Receiving Health Care Research Articles

Assessment of the Level of Awareness and Knowledge of Covid-19 among rural population in Khulna, Bangladesh

Objective: The objective of the study was to find out level of Awareness and knowledge about covid-19 among rural population in Bangladesh. Methods: A cross-sectional descriptive type of study was carried out in Bathiaghata Upazilla, Khulna from 25.11.21 to 25.12.2021. Adult persons, 455 (male 181 and female 274) with mean age ± SD was 24 ±1.5 years, selected purposively from the households in the adjacent villages were included in the study as respondents. Results: Among the respondents, 97.4% heard about covid-19. Of them, 292 (71.6%) had knowledge that the disease is transmitted by cough, sneezing, direct contact and the proportion of the respondents who knew about symptoms like high fever, headache, cough, loss of taste and loss of smell were 50.1%, 16.7%,16% and 7.4%, respectively. Most of the respondents received health care services from MBBS doctors (87.3%). The majority of the respondent (76.5%) identified who heard about prevention of covid-19 by wearing mask, as a good preventive practice against covid-19 infection, followed by frequent hand washing (18.4%) which is eventually important for the prevention of covid-19. Conclusion: It was a unique study that describing adult heath related knowledge on covid-19 among adult population in a rural area. The study results suggest a further need to strengthen health education about covid-19 among rural population in Bangladesh. Mediscope 2024;11(2): 62-67

EXAMINING THE INSTITUTIONS PREFERRED BY UNIVERSITY STUDENTS WHILE RECEIVING HEALTH SERVICES

People who want to receive health services choose the institution or organization from which they will receive service based on different reasons, not the type of disease. This study was conducted to determine which institution students studying in the field of health prefer while receiving health care and for what reason. A survey consisting of 21 questions was applied to associate degree students studying at the health services vocational school of a private university in Istanbul. When the answers to the questions and statements in the survey were examined, the statement 'Indicate the health institution you would prefer to go to first in case of an illness or illness' was answered by 'State Hospital (56.3%)', 'In case of an illness, state your reason for choosing the health institution you prefer to go to first.' 'Because it is close/easy to reach' (39.2%), 'Where did you last apply for health care?', 'Public Hospital (53.2%)', 'For what reason did you apply for health care before this application? 'For My New Complaint (46%)', 'What health institution would you definitely not consider applying to in case of illness/illness?', 'Family Health Center (29%)', 'Indicate the reason for not applying to this institution that you would definitely not consider applying to in case of illness.' to 'I Cannot Have Every Test Done (24%)', 'Are there times when you need health care but you do not apply?' The answers to the question were 'Yes (76.8%)', to the statement 'Indicate the reason for not seeking health care.', 'Not caring about the disease (29%)' and 'Not being able to access health care (29%)'. Within the framework of the findings obtained, other health institutions should also be made attractive in order to alleviate the high demand for public hospitals.

50 Co-designing an intervention with asylum seeking youth to improve access to healthcare in Canada using human-centered design

Abstract Background Asylum seeking youth in Canada and the United States face multiple barriers to accessing healthcare, leaving them at greater risk of worse health outcomes. In a previous study, we found that limited knowledge of the Canadian health care system and few navigation supports were a key barrier to care for asylum seeking youth, yet no youth-developed intervention existed to support this population. Human-centered design (HCD) develops meaningful interventions with communities who have been historically marginalized. Objectives This study sought to co-design an intervention to increase youth empowerment and access to health care for asylum seeking youth in Canada. Design/Methods This was a community-based participatory-action research (CBPAR) study, and combined human-centered design (HCD) methodologies. We obtained research ethics board approval for this study (#SMH REB 22-117). In partnership with two community organizations that supported asylum seeking youth in a large Canadian city, a youth advisory board was created. In multiple co-creation sessions over a calendar year, an intervention was developed in rapid prototyping sessions and refined with feedback, to develop a final pilot intervention. Results A total of 7 asylum-seeking youth participated in the youth advisory board, ranging in age from 12-19, representing 3 different languages and included youth who self-identified with chronic medical conditions. Over a 15-month period, they participated in 6 co-creation sessions to develop a multi-lingual, web-based tool; youth specifically stated they did not believe an app would be helpful, but rather a resource that could be easily accessed. The youth advisory board shared they had limited understanding of the Canadian healthcare system, as well as interim and provincial health insurance. Youth felt the tool should answer questions about how health insurance worked, be brightly colored, use dyslexia-friendly font and be easily saved on a smartphone as an image. A multi-lingual wallet card was developed for youth to easily present at healthcare encounters, particularly if they did not have provincial health insurance, to help youth communicate their coverage, language and needs. Conclusion To our knowledge, we developed the first co-designed tool in Canada for youth asylum seekers, by youth, to improve and empower youth to receive health care services they are entitled to through navigation support. Given the high degree of marginalization faced by asylum seeking youth, this intervention has the promise to improve health outcomes. Feasibility and acceptability of this study will be evaluated in subsequent studies.

