Doctor Visits Research Articles

P-1455. Socioeconomic and Regional Impact on Influenza Vaccination in Young Children During the COVID-19 Pandemic

Abstract Background Influenza (flu) vaccination reduces hospitalizations and severe illness, especially in young children particularly vulnerable to complicationsTable 1:Comparison of Influenza Vaccination Rates and Associated Predictors Among American Children Aged 0-5 Years in 2019 and 2022 This table provides an overview of key variables influencing flu vaccination rates among young children, showing changes between 2019 and 2022. It includes data on the total number of children surveyed, vaccination status, average age, gender distribution, educational levels of parents, family income quartiles, ethnic groups with the highest and lowest vaccination rates, insurance coverage, and whether the child had a doctor's visit in the past year. Methods Data from the National Health Interview Survey for 2019 and 2022 were analyzed to assess the impact of parental education, household income, health insurance, and race/ethnicity on flu vaccination rates among U.S. children ≤5 years. Employing logistic regression, Chi-square tests, and Mann-Whitney U tests in STATA, the potential influence of socioeconomic factors on influenza vaccination during the COVID-19 pandemic was evaluated.Table 2:Factors Influencing Influenza Vaccination Rates Among Young Children in the United States, 2019-2022: Results from Logistic Regression Analysis This table summarizes the logistic regression analysis results, presenting odds ratios, 95% confidence intervals, and p-values for predictors influencing influenza vaccination rates among young children aged 0-5 years. The analysis underscores the significant impact of the survey year, child's age, ethnicity, region, parental education, family income, insurance status, and recent healthcare interactions on vaccination likelihood. Results Records for 7636 children in 50 states were reviewed (2858 in 2019 and 4778 in 2022). Flu vaccination rates decreased from 56.02% in 2019 to 46.38% in 2022 (p < 0.001). The decline in flu vaccination rates was most pronounced among younger children, with rates for 2-year-olds reducing from 66.60% to 53.38%, 1-year-olds from 62.95% to 49.03%. and infants from 30.87% to 24.22% (p < 0.001). Insured children were more likely to be vaccinated than uninsured (OR=1.64, p< 0.001). A recent doctor's visit increased the likelihood of receiving a flu vaccine (OR=5.68, p< 0.001). Children from households earning ≥400% of the federal poverty level and those with college or above-educated parents had higher odds of vaccination (OR=1.93, p< 0.001 and OR=1.84, p=0.001, respectively). Significant regional variations in flu vaccination were noted, especially in the Southern U.S. (OR=0.70, p< 0.001). Racial differences were significant, with lower flu vaccination rates among non-Hispanic Black children compared to non-Hispanic Whites (OR=0.70, p< 0.001), while non-Hispanic Asian children exhibited higher flu vaccination rates (OR=1.32, p=0.018). Conclusion The decline in flu vaccination rates among young children during the COVID-19 pandemic highlights the influence of socioeconomic factors, healthcare access, and racial disparities on public health outcomes. Addressing these issues is crucial for improving vaccination rates and reducing influenza's impact on young children. Disclosures All Authors: No reported disclosures

