores experienced more physical overload (P = .02), higher psychological overload (P &lt; .01), poor teamwork (P = .02), more distress due to new circumstances (P &lt; .01), more personal impact of how society responded to COVID-19 (P &lt; .01), anticipation of negative future consequences (P &lt; .01), and worse balance between family and work (P &lt; .01). The area under the curve for the cutoff point of Psychological Stress and Adaptation at work Score 40 was 0.82 (95% confidence interval, 0.79-0.91), with 70% sensitivity and 81% specificity. The positive predictive value was 72%, and the negative predictive value was 80%. Conclusion Psychological Stress and Adaptation at work Score is a rapid and accurate test for evaluating the psychological well-being of health care staff that can be used when crisis prevents the use of conventional stress diagnosis methods. Higher psychological impact was observed in nurses who worked in the intensive care unit and in the hospital ward.

Problems and critical reforms in mental health care: an examination of Nigeria’s situation

Problems and critical reforms in mental health care: an examination of Nigeria’s situation

Fecal Microbiota, Live-jslm (RBL; REBYOTA™) for Recurrent Clostridioides difficile Infection

Clostridioides difficile infection (CDI) is one of the most common causes of health care–associated infections and is often precipitated by recent antibiotic use. CDI occurs after the healthy gut microbiota is disrupted and becomes dysbiotic. Standard-of-care antibiotics for CDI may perpetuate dysbiosis, fueling risk of recurrent CDI (rCDI). New therapeutic options for preventing rCDI include fecal microbiota, live-jslm (RBL), a US Food and Drug Administration–approved, single-dose, rectally administered, microbiota-based live biotherapeutic product. RBL, which is easily given by any health care professional, is hypothesized to assist in restoring dysbiosis and has proven efficacy, safety, and tolerability across diverse patient populations to prevent rCDI.

Bacterial film-based degradable triboelectric nanogenerator for both contact and non-contact sensing

As an emerging environmentally friendly energy conversion device, degradable triboelectric nanogenerators (TENGs) play an important role in self-powered sensing, health care and human–machine interaction. However, traditional degradable materials used in TENGs often suffer from limited material sources and complex preparation processes, restricting large-scale production for widespread applications. Here, we propose a simple and efficient way to prepare degradable TENGs with inactivated bacterial film, taking advantage of wide source, self-proliferation and easy culture properties of bacteria. The prepared bacterial film-based TENG (BF-TENG) has stable electrical output, good durability and fatigue resistance, along with superior capabilities in both contact and non-contact sensing. In contact mode, the BF-TENG can generate a peak voltage of up to 83.3 V, which is employed for accurate Morse code transmission. In non-contact mode, the BF-TENG is capable of effectively perceiving the target polymer at a distance of 150 cm. The non-contact LED control circuit and a sensing array based on BF-TENG further demonstrate its practical potential for gesture recognition and spatial position perception. Furthermore, the fully degradable nature of BF-TENG ensures effortless disposal after use without environmental impact, serving as a promising solution for the new generation of eco-friendly and sustainable sensing devices.

Lower Socioeconomic Status Predicts Greater Obstacles to Care: Using Outpatient Cholecystectomy as a Model Cohort.

Patients with low socioeconomic status (SES) are disadvantaged in terms of access to health care. A novel metric for SES is the Distressed Communities Index (DCI). This study evaluates the effect of DCI on hospital choice and distance traveled for surgery. A Florida database was queried for patients with symptomatic cholelithiasis or chronic cholecystitis who underwent an outpatient cholecystectomy between 2016 and 2019. Patients' DCI was compared with hospital ratings, comorbidities, Charlson Comorbidity Index, and distance traveled for surgery. Stepwise logistic regression was used to determine which factors most influenced distance traveled for surgery. There were 54,649 cases-81 open, 52,488 laparoscopic, and 2,080 robotic. There was no difference between surgical approach and patient's DCI group (p = 0.12). Rural patients traveled the farthest for surgery (avg 21.29 miles); urban patients traveled the least (avg 5.84 miles). Patients from distressed areas more often had surgery at one- or two-star hospitals than prosperous patients (61% vs 36.3%). Regression indicated distressed or at-risk areas predicted further travel for rural/small-town patients, while higher hospital ratings predicted further travel for suburban/urban patients. Compared to prosperous areas, patients from distressed areas have surgery at lower-rated hospitals, travel further if they live in rural/small-town areas, but travel less if they live in suburban areas. We postulate that farther travel in rural areas may be explained by a lack of health care resources in poor, rural areas, while traveling less in suburban areas may be explained by personal lack of resources for patients with low SES.