Investigating the Effect of Educational Intervention on Postpartum Health Attitudes and Behaviors in Women Referring to Health Centers in Qom Province, Iran

Background and Objectives: Postpartum is one of the most critical and dangerous periods in the life of a mother and a newborn. The health behaviors of mothers are influenced by their attitudes. Some attitudes act like dams against receiving health care. The health behaviors of mothers can be improved through education, increasing public awareness, and correcting attitudes. The present study was conducted to investigate the effectiveness of educational intervention on the attitudes and behaviors of mothers referring to health and treatment centers in Qom Province, Iran. Methods: This qualitative study investigates the attitudes and behaviors of mothers during the postpartum period. It is an educational intervention conducted on 110 mothers during their postpartum period. The mothers were selected by available sampling from the health and treatment centers of Qom Province and were randomly assigned to the intervention and control groups. The intervention took four months, and the education was conducted in four sessions using educational clips, lectures, posters, and pamphlets. The follow-up feedback was accomplished until 42 days after delivery. Results: After the educational intervention, significant differences were observed between the intervention and control groups in the components of health attitudes and behaviors, including maternal behaviors, nutritional behaviors, and infant-related behaviors of mothers in the postpartum period (P<0.05). Conclusion: The results of the present study showed that multimedia educational intervention, along with individual counseling and continuous communication with mothers, has a positive effect on their health attitudes and behaviors in the postpartum period.

Mapping the Fetal Alcohol Spectrum Disorder Continuum of Care Across the Military Health System.

Although a leading cause of developmental disability in the United States, many individuals with fetal alcohol spectrum disorders (FASDs) do not receive a timely diagnosis, are misdiagnosed, or are never diagnosed. Prevention, diagnosis, and clinical management of FASD have not been previously studied in the U.S. Military Health System (MHS), where nearly 1 million of the nation's children receive health care. To address this gap, we undertook an environmental scan of the clinical guidelines, services, programs, educational resources, and policies within the MHS pertaining to alcohol use (AU), AU disorder (AUD), prenatal alcohol exposure, and FASD. From March to June 2023, we undertook an environmental scan of MHS clinical guidelines, services, programs, educational resources, and policies that address AU, AUD, prenatal alcohol exposure, and FASD. We identified multiple resources that attended to AU and AUD before and during pregnancy in the MHS. However, despite numerous resources for other neurodevelopmental disorders, we did not find any MHS-specific resources that address diagnosis and management of FASD. Findings suggest opportunities to raise awareness, educate providers, and improve guidelines, policies, and practices in the MHS.

Examining determinants of control of metabolic syndrome among older adults with NCDs receiving service at NCD Plus clinics: multilevel analysis