P-674. The Economic Burden of Infant RSV Among US Caregivers

Abstract Background Respiratory syncytial virus (RSV) is the most common cause of lower respiratory infections in infants and an important cause of infant hospitalization. The burden of RSV extends to infants’ caregivers (CGs) through increased expenses, reduced earnings, and work productivity loss. This study aimed to elucidate the economic impact of providing care for an infant with RSV on CGs.Figure 1.Work Productivity Loss and Non-Work Activity Impairment Methods A cross-sectional survey of primary CGs (aged ≥18 years, US residents) of infants aged ≤12 months who had a medically attended visit for RSV in the prior 6 months between October 2023-April 2024 was conducted. CGs self-reported on sociodemographic characteristics, work productivity loss, lost workdays, healthcare resource utilization (HCRU), income loss, and total household out-of-pocket (OOP) costs based on a 6-month recall during the infant’s RSV episode. Data collection commenced in March 2024 and is ongoing. An interim analysis restricted to the subset of currently employed CGs was performed, with results summarized via descriptive statistics for the total sample and by highest level of care setting that infants received during the RSV episode (Hospital Overnight [HO], Hospital No Overnight [HNO], Emergency Room [ER], Doctor’s Office [DO]).Figure 2.Income Loss and Total Household Out-of-Pocket Costs Results Employed CGs (N=209) were mostly white (91%), male (57%) and had a mean age of 34 (interquartile range [IQR]: 29, 36). Most CGs reported the RSV care setting as HO (51%), followed by HNO (23%), DO (16%) and ER (10%). CGs reported a median of 2 doctor visits, 1 ER visit, and 1 hospitalization during the RSV episode. A majority (57%) reduced working hours during the RSV episode; of these, 37% stopped working completely. CGs reported a mean of 8 (IQR: 3, 8) lost workdays, with the most lost workdays reported for HO (mean: 9 [IQR: 4,8]) and ER (mean: 8 [IQR: 4, 10]) care settings. Mean absenteeism, presenteeism, overall work productivity loss, and activity impairment, as well as median income loss, were highest for HO care setting; CGs incurred a median of $115 in total household OOP costs and $1200 in income loss (Figures 1-2). Conclusion Economic burden among CGs was substantial across care settings, with the highest burden among HO. Protecting infants from severe RSV illness can also reduce the economic burden for CGs. Disclosures Martine C. Maculaitis, PhD, Oracle Life Sciences: Employee of Oracle Life Sciences, which received funding from Pfizer to conduct the study. Cassandra Rene, PhD, MPH, Pfizer Inc.: Advisor/Consultant Joseph C. Cappelleri, PhD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Sarah J. Pugh, PhD, MPH, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Ronika Alexander-Parrish, RN, MAEd, Pfizer, Inc.: Employee|Pfizer, Inc.: Ownership Interest|Pfizer, Inc.: Stocks/Bonds (Private Company) Jennifer Deese, PhD, MPH, Pfizer: Stocks/Bonds (Private Company) Michelle Vichnin, MD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Monica F. Turiga, MD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Nemin Chen, PhD, Pfizer: Advisor/Consultant Jessica E. Atwell, PhD, MPH, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Amy W. Law, PharmD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company)

Smokeless tobacco: knowledge, attitudes and usage in Pakistan

BackgroundSmokeless tobacco (SLT) encompasses products that are not burnt but instead consumed orally or nasally. One-third of tobacco is consumed in the smokeless form in South Asia. Despite its widespread usage, there has been limited empirical research on the prevalence and factors influencing SLT consumption in Pakistan. This study aimed to provide an assessment of SLT knowledge, attitudes, and usage in Pakistan.MethodsUsing an online questionnaire, a cross-sectional survey was conducted across Pakistan. Convenience sampling was used to disseminate, and expert approval was sought followed by a pilot study to validate the questionnaire. A comprehensive questionnaire was developed using elements from the Global Adult Tobacco Survey and other tools which had previously been utilized within Pakistan. Participants’ responses were described using descriptive statistics, and SPSS version 26 was used to perform linear and logistic regression. A p-value of less than 0.05 was considered statistically significant.ResultsData was collected from 1,195 participants among which 85.86% of participants had heard of SLTs prior to the survey. Sex, province, household income and previous doctor visits were significant determinants to product knowledge through which 72.55% agreed that these products can lead to serious illnesses but 30% noted a lack of knowledge on legality. General attitudes agreed that it makes one feel unwell (44.1%), gives a sense of guilt (43.85%) and more research is needed on it (54.39%). Negative health effects were the biggest deterrent from pursuing these products for 60.33% of participants. Among significant factors influencing the use of SLTs, the greatest odds of use were found with use as an alternative to cigarettes (OR 4.45) and secondly, due to its availability in a liked flavor (OR 2.27). About 31% reported to have used the product once, with 69.82% of current users expressing a desire to quit.ConclusionsAlthough adequate knowledge and aligning attitudes exist for SLTs, light is shed in the face of a sustaining public health problem. We offer important insights that can guide the creation of focused interventions meant to lower SLT use, and the health hazards associated with it in the Pakistani community by highlighting important myths, incentives, and deterrents.