Internet based highly secure data transmission system in health care monitoring system

&lt;span&gt;The health care systems in our contemporary countries are advancing rapidly in terms of maturity and professionalism. In an effort to alleviate the current burden on the public health system and boost the popularity of regular health self-checks, this method has been developed for producing prediagnoses that are easier to use, quicker, and more accurate. To ascertain how well the heart is circulating oxygen throughout the body, a pulse test, a painless examination that measures an individual's degree of oxygen saturation, is used. It can be used to evaluate the state of any patient with a disease, particularly those with pulmonary problems. Diseases in these patients could need ongoing observation and care. Our system comes to the rescue in order to resolve this problem. This portable system is simple to use and may be taken anywhere by the subject. The internet of things (IoT) will update the pertinent parameters. This health monitoring system's controller is made up of an adaptor, a saturation of peripheral oxygen (SPO2 ) sensor (a blood oxygen meter), a temperature sensor, a heart rate sensor, a WiFi module, and a liquid crystal display (LCD).&lt;/span&gt;

Lower urinary tract symptoms in children with Duchenne muscular dystrophy: An evaluation in terms of functional level, posture, and muscle strength.

To examine factors associated with lower urinary tract symptoms (LUTS) and lower urinary tract dysfunction (LUTD) in children with Duchenne muscular dystrophy (DMD). This cross-sectional study included 45 individuals diagnosed with DMD between the ages of 5 and 18 years. LUTS were evaluated with the Dysfunctional Voiding and Incontinence Scoring System, functional levels with the Brooke Upper Extremity Functional Classification and the Vignos Scale, lumbar lordosis angle with a bubble inclinometer, pelvic inclination angles with a digital inclinometer, and muscle strength with a hand-held dynamometer. The mean age of the children was calculated as 9.00 ± 3.32 years, body weight as 31.10 ± 12.59 kg, and height as 125.87 ± 18.46 cm. LUTD was detected in 20 children (44.44%). There was an association between high LUTD severity and low strength of the following muscles: bilateral hip flexor (Dominant: r = -0.338, p = 0.023; nondominant: r = -0.411, p = 0.005), quadriceps femoris (Dominant: r = -0.445, p = 0.002; nondominant: r = -0.504, p < 0.001), elbow flexor (Dominant: r = -0.461, p = 0.001; nondominant: r = -0.455, p = 0.002), and elbow extensor (Dominant: r = -0.442, p = 0.002; nondominant: r = -0.450, p = 0.002). Upper extremity functionality level was significantly higher in the LUTD-negative group (p = 0.004). There was no relationship between lumbar lordosis and pelvic inclination angles and LUTS symptoms (p > 0.05). To provide the adequate care for bladder health in children with DMD, it is essential to focus on parameters that will increase functionality and independence in this population.

Perceived health and working life in caregivers from nursing homes that used or did not use nighttime personalized non-pharmacological therapies to address residents’ behavioral and psychological symptoms of dementia

Dementia is frequent in nursing home (NH), affecting between 40 and 50 % of the residents and is associated in 90 % of the cases with behavioral and psychological symptoms (BPSD) which are detrimental to caregivers’ working life and perceived health. We compared perceived health and working life between NHs that used or did not use nighttime personalized non-pharmacological therapies (PNPT) to address BPSD. This anonymous survey included 96 caregivers from 25 NHs which used (n = 69) or not (n = 27) nighttime PNPT. Perceived health, nursing and medical care, quality of care and internal motivation were significantly higher, stress symptoms and workload were significantly lower and there was a tendency to enhanced satisfaction with work in caregivers from NHs which used nighttime PNPT. Our present data open a new window on the benefits of PNPT.