BackgroundMetabolic syndrome (MetS) in older adults with hypertension, diabetes, and hyperlipidemia increases the risks of cardiovascular diseases by 2.5 times and type 2 diabetes by five times. This study aimed to explain the multilevel relationships between health service system factors and individual-level factors influencing the control of MetS among older adults with NCDs receiving health care services at the NCD Plus clinics of hospitals in 1 year.MethodsThis cross-sectional analytical study employed a systematic sampling method to have two groups of samples from 4 regions of Thailand: (1) 600 older adults having at least one diagnosis of NCDs receiving services at NCD Plus clinics and (2) 12 nurses in charge of the NCD Plus clinics at the hospitals providing services to these patient samples. Data were analyzed using multilevel logistic regression analysis.Results24% of older adults with NCDs can control MetS within one year. The MetS escalation from the initial assessment to 1-year follow-up varied according to the level of the hospitals. The transition from MetS to non-MetS status was rare in older adults with NCDs. Among health service system factors, complete screening for MetS influenced 1-year MetS control (95% CI [1.06, 2.92]). Older adults who were female and who had polypharmacy had a 66% (95% CI [0.22, 0.53]) and a 54% (95% CI [0.29 − 0.71]) reduction chance in MetS control. Older adults, who were ≥ 80 years old, labor-employed, healthy dietary patterns, and medication adherence increased chances of controlling MetS by 2.38 times (95% CI [1.12, 5.05]), 2.14 times (95% CI [1.03, 4.42]), 1.61 times (95% CI [1.06–2.46]), and 3.18 times (95% CI [1.51, 6.70]), respectively.ConclusionsNCDs Plus clinics that provide complete screening for MetS significantly enhance their effectiveness in reducing the proportion of older adults with MetS. In addition, the service should pay attention to older adults who are female, are retired, and take multiple medications to achieve MetS control better. The insights gained from such an analysis could be instrumental in pinpointing the resources necessary to bolster the efficacy of NCD Plus clinics.

Two-Spirit Peoples’ experiences accessing and receiving care from community pharmacies

Background: Two-Spirit Peoples face unique challenges in accessing and receiving health care in Canada due to health services, including community pharmacy services, being built on hetero- and cis-normative models that impede appropriate care for this group. Currently, there is limited published information on Two-Spirit Peoples’ experiences accessing and receiving care in community pharmacy settings. Methods: To address the lack of published information, 21 Two-Spirit individuals shared their experiences in a focus group setting. Four different focus groups were held across Canada, including 1 in Saskatoon, Vancouver, Edmonton, and Toronto. Informed by Indigenous methodologies, data were recorded via audio recording and notetaking, and the audio was transcribed and then analyzed for themes using the Voice-Centred Relational Method. Results: Three major structural systems that affect the experiences of Two-Spirit Peoples in community pharmacies were identified: 1) white supremacy, 2) capitalism, and 3) heteronormativity. These 3 systemic issues presented themselves via racism, homophobia, transphobia, pharmacists’ lack of knowledge about Two-Spirit individuals and their health and lack of time spent educating or building relationships with Two-Spirit Peoples. Participants provided suggestions for how community pharmacists can better serve the Two-Spirit community, such as using inclusive language, adding pronouns and preferred names to patient files, increasing knowledge about Two-Spirit health and advocating for Two-Spirit Peoples. Discussion: The results suggest that dismantling current structures and ideologies in community pharmacy and society are required to overcome the identified issues. Conclusion: Two-Spirit Peoples face barriers when it comes to accessing and receiving care in community pharmacies, resulting in many Two-Spirit individuals avoiding health care to save themselves from unsafe and uncomfortable interactions. Pre- and postlicensure pharmacy education about Two-Spirit Peoples is required to improve Two-Spirit Peoples’ experiences accessing and receiving care in community pharmacies.

Time to Gender-Affirming Hormone Therapy Among US Military–Affiliated Adolescents and Young Adults