A contaminated regression model for count health data.

In medical and health research, investigators are often interested in countable quantities such as hospital length of stay (e.g., in days) or the number of doctor visits. Poisson regression is commonly used to model such count data, but this approach can't accommodate overdispersion-when the variance exceeds the mean. To address this issue, the negative binomial (NB) distribution (NB-D) and, by extension, NB regression provide a well-documented alternative. However, real-data applications present additional challenges that must be considered. Two such challenges are (i) the presence of (mild) outliers that can influence the performance of the NB-D and (ii) the availability of covariates that can enhance inference about the mean of the count variable of interest. To jointly address these issues, we propose the contaminated NB (cNB) distribution that exhibits the necessary flexibility to accommodate mild outliers. This model is shown to be simple and intuitive in interpretation. In addition to the parameters of the NB-D, our proposed model has a parameter describing the proportion of mild outliers and one specifying the degree of contamination. To allow available covariates to improve the estimation of the mean of the cNB distribution, we propose the cNB regression model. An expectation-maximization algorithm is outlined for parameter estimation, and its performance is evaluated through a parameter recovery study. The effectiveness of our model is demonstrated via a sensitivity analysis and on two health datasets, where it outperforms well-known count models. The methodology proposed is implemented in an R package which is available at https://github.com/arnootto/cNB.

Menstrual health symptoms and literacy among young women in Aotearoa New Zealand: A nationwide cross-sectional survey.

To explore menstrual cycle symptoms, information sources and menstrual health literacy in young women (aged 13-25) and those who menstruate in Aotearoa New Zealand. Cross-sectional online survey in Aotearoa New Zealand. 1334 respondents (age 13-25 years, mean age 19.8), who have had at least three periods and were currently living in New Zealand. Online survey hosted by Qualtrics between October 2021, and January 2022. Information on menstrual cycle characteristics and symptoms, and menstrual health literacy. Respondents reported high rates of regular dysmenorrhoea (89%), fatigue/tiredness (78.1%) and mood changes (72.5%) associated with menstruation. A higher proportion of rangatahi (younger generation) Māori reported irregular cycles (53.5%) compared to non-Māori respondents (41.7%). Normalisation of symptoms, especially pain (80.2%), was high. Most respondents recognised the need to see a doctor for period pain which impacted their daily lives (84.7%). However, non-cyclical pelvic pain (45.7%), heavy bleeding (39%) and intermenstrual bleeding (29%) were less likely to be recognised as symptoms that require a doctor's visit. The main sources of menstrual health knowledge prior to menarche were a family member (74.2%) and health and physical education classes at school (63.7%). Many young people reported receiving little or no information about periods prior to menarche (37.9%), with very few respondents receiving information on how to manage menstrual symptoms (15.1%). Menstrual symptoms are common and the provision of culturally safe information and opportunities to learn is important for young people, whānau, schools and healthcare practitioners.

Satisfaction and Usability of a Commercially Available Medication Adherence App (Medisafe) Among Medically Underserved Patients With Chronic Illnesses: Survey Study.