Strengthening the pain care ecosystem to support equitable, person-centered, high-value musculoskeletal pain care

Abstract Improving health and wellbeing outcomes for people experiencing chronic musculoskeletal pain requires collective efforts across multiple levels of a healthcare ecosystem. System-wide barriers to care equity must however be addressed (eg, lack of co-designed services; overuse of low value care/underuse of high value care; inadequate health workforce; inappropriate funding models; inequitable access to medicines and technologies; inadequate research and innovation). In this narrative review, utilizing a systems’ thinking framework, we synthesize novel insights on chronic musculoskeletal pain research contextualized through the lens of this complex, interconnected system, the “pain care ecosystem.” We examine the application of systems strengthening research to build capacity across this ecosystem to support equitable person-centred care and healthy ageing across the lifespan. This dynamic ecosystem is characterized by three interconnected levels. At its centre is the person experiencing chronic musculoskeletal pain (micro-level). This level is connected with health services and health workforce operating to co-design and deliver person-centred care (meso-level), underpinned further upstream by contemporary health and social care systems (macro-level context). We provide emerging evidence for how we, and others, are working towards building ecosystem resilience to support quality musculoskeletal pain care: at the macro-level (eg, informing musculoskeletal policy and health strategy priorities); at the meso-level (eg, service co-design across care settings; health workforce capacity); and downstream, at the micro-level (eg, person-centred care). We outline the mechanisms and methodologies utilized and explain the outcomes, insights and impact of this research, supported by real world examples extending from Australian to global settings.

Leveraging Social Networks to Integrate Depression Treatment into Primary Health and Tuberculosis Care in Brazil.

Tuberculosis (TB) and depression are highly comorbid and linked to higher rates of death and disability. Several evidence-based treatments for depression have been successfully implemented in low- and middle-income countries, but more knowledge is needed on how to bring these innovations to scale within complex 'real world' public health systems. To explore whether the principles of social network analysis could be used to enhance receptivity to integrating depression treatment into primary care for individuals with and without TB in Brazil. We used existing scales to identify settings and providers with high receptivity and connectivity within the primary care network. We trained and supervised existing staff in three primary care sites to deliver a brief evidence-based intervention over one year, coupled with active dissemination activities. Afterwards, we reassessed receptivity among individuals involved, and not involved, in the pilot. Highly significant changes were observed in mental health literacy, attitudes towards evidence-based practices, work self-efficacy, and implementation leadership supporting our hypothesis. Limited social connections between primary care clinics precluded the examination of the hypothesis that targeting settings with high connectivity could capitalize on the information flow between and transcend the decentralized structure of the network, but leveraging the centralized nature of the TB program to integrate mental health services emerged as a promising alternative. The findings of this study strongly suggest that social networks may be leveraged to change individual providers' attitudes, thereby contributing to the enhanced dissemination of evidence-based interventions.

Evaluation of Clozapine-induced Toxicities in Psychic Patients in Mental Health Care Hospitals in the Southern Region of the Saudi Arabia Kingdom

Background: Clozapine is a psychiatric medication that may cause various side effects, some of them may be serious and fatal adverse effects, such as severe neutropenia, agranulocytosis, lymphocytopenia, myocarditis, and orthostatic hypotension, that have been associated to an increased risk of death. Objective: This study aimed to evaluate the serious and potentially fatal adverse effects of clozapine toxicity in psychic patients at mental health care hospitals in the Southern region of the Kingdom of Saudi Arabia. Methods: By using a survey, data were retrospectively collected from 193 adult psychic patient reports who have been administrated clozapine with regular follow-ups, in mental health hospitals in the Southern region of Saudi Arabia between 2019 and 2021. Then, these data are recorded and analyzed Statistically using SPSS software, with suitable tests, and predetermined statistical significance (p-value) of less than 0.001. Results: The occurrence of agranulocytosis, neutropenia, hypotension, and seizures showed a highly significant correlation with higher doses of clozapine administration (i.e. p &lt; 0.001). Similarly, agranulocytosis and neutropenia were significantly associated with the occurrence of both hypotension and seizures (i.e. p &lt; 0.001). Conclusion: The collected data in this study showed an increased incidence of agranulocytosis and neutropenia associated with clozapine-treated psychic patients in the Southern region of the Kingdom of Saudi Arabia which warrants further clinical studies to find this correlation.

Utilizing a university and state collaboration to advance student training and support public mental health care.

Utilizing a university and state collaboration to advance student training and support public mental health care.