Use of exogenous sex steroid hormones, when indicated, may improve outcomes in adolescents and young adults with gender incongruence. Little is known about factors associated with the time from diagnosis of gender dysphoria to initiation of gender-affirming hormone therapy. Identification of inequities in time to treatment may have clinical, policy, and research implications. To evaluate factors associated with time to initiation of gender-affirming hormone therapy after a diagnosis of gender dysphoria in adolescents and young adults receiving care within the US Military Health System. This retrospective cohort study used TRICARE Prime billing and pharmacy data contained in the Military Health System Data Repository. Patients aged 14 to 22 years, excluding service members and their spouses, who received a diagnosis of gender dysphoria between September 1, 2016, and December 31, 2021, were included. The data were analyzed between August 30 and October 12, 2023. Included patient characteristics were race and ethnicity, age group, first sex assigned in the medical record, and TRICARE Prime sponsor military rank and service at the time of diagnosis. Health care and contextual characteristics included the year of diagnosis and the primary system in which the patient received health care. The primary outcome was the time between initial diagnosis of gender dysphoria to the first prescription for gender-affirming hormone medication within a 2-year period. A Poisson generalized additive model was used to evaluate this primary outcome. Adjusted probability estimates were calculated per specified reference categories. Of the 3066 patients included (median [IQR] age, 17 [15-19] years; 2259 with first assigned gender marker of female [74%]), an unadjusted survival model accounting for censoring indicated that 37% (95% CI, 35%-39%) initiated therapy by 2 years. Age-adjusted curves indicated that the proportion initiating therapy by 2 years increased by age category (aged 14-16 years, 25%; aged 17-18 years, 39%; aged 19-22 years, 55%). Incidence rate ratios (IRRs) and 2-year adjusted probabilities indicated that longer times to hormone initiation were experienced by adolescents aged 14 to 16 years (IRR, 0.36; 95% CI, 0.30-0.44) and 17 to 18 years (IRR, 0.66; 95% CI, 0.54-0.79) compared with young adults aged 19 to 22 years and Black compared with White adolescents (IRR, 0.73; 95% CI, 0.54-0.99). Senior officer compared with junior enlisted insurance sponsor rank (IRR, 1.93; 95% CI, 1.04-3.55) and civilian compared with military health care setting (IRR, 1.21; 95% CI, 1.02-1.43) was associated with shorter time to hormone initiation. In this cohort study, most adolescents and young adults with a diagnosis of gender dysphoria receiving health care through the US military did not initiate exogenous sex steroid hormone therapy within 2 years of diagnosis. Inequities in time to treatment indicate the need to identify and reduce barriers to care.

Mortality among veterans with epilepsy: Temporal significance of traumatic brain injury exposure.

Epilepsy is associated with significant mortality risk. There is limited research examining how traumatic brain injury (TBI) timing affects mortality in relation to the onset of epilepsy. We aimed to assess the temporal relationship between epilepsy and TBI regarding mortality in a cohort of post-9/11 veterans. This retrospective cohort study included veterans who received health care in the Defense Health Agency and the Veterans Health Administration between 2000 and 2019. For those diagnosed with epilepsy, the index date was the date of first antiseizure medication or first seizure; we simulated the index date for those without epilepsy. We created the study groups by the index date and first documented TBI: (1) controls (no TBI, no epilepsy), (2) TBI only, (3) epilepsy only, (4) TBI before epilepsy, (5) TBI within 6 months after epilepsy, and (6) TBI >6 months after epilepsy. Kaplan-Meier estimates of all-cause mortality were calculated, and log-rank tests were used to compare unadjusted cumulative mortality rates among groups compared to controls. Cox proportional hazard models were used to compute hazard ratios (HRs) with 95% confidence intervals (CIs). Among 938 890 veterans, 27 436 (2.92%) met epilepsy criteria, and 264 890 (28.22%) had a TBI diagnosis. Mortality was higher for veterans with epilepsy than controls (6.26% vs. 1.12%; p < .01). Veterans with TBI diagnosed ≤6 months after epilepsy had the highest mortality hazard (HR = 5.02, 95% CI = 4.21-5.99) compared to controls, followed by those with TBI before epilepsy (HR = 4.25, 95% CI = 3.89-4.58), epilepsy only (HR = 4.00, 95% CI = 3.67-4.36), and TBI >6 months after epilepsy (HR = 2.49, 95% CI = 2.17-2.85). These differences were significant across groups. TBI timing relative to epilepsy affects time to mortality; TBI within 6 months after epilepsy or before epilepsy diagnosis was associated with earlier time to death compared to those with epilepsy only or TBI >6 months after epilepsy.

Patterns and Consequences of Delayed Self Care Among Rural Medical Providers.