Research supports the use of mobile phone apps to promote medication adherence, but the use of and satisfaction with these apps among medically underserved patients with chronic illnesses remain unclear. This study reports on the overall use of and satisfaction with a medication adherence app (Medisafe) in a medically underserved population. Medically underserved adults who received care for one or more chronic illnesses at a federally qualified health center (FQHC) were randomized to an intervention group in a larger randomized controlled trial and used the app for 1 month (n=30), after which they completed a web-based survey. Objective data on app usage were provided as secondary data by the app company. The participants were very satisfied with the app, with all participants (30/30, 100%) somewhat or strongly agreeing that they would recommend the app to family and friends. Participants strongly agreed (28/30, 93%) that the reminders helped them remember to take their medications at the correct time each day, and they (28/30, 93%) found the app easy to use. Additional features accessed by some included educational features and the adherence report. Participants noted the helpfulness of having a medication list on their phones, and some used it during medication reconciliation at doctor visits. Use of the Medfriend feature, which alerts a social support person if a medication is missed, was low (n=2), but those who used it were very positive about the feature. A commercially available medication adherence app was found to be useful by participants, and they were satisfied with the app and the additional features provided. The use of medication adherence mobile phone apps has the potential to positively influence chronic disease management in a medically underserved population on a large scale. ClinicalTrials.gov NCT05098743; https://clinicaltrials.gov/study/NCT05098743.

Exploring social determinants of healthcare and cognition levels among diverse older adults.

The purpose was to investigate the impact of social determinants of health on healthcare utilization among older adults in two cognition groups: normal and dementia/impaired cognition. We used cross-sectional data from the Health and Retirement Study (N = 16,339) to assess healthcare utilization: hospital stay, nursing home stay, hospice care, and doctor visits. The respondents were classified into two cognition groups using the Langa-Weir approach. A cohort comparison between normal (mean age = 66.1) and dementia/impaired cognition (mean age = 71.9) groups revealed dementia/impaired group included more individuals from racial and ethnic minorities (42.7 % Black/Other, 20.8 % Hispanic) compared to the normal cognition (24.7 % Black/Other, 12.1 % Hispanic). They experienced longer hospital, nursing home, and hospice stays and varied doctor visit frequencies. These differences were influenced by race, age, marital status, education, and rurality. Social determinants of health play an important role in predicting disparities in healthcare utilization among older adults across cognition levels.

Impact of COVID-19 lockdowns and refugee influx on scabies presentations to dermatology outpatient clinics in Turkey.

The frequency of scabies and its relationship with the coronavirus disease 2019 (COVID-19) pandemic is a current scientific curiosity in Turkey and worldwide. The data presented in this article will help raise awareness of dermatologists in situations such as pandemic-induced quarantines where scabies can spread rapidly. This was a retrospective study to compare patients who presented with scabies and were evaluated during the COVID-19 pandemic, with those who presented before and after the pandemic, in terms of the diagnosis ratios. In addition, the recurrence rates were compared in terms of age, nationality, and the environment in which they lived. The frequency of scabies was statistically significantly higher in the post-COVID period in all quarters of the year, with a higher rate of patients in the first and last quarters, which is typical of scabies patients. However, a significant difference in recurrence rates was not detected. Several factors might be responsible for the increased frequency of scabies during the lockdown periods in Turkey. First, entire families, including relatives, had to live together in a crowded space. Second, there was a relative increase in doctor visits, in spite of the stay-at-home policy, owing to the overwhelming itchiness of scabies.

Physician-Visit Frequency and Its Impact on Glycemic Control in People With Type 2 Diabetes: Quantifying Care Acceptance Parameters From Retrospective Electronic Health Record Data.