In-Hospital Drug Use Affects a Broad Patient Population and the Health Care System

IntroductionPatients who suffer from addiction sometimes take illicit substances while in the hospital (in-hospital drug use [IHDU]), which can lead to unnecessary work-up and preventable treatments when symptoms develop. The purpose of this study was to define the frequency and scope of this problem, who it affects, and its impact on the medical system. MethodsWe reviewed all incident reports from our large, urban level 1 trauma center that involved a patient being found with illicit substances in the hospital between January 2020 and January 2023. Reports were included if patients were witnessed taking the illicit substance or if they admitted to taking one in the hospital. Individual medical charts were then reviewed to determine the details of the incident and the response of the medical team. ResultsThirty-one incidents meeting the inclusion criteria were found. Of the patients involved, 74.2% were male and ranged in age from 21 to 82 years old. The admitting services included internal or family medicine (48.4%), trauma (32.3%), surgical intensive care unit (ICU) (6.5%), medical ICU (6.5%), obstetrics and gynecology (3.2%), and plastic surgery (3.2%). Interventions ranged from no intervention to transfer to the ICU and intubation. 29.0% had visitors immediately prior to the incident, which may be how the substances were obtained. 16.1% left against medical advice after having their drugs confiscated. ConclusionsOur findings suggest that a broad range of patients are at risk for IHDU, and that IHDU can lead to medical complications, additional medical expense, or patients at risk of incomplete care due to leaving against medical advice. Future work is necessary to understand patient outcomes and financial implications of IHDU, as well as to develop tools to identify those patients most at risk.

Mobile Medicine in Ukraine

Global Care Force, an international health nongovernmental organization, sent teams of physicians, physician assistants, nurses, and nurse practitioners every month to Ukraine to provide primary care for war-affected communities. I had the opportunity to partner with GCF in May 2024 during its monthly mission trip to this conflict-ravaged country. I described this medical outreach initiative in a first-person narrative in order to relay to a wider audience the realities of warfare for Ukrainian patients and health care workers. Our team treated chronic diseases in northern as well as southern Ukrainian villages near the front line near Kherson. We set up mobile medical clinics in these regions and delivered medications to patients suffering from blast injuries, hyperglycemia, hypertension, and posttraumatic stress disorder.

Training physicians in motivational communication: An integrated knowledge transfer study protocol.

While behavior change counseling (BCC) targeting health risk behaviors has shown efficacy for improving patient health outcomes, barriers to knowledge translation have resulted in poor uptake among health care providers (HCPs). This article outlines the development of a new BCC training framework for HCPs, from inception to readiness for efficacy testing. It provides an example of integrated knowledge translation (iKT) used in alignment with the obesity-related behavioral intervention trials model. (a) A modified Delphi process identified essential BCC skills for HCPs; (b) a survey assessed HCP attitudes and training needs; (c) an online competency assessment tool was developed using iKT mixed methods; (d) a training program was developed and refined using a logic model; and (e) the program was optimized using iterative rounds of participant feedback. A future proof-of-concept trial (f) will determine the program's readiness for full efficacy testing. A Delphi panel (n = 46) identified 11 core BCC competencies for HCPs, defining "motivational communication." The HCP survey (n = 80) showed willingness to devote 4 hr to introductory training in BCC. The Motivational Communication Competency Assessment Test (MC-CAT: an online, interactive evaluation tool) and a motivational communication training program (MOTIVATOR: accredited for continuing education by the Royal College of Physicians and Surgeons of Canada) were collaboratively developed with knowledge users. The optimization process (n = 11) provided key feedback, with minor changes being made to the program. In developing a new BCC framework, obstacles to BCC implementation were addressed through an iterative iKT process. This should improve eventual intervention uptake. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impact of social determinants of health on hepatocellular carcinoma surveillance, treatment, and health care costs.