The purpose of this study was to (a) examine personal healthcare practices of rural medical providers by issue type (e.g., physical health, social health, or mental health), (b) identify perceived consequences of taking time off and (c) determine whether greater delay in self-care was associated with perceived stress and burnout. Electronic surveys were sent to 805 medical providers (response rate = 17.8%, n = 143). The setting was a rural teaching hospital and affiliated community clinics. Participants included 143 rural medical providers. The survey included demographic information, perceived personal health risk, and questions about delaying health care, and perceived consequences of receiving health care. Medical providers delayed mental health care needs significantly more than physical health needs, t131 = 5.13, P < .01, d = .38. Respondents believed that there would be significantly more retaliation against them for taking time off for psychosocial issues, t124 = -3.80, P < .001, d = .25. There was a significant negative association between burnout and physical health self-care (r = -.24, P < .01), psychosocial self-care (r = -.20, P = .01), and mental health self-care (r = -.23, P < .01). Our study identified commonly reported consequences related to taking off work for care seeking behavior. Understanding perceived consequences can help guide health care organizations in dismantling these barriers. This study is limited by the generalizability of its sample.

Variations in Unmet Health Care Needs by Perceptions of Social Media Health Mis- and Disinformation, Frequency of Social Media Use, Medical Trust, and Medical Care Discrimination: Cross-Sectional Study.

Unmet need for health care is defined as choosing to postpone or completely avoid necessary medical treatment despite having a need for it, which can worsen current conditions or contribute to new health problems. The emerging infodemic can be a barrier that prevents people from accessing quality health information, contributing to lower levels of seeking medical care when needed. We evaluated the association between perceptions of health mis- and disinformation on social media and unmet need for health care. In addition, we evaluated mechanisms for this relationship, including frequency of social media use, medical trust, and medical care discrimination. Data from 3964 active adult social media users responding to the 2022 Health Information National Trends Survey 6 (HINTS 6), a nationally representative survey, were analyzed. The outcome was unmet need for medical care, defined as delaying or not getting the necessary medical care. The predictor variables were perception of social media health mis- and disinformation, frequency of social media use, level of trust in the health care system, and perceived racial and ethnic discrimination when receiving health care. Multivariable logistic regression models indicated that perception of substantial social media health mis- and disinformation (odds ratio [OR] 1.40, 95% CI 1.07-1.82), daily use of social media (OR 1.34, 95% CI 1.01-1.79), low medical trust (OR 1.46, 95% CI 1.06-2.01), and perceived discrimination (OR 2.24, 95% CI 1.44-3.50) were significantly associated with a higher likelihood of unmet need for medical care. Unmet need among adults who did not use social media daily and who did not perceive substantial mis- and disinformation (24%; 95% CI 19%-30%) was lower compared to daily social media users who perceived substantial mis- and disinformation (38%; 95% CI 32%-43%). Adults who perceived substantial mis- and disinformation and had low trust in health care had the highest probability of reporting unmet need (43%; 95% CI 38%-49%) compared to the other three groups. Adults who perceived substantial mis- and disinformation and experienced medical care discrimination had a statistically significant higher probability of reporting unmet need (51%; 95% CI 40%-62%) compared to adults who did not experience medical care discrimination and did not perceive substantial mis- and disinformation (29%; 95% CI 26%-32%). Unmet need for medical care was higher among individuals who perceived a substantial degree of social media mis- and disinformation, especially among those who used social media daily, did not trust the health care system, and experienced racial or ethnic discrimination when receiving health care. To counter the negative effects of social media mis- and disinformation on unmet need for health care, public health messaging must focus on daily social media users as well as improving trust and reducing structural racism in the health care system.

Multilevel analysis of healthcare utilization for childhood diarrhea in high under five mortality countries

Globally, 4.9 million under-five deaths occurred before celebrating their fifth birthday. Four in five under-five deaths were recorded in sub-Saharan Africa and Southern Asia. Childhood diarrhea is one of the leading causes of death and is accountable for killing around 443,832 children every year. Despite healthcare utilization for childhood diarrhea has a significant effect on the reduction of childhood mortality and morbidity, most children die due to delays in seeking healthcare. Therefore, this study aimed to assess healthcare utilization for childhood diarrhea in the top high under-five mortality countries. This study used secondary data from 2013/14 to 2019 demographic and health surveys of 4 top high under-five mortality countries. A total weighted sample of 7254 mothers of under-five children was included. A multilevel binary logistic regression was employed to identify the associated factors of healthcare utilization for childhood diarrhea. The statistical significance was declared at a p-value less than 0.05 with a 95% confidence interval. The overall magnitude of healthcare utilization for childhood diarrhea in the top high under-five mortality countries was 58.40% (95% CI 57.26%, 59.53%). Partner/husband educational status, household wealth index, media exposure, information about oral rehydration, and place of delivery were the positive while the number of living children were the negative predictors of healthcare utilization for childhood diarrhea in top high under-five mortality countries. Besides, living in different countries compared to Guinea was also an associated factor for healthcare utilization for childhood diarrhea. More than four in ten children didn’t receive health care for childhood diarrhea in top high under-five mortality countries. Thus, to increase healthcare utilization for childhood diarrhea, health managers and policymakers should develop strategies to improve the household wealth status for those with poor household wealth index. The decision-makers and program planners should also work on media exposure and increase access to education. Further research including the perceived severity of illness and ORS knowledge-related factors of healthcare utilization for childhood diarrhea should also be considered by other researchers.