Type 2 diabetes is a metabolic disorder characterized by insulin resistance and hyperglycemia affecting many individuals worldwide. For effective management, adherence to recommended physician visits is important, along with lifestyle modification and pharmacological interventions. Regular doctor visits can improve adherence and help prevent complications. This study examined how doctor-visit frequency impacts blood glucose (BG) control in people with type 2 diabetes. This retrospective, single-center study included adults with type 2 diabetes who had at least two visits and two hemoglobin A1c (HbA1c) values recorded at least 90 days apart between March 2019 and November 2023. Visit per quarter ratio (VQR) and the standardized delta HbA1c (ΔHbA1c) were defined. Data were analyzed for descriptive statistics and compared for significance between the groups. Statistical differences among the groups were determined using the Kruskal-Wallis test and Dwass-Steel-Critchlow-Fligner pairwise comparisons. Five hundred seventy-seven participants with type 2 diabetes were analyzed, with a mean age of 53.9 years (±12.7). The HbA1c outcome was significantly lower in the good compliance group (7.3%) than in the poor (7.7%). The high VQR group had a significantly lower HbA1c outcome (7.4%) than the low VQR group (7.7%); 50.98% (n = 104) in the low VQR group, 65.54% (n = 97) in the medium VQR group, and 60.44% (n = 136) in the high VQR group achieved HbA1c below the target. The mean ΔHbA1c was significantly lower in the good compliance group compared to the poor compliance group. The average follow-up durations were 11.22 quarters (±4.11) for low VQR, 9.75 quarters (±4.69) for medium VQR, and 5.50 quarters (±4.84) for high VQR. Ahigher frequency of follow-up may be needed to encourage people with type 2 diabetes mellitus to visit their doctor regularly. The frequency of doctor visits has a positive impact on BG control. Regular visits enable timely adjustment of therapy and ensure high compliance with prescribed treatment. These findings have significant implications for mitigating nonadherence in chronic conditions like type 2 diabetes mellitus and warrant further investigation.

Household income and county income inequality are associated with financial hardship among cancer survivors in New Jersey.

To examine how household income and county income inequality are linked to financial hardship among cancer survivors. Cancer survivors (n = 864) identified through the New Jersey State Cancer Registry were surveyed from August 2018 to January 2022. Local area income inequality was reflected by the Gini index a measure of income inequality at the county level. Multivariable logistic regression analyses were performed, and the average marginal effect (AME) was calculated. Compared to survivors residing in households with income of $90,000 or more (higher income), those with household incomes between $50,000 and $89,999 (middle income) had a significantly higher risk of ever being unable to cover their share of the cost of cancer-related medical care (AME = .104, p = .001), higher risk of foregoing care in the past 12months because of cost, including dental care (AME = .124, p < .001), eye care (AME = .082, p = .005), and mental health care or counseling (AME = .067, p = .002). An increase in the Gini index from the 25th to 75th percentile was associated with an increased risk of unmet needs in paying for follow-up care or medications related to cancer (AME = .021, p = .014) and an increased risk of foregoing doctor visits (AME = .017, p = .02) and eye care (AME = .03, p = .002) because of cost in the past 12months. Local area income inequality was associated with certain aspects of cancer survivors' experience of financial hardship. It is important to consider refining and extending financial navigation programs to survivors residing in areas with high income inequality.

Family Care Partners and Paid Caregivers: National Estimates of Role-Sharing in Home Care.

We describe "role-sharing" in home care, defined as family care partners and paid caregivers assisting with the same task(s). We studied 440 participants in the 2015 National Health and Aging Trends Study (NHATS) receiving paid help with self-care, mobility, or medical care. We describe patterns in receiving paid help only, help from care partners only, and role-sharing. We examine whether sole reliance on paid help or role-sharing differs by Medicaid-enrollment and dementia status. Half (52.9%) of care networks involved role-sharing. Care networks involving role-sharing more often occurred among older adults with dementia (48.7% vs. 25.6%, p<0.001) and less often for those who were Medicaid-enrolled (32.1% vs. 49.4%, p<0.01). Those living with dementia more often experienced role-sharing in eating (OR 3.9 [95% CI 1.20, 8.50]), bathing (OR 2.7, [95% CI 1.50, 4.96]), dressing (OR 2.1 [95% CI 1.14, 3.86]), toileting (OR 2.9 [95% CI 1.23, 6.74]), and indoor mobility (OR 2.8 [95% CI 1.42, 5.56]), and less often received help solely from paid helpers with medication administration (OR 0.24, [95% CI 0.12, 0.46]). Medicaid-enrollees more often received paid help only in dressing (OR 2.0 [95% CI 1.12, 3.74]), outdoor (OR 2.4 [95% CI 1.28, 4.36]) and indoor mobility (OR 4.3 [95% CI 2.41, 7.62]), and with doctor visits (OR 2.8 [95% CI 1.29, 5.94]). Role-sharing is common, especially among older adults living with dementia who are not Medicaid-enrolled. Strategies supporting information sharing and collaboration in home-based care merit investigation.