The impact of clinical factors and social determinants of health on treatment patterns and health care costs among patients with HCC is unknown. Using 100% Medicare Fee-For-Service claims and a commercial multipayor claims database, we identified patients diagnosed with HCC from January 1, 2017, to December 31, 2020. Surveillance receipt was defined 12 months prior to HCC diagnosis, whereas treatment and health care costs were assessed post-HCC diagnosis. Multinomial logistic regression was used to assess the association between demographics, social determinants of health, and surveillance or HCC treatment. Multivariable generalized linear regression was used to identify factors associated with total health care costs. Of the 32,239 patients with HCC (mean age 68 y, 67% male, 73% White), 70% received surveillance and only half (51%) received any treatment. Curative treatment receipt was higher among those with prior surveillance (24% with CT/MRI and 18% with ultrasound vs. 9% with no surveillance). Curative treatment was independently associated with HCC surveillance and inversely associated with Black race, lower education level, and diagnosis in the year 2020 (COVID-19 year). Higher health care costs were independently associated with Black race, low English proficiency, living alone, and diagnosis in 2018-2020, and inversely associated with CT/MRI-based surveillance. Race and social determinants of health were independently associated with curative treatment receipt and health care costs. Increasing access to high-quality HCC surveillance may improve treatment receipt and reduce health disparities among patients with HCC.

Facile synthesis of Fe3O4 photothermal nanoparticles coated with poly-3,4-dihydroxybenzaldehyde for improved photothermal therapy of cancer cells

Given the significant rise in the number of individuals diagnosed with cancer, the management of cancer therapy has become a prominent concern in society and a formidable task in human health care. Photothermal therapy has garnered significant interest in cancer treatment because of its exceptional efficacy and minimal invasiveness. Thus, current research mainly focuses on developing biocompatible materials with excellent photothermal properties. Therefore, we synthesized Fe3O4 nanoparticles coated with poly-3,4-dihydroxybenzaldehyde (Fe3O4@PDBA) where 3,4-dihydroxybenzaldehyde was covalently polymerized onto the surface of Fe3O4. The induction of PDBA leads to a dramatical improvement in the photothermal properties of Fe3O4. Besides, the thickness of the PDBA shell layer is also a key factor in the photothermal performance and various physicochemical properties of Fe3O4@PDBA and the photothermal performance of Fe3O4@PDBA increases with increasing thickness of the PDBA shell. Additional structural characterization of the products, DFT calculations of the UV-Vis absorption spectra and the HOMO-LUMO gap under the simple model of the polymer, and product identification by the use of H1NMR, MS, and other techniques were performed. Through multiple characterizations, the reaction solution color and UV-Vis absorption spectra were essentially consistent with the computed findings. The calculations confirm that the polymerization process of PDBA is progressively red-shifted and the absorption is gradually enhanced in the NIR region. Fe3O4@PDBA exhibited strong cytotoxicity against cancer cells (Hela, 98.0%) in vitro photothermal treatment. Hence, Fe3O4@PDBA exhibits superior photothermal characteristics, targeting, biocompatibility (99.0%), and degradability, which brings about significant potential for photothermal cancer therapy.

Improving Interprofessional Provider Perceptions About Opioid Use Disorder in the Acute Care Setting Through a Blended Educational Simulation Intervention

Background The influx of patients in the acute care setting with opioid use disorder (OUD) has outpaced many hospitals’ ability to educate interprofessional staff. This creates distressing experiences for interprofessional staff and patients, leading to moral distress and burnout in staff and poor patient outcomes. Objective The purpose of this study was to improve interprofessional staff knowledge, attitudes, and perceptions toward working with patients who have OUD using a blended classroom-simulation–based curriculum. Methods A preintervention and postintervention design was selected. Interprofessional staff (n = 46) participated in a blended classroom-simulation educational intervention focused on the neurobiology of OUD, stigma reduction, pain management, and harm reduction principles, followed by 3 high-fidelity simulation scenarios. Participants completed the Drug and Drug Problems Perceptions Questionnaire to measure staff self-perceived knowledge, skills, and attitudes when working with patients who use drugs before, immediately after, and again 3 and 6 months postintervention. Results Most respondents were nurses with an average of 7.6 (SD, 9.6) years of experience. The majority did not have prior training in substance use disorder before (75.6%). There was a statistically significant decrease in mean Drug and Drug Problems Perceptions Questionnaire scores across the total score mean: 55.2 (95% confidence interval, 52.2-58.3) versus 45.5 (95% confidence interval, 43.9-47.1), P &lt; .001. Decreased score indicates improved attitude and perception. Discussion A curriculum consisting of a blended classroom-simulation intervention was successful at improving several domains regarding perceptions of caring for patients with OUD. This educational intervention can serve as a model for health care systems with goal of improving patient outcomes and staff well-being.