Predicting Out-of-Hospital Cardiac Arrest in the General Population Using Electronic Health Records.

The majority of out-of-hospital cardiac arrests (OHCAs) occur among individuals in the general population, for whom there is no established strategy to identify risk. In this study, we assess the use of electronic health record (EHR) data to identify OHCA in the general population and define salient factors contributing to OHCA risk. The analytical cohort included 2366 individuals with OHCA and 23 660 age- and sex-matched controls receiving health care at the University of Washington. Comorbidities, electrocardiographic measures, vital signs, and medication prescription were abstracted from the EHR. The primary outcome was OHCA. Secondary outcomes included shockable and nonshockable OHCA. Model performance including area under the receiver operating characteristic curve and positive predictive value were assessed and adjusted for observed rate of OHCA across the health system. There were significant differences in demographic characteristics, vital signs, electrocardiographic measures, comorbidities, and medication distribution between individuals with OHCA and controls. In external validation, discrimination in machine learning models (area under the receiver operating characteristic curve 0.80-0.85) was superior to a baseline model with conventional cardiovascular risk factors (area under the receiver operating characteristic curve 0.66). At a specificity threshold of 99%, correcting for baseline OHCA incidence across the health system, positive predictive value was 2.5% to 3.1% in machine learning models compared with 0.8% for the baseline model. Longer corrected QT interval, substance abuse disorder, fluid and electrolyte disorder, alcohol abuse, and higher heart rate were identified as salient predictors of OHCA risk across all machine learning models. Established cardiovascular risk factors retained predictive importance for shockable OHCA, but demographic characteristics (minority race, single marital status) and noncardiovascular comorbidities (substance abuse disorder) also contributed to risk prediction. For nonshockable OHCA, a range of salient predictors, including comorbidities, habits, vital signs, demographic characteristics, and electrocardiographic measures, were identified. In a population-based case-control study, machine learning models incorporating readily available EHR data showed reasonable discrimination and risk enrichment for OHCA in the general population. Salient factors associated with OCHA risk were myriad across the cardiovascular and noncardiovascular spectrum. Public health and tailored strategies for OHCA prediction and prevention will require incorporation of this complexity.

Quantifying relational change in community organisations participating in a Veteran suicide prevention learning collaborative: a social network analysis

BackgroundVeteran suicide remains a significant issue, as 17.5 Veterans die by suicide each day. The US Department of Veteran Affairs (VA) has implemented a robust suicide prevention program within its...

Racial and Ethnic Differences in Health Care Experiences for Veterans Receiving VA Community Care from 2016 to 2021