Translation and Critical Evaluation of the Columbia University Autobiographical Memory Interview-Short Form for use in the Dutch Language.

Assessment of autobiographical memory following electroconvulsive therapy is lacking multilingual options. We therefore developed the Dutch translation of the Columbia University Autobiographical Memory Interview-Short Form (CUAMI-SF). We aimed to assess its practical use and identify segments for potential revision to improve the interview's applicability. The CUAMI-SF comprises 30 questions asking details about 6 segments (eg, last trip, last birthday) and 7 question categories (eg, dates, list of persons present). The interview was translated to Dutch using blind back-translation principles. We evaluated practicality and potential redundancy, through surveying a focus group and quantitative analyses of 60 participants, including depressed patients treated with electroconvulsive therapy (n = 14) or deep brain stimulation (n = 25) and healthy controls (n = 21). For the quantitative analyses, we compared the average percentage of nonanswered questions at baseline between groups. The average consistency scores after a follow-up of approximately 6 weeks were also calculated and compared for each segment between the groups. The focus group mostly found the CUAMI-SF easy to use and to score, but argued redundancy in specific questions asking for dates, numbers, and addresses. The largest differences in consistency scores between the groups were present for the segments "travel," "birthdays," "New Year's Eve," and "doctor's visits," indicating higher sensitivity compared with "family member" and "job." The CUAMI-SF was found easy to use by administrators. The segments "family member" and "job" emerged as less sensitive. Therefore, removal might maintain sensitivity while reducing administration time, which could prove beneficial in clinical and research settings.

Retention in primary care among unstably housed residents of a low-income, inner-city neighborhood with a high prevalence of substance use and related disorders

IntroductionAccess to and engagement with primary healthcare can be difficult for marginalized low-income populations residing in inner cities in high-income countries. We designed a study to examine retention in primary care among clients of a novel interdisciplinary primary care clinic in the Downtown Eastside of Vancouver, Canada who did not previously have access to care.MethodsBeginning in June 2021, clients of the Hope to Health clinic were offered enrolment in a cohort study which involved a baseline and follow-up surveys every six months, and linking their data to information from the clinic’s electronic medical records. We used Chi-square or Fisher’s Exact test and Wilcoxon rank sum test to compare clients who were lost to follow-up (LTFU) or deceased, with clients who were retained in care at the end of follow-up, Cox proportional hazards modeling was used to examine independent associations with mortality or LTFU.ResultsAmong 425 participants enrolled, the median age was 50 years (IQR 40–59), 286 (67.3%) participants were men and 128 (25.4%) were unstably housed at enrollment. Among 338 participants with at least six months of follow-up after enrolment, 262 participants (67.5%) were retained in care, 20 (5.2%) had moved, 57 (14.7%) were classified as LTFU, and 28 (7.2%) had died with a median of 19.9 months of follow-up time. The risk of death or LTFU was independently associated diagnosed with alcohol use disorder (AUD) (adjusted hazard ratio [AHR] = 2.23 vs. not; 1.38–3.60), frequency of medical doctor visits (AHR = 0.69 per visit per 3 months; 0.60–0.79) and social work visits (AHR = 0.73 per visit per 3 months; 0.59–0.90. Stimulant use disorder or asthma were not significantly associated with retention in care.ConclusionWe found that a primary healthcare model of care was successful in retaining over two-thirds of clients in primary healthcare after more than 18 months of follow-up. Additional supports for those diagnosed with alcohol use disorder are needed to retain them in care.

Healthcare inequity arising from unequal response to need in the older (45+ years) population of India: Analysis of nationally representative data

Given the large and growing number of older (45+ years) people in India, inequitable access to healthcare in this population would slow global progress toward universal health coverage. We used a 2017-18 nationally representative sample of this population (n = 53,687) to estimate healthcare inequality and inequity by economic status. We used an extensive battery of indicators in nine health domains, plus age and sex, to adjust for need. We measured economic status by monthly per capita consumption expenditure and used a concentration index to measure inequalities in probabilities of any doctor visit and any hospitalisation within 12 months. We decomposed inequality with a regression method that allowed for economic and urban/rural heterogeneity in partial associations between healthcare and both need and non-need covariates. We used the associations achieved by the richest fifth of urban dwellers to predict a need-justified distribution of healthcare and compared the actual distribution with that benchmark to identify inequity. We found pro-rich inequalities in doctor visits and hospitalisations, which were driven by use of private healthcare. Adjustment for the greater need of poorer individuals revealed pro-rich inequity that exceeded inequality by about 65% and 39% for doctor visits and hospitalisations, respectively. These adjustments would have been substantially smaller, and inequity underestimated, without allowing for use-need heterogeneity, which accounted for 11% of the inequity in doctor visits and was 373% of inequity in hospitalisations. Targeting service coverage on poorer and rural groups, and increasing their access to private providers, would both reduce inequity and raise average coverage in the older population of India.

Impact of COVID-19 pandemic on influenza vaccination rate among health care workers

ABSTRACT Vaccinations against influenza are critical in mitigating the severity of the disease, preventing its transmission, and restricting its dissemination. Concerns about vaccination hesitancy among healthcare workers (HCWs) have been duly recognized during and following the COVID-19 pandemic. To examine the extent to which the COVID-19 pandemic has influenced the adoption of vaccinations among HCWs. A cross-sectional online survey was conducted four years after the COVID-19 pandemic among HCWs in Saudi Arabia. We performed a logistic regression analysis using influenza vaccination uptake as the dependent variable and perceived COVID-19 pandemic’s impact, age, gender, marital status, employment status, education level, monthly income, respondent’s overall health, doctor visits, tobacco use, number of adults in the household, and number of children in the household as independent variables. The study included 574 participants, an 86% response rate. Of the sample, 47% reported they had the influenza vaccination. HCWs who reported a greater negative impact due to the COVID-19 pandemic were 40% more likely to acquire the influenza vaccine (OR = 1.4, 95% CI [1.24, 1.58]). Compared to HCWs without children, HCWs with a child had a 44% lower likelihood of taking the influenza vaccination (OR = 0.34, 95% CI [0.16, 0.69]). The odds of HCWs obtaining the influenza vaccine were 4.5 times higher for those who reported one yearly medical visit, 2.6 times higher for two, and 1.4 times higher for three or more. HCWs who experienced more severe COVID-19 outcomes were more likely to get vaccinated against the virus. However, long-term monitoring of this inclination is necessary.

Aging population in urban India: Challenges and insights from Kolkata

In Kolkata, the elderly people represent 11.76% of the total population. Here we present new data on the aging population of Kolkata, and address its causes, and consequences. We interviewed 110 elderly male and female who are living with their family members and in old age homes in Kolkata. The data was collected from low, medium, and high-income groups from three urban housing societies as well as five old age homes. It has been observed that the elderly male and female of the low-income group have no medical and life insurance, and many of them are suffering from health issues. Although females up to 60 years are part of Self-Help Group, males are suffering from Loneliness. The elderly male and female of the medium, and high-income group do not have financial issues, but most of them do not visit doctors and health care centers for regular health check-ups. Digital literacy has to be improved. Elderly people staying in old age homes are mentally and physically much better than their counterparts who live with family members. Analysis of existing government policies reveal scope for improvement of the elderly people. We propose social innovation for the elderly population in Kolkata.

COTIDIANA Dataset - Smartphone-Collected