BackgroundPrior research documented racial and ethnic disparities in health care experiences within the Veterans Health Administration (VA). Little is known about such differences in VA-funded community care programs, through which a growing number of Veterans receive health care. Community care is available to Veterans when care is not available through the VA, nearby, or in a timely manner.ObjectiveTo examine differences in Veterans’ experiences with VA-funded community care by race and ethnicity and assess changes in these experiences from 2016 to 2021.DesignObservational analyses of Veterans’ ratings of community care experiences by self-reported race and ethnicity. We used linear and logistic regressions to estimate racial and ethnic differences in community care experiences, sequentially adjusting for demographic, health, insurance, and socioeconomic factors.ParticipantsRespondents to the 2016–2021 VA Survey of Healthcare Experiences of Patients-Community Care Survey.MeasuresCare ratings in nine domains.Key ResultsThe sample of 231,869 respondents included 24,306 Black Veterans (mean [SD] age 56.5 [12.9] years, 77.5% male) and 16,490 Hispanic Veterans (mean [SD] age 54.6 [15.9] years, 85.3% male). In adjusted analyses pooled across study years, Black and Hispanic Veterans reported significantly lower ratings than their White and non-Hispanic counterparts in five of nine domains (overall rating of community providers, scheduling a recent appointment, provider communication, non-appointment access, and billing), with adjusted differences ranging from − 0.04 to − 0.13 standard deviations (SDs) of domain scores. Black and Hispanic Veterans reported higher ratings with eligibility determination and scheduling initial appointments than their White and non-Hispanic counterparts, and Black Veterans reported higher ratings of care coordination, with adjusted differences of 0.05 to 0.21 SDs. Care ratings improved from 2016 to 2021, but differences between racial and ethnic groups persisted.ConclusionsThis study identified small but persistent racial and ethnic differences in Veterans’ experiences with VA-funded community care, with Black and Hispanic Veterans reporting lower ratings in five domains and, respectively, higher ratings in three and two domains. Interventions to improve Black and Hispanic Veterans’ patient experience could advance equity in VA community care.

Trauma exposure correlates among patients receiving care in federally qualified health centers.

Over 80% of adults in the general population experience trauma. Rates of patients with posttraumatic stress disorder (PTSD) are high in primary care settings and are likely to be even higher in federally qualified health centers (FQHCs). Trauma exposure has been linked to psychiatric symptoms and physical health comorbidities, though little research has focused on FQHC patients. This study addresses this by examining clinical and sociodemographic correlates of specific trauma types among FQHC patients. We analyzed secondary data from patients who screened positive for PTSD and were receiving health care in FQHCs in a clinical trial (N = 978). Individuals who did versus did not experience a specific trauma type were compared using between-group tests. In the sample, 91.3% of participants were exposed to a DSM-5 Criterion A traumatic event, with 79.6% experiencing two or more trauma types. Witnessing a life-threatening event (57.3%) and physical assault (55.7%) were the most common traumatic experiences. Physical health comorbidities and worse physical health functioning were associated with a higher likelihood of exposure to all trauma types, with effect sizes larger than PTSD, ds = 0.78-1.35. Depressive and anxiety symptoms were also associated with a higher likelihood of experiencing nearly all trauma types to a lesser magnitude. People of color, OR = 2.45, and individuals experiencing financial inequities, OR = 1.73, had higher odds of experiencing serious accidents as well as other trauma types. The findings highlight the need for trauma-informed care, including routine trauma and PTSD screening, for FQHC patients.

Discussion of federal policies affecting broadband expansion and telehealth in Appalachia

Background There have been 188 rural hospital closures in the United States since 2010 with approximately 20% of these in Appalachia. Telehealth has become a way that nurses can reach rural patients who might not otherwise receive health care. Objectives The purpose of this paper is to (1) outline the federal policies enacted during COVID-19 for broadband expansion; and (2) suggest how advanced practice nursing care might be affected by broadband expansion and telehealth in the region. Methods A search of PubMed was conducted in January 2023, using the search words, “policy”, “telehealth”, “broadband”, and “Appalachia”. Findings New laws appropriated funds to expand broadband infrastructure that made it possible for telehealth to be used by nurses to deliver health care to rural patients. Conclusion This discussion paper found that broadband legislation was instrumental in expanding telecommunications and telehealth by NPs. There is a great need for broadband to continue to expand and for trained nurses to provide care via telehealth.

High Rates of Eye Surgery Cancellation in Veterans Related to Mental Health.

Approximately 9 million veterans receive health care at the Veterans Health Administration, many of whom have psychiatric illnesses. The military continues to have higher rates of psychiatric illness compared to the civilian population. Having a diagnosis such as posttraumatic stress disorder or depression may create challenges in using health care services, such as surgery. The aim of this study was to evaluate eye surgery cancellation, risk factors for cancellation, and areas for intervention within the VA. This was a single-center retrospective cohort study. The Veteran Health Information Systems and Technology Architecture were queried to identify all surgical requests at the West Los Angeles VA in 2019. Data collection included sociodemographic information and comorbid medical conditions, including psychiatric illness. Exploratory analyses using univariate logistic regression were used to evaluate factors associated with surgery cancellation. A total of 1,115 surgical requests were identified with a cancellation rate of 23.7% (n = 270). Sociodemographic factors were similar between those with completed and cancelled surgery. However, having a psychiatric diagnosis correlated with surgery cancellation. For all subspecialties, patients with schizophrenia were more likely to have cancellation (odds ratio [OR], 2.53, P = .04). For retina surgery, patients with posttraumatic stress disorder were more likely to have cancellation (OR, 4.23, P = .01). Glaucoma patients with anxiety (OR, 5.78, P = .05) and depression (OR, 4.05, P = .04) were more likely to have cancellation. There was a significant amount of eye surgery cancellations in veterans with variation by subspecialty and comorbid conditions. Having a psychiatric illness was correlated with increased rates of surgery cancellation amongst veterans. Areas to improve surgical utilization include risk stratification and increased support of vulnerable patients before surgery.

THE EFFECT OF PATIENT EXPECTATIONS AND SATISFACTION ON REGIONAL TRUST IN HEALTH TOURISM: A PRIVATE HOSPITAL EXAMPLE

In this study, the effect of health tourists' expectations and satisfaction on their sense of trust in Turkey was examined. In line with the purpose of the research, the sample of the study consists of 178 patients whose structure was determined by the simple random sampling method among the patients in the institution in order to receive health care services. The data were analyzed with the SPSS program. 52.8% of the 178 tourists participating in the research were female and 47.2% were male. In terms of the age variable, 41.6% of the tourists were between the ages of 18-30, 36.5% were between the ages of 31-45, and 21.9% were aged 46 and over. When the educational status variable of the tourists is examined, it was determined that 42.7% of them are primary school graduates, 14.6% were high school graduates, 33.1% were university graduates, and 9.6% were master's and doctorate degrees. As a result of the analysis, it has been determined that meeting the expectations and satisfaction of the participating health tourists has a statistically significant and positive effect on the sense of trust in Turkey. In line with these results, as the expectations of the patients are met and their satisfaction increases, their confidence in Turkey increases

Deployment to Military Bases With Open Burn Pits and Respiratory and Cardiovascular Disease

Many veterans who served in Afghanistan and Iraq during Operations Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) were deployed to military bases with open burn pits and exposed to their emissions, with limited understanding of the long-term health consequences. To determine the association between deployment to military bases where open burn pits were used for waste disposal and the subsequent risk of developing respiratory and cardiovascular diseases. This retrospective observational cohort study used Veterans Health Administration medical records and declassified deployment records from the Department of Defense to assess Army and Air Force veterans who were deployed between 2001 and 2011 and subsequently received health care from the Veterans Health Administration, with follow-up through December 2020. Data were analyzed from January 2023 through February 2024. Duration of deployment to military bases with open burn pits. Diagnosis of asthma, chronic obstructive pulmonary disease, interstitial lung disease, hypertension, myocardial infarction, congestive heart failure, ischemic stroke, and hemorrhagic stroke. The study population included 459 381 OEF and OIF veterans (mean [SD] age, 31.6 [8.7] years; 399 754 [87.0%] male). Median (IQR) follow-up from end of deployment was 10.9 (9.4-12.7) years. For every 100 days of deployment to bases with burn pits, veterans experienced increased adjusted odds for asthma (adjusted odds ratio [aOR], 1.01; 95% CI, 1.01-1.02), chronic obstructive pulmonary disease (aOR, 1.04; 95% CI, 1.02-1.07), hypertension (aOR, 1.02; 95% CI, 1.02-1.03), and ischemic stroke (aOR, 1.06; 95% CI, 0.97-1.14). Odds of interstitial lung disease, myocardial infarction, congestive heart failure, or hemorrhagic stroke were not increased. Results based on tertiles of duration of burn pit exposures were consistent with those from the continuous exposure measures. In this cohort study, prolonged deployment to military bases with open burn pits was associated with increased risk of developing asthma, COPD, and hypertension. The results also point to a possible increased risk in ischemic stroke. The novel ability to use integrated data on deployment and health outcomes provides a model for additional studies of the health impact of environmental exposures during military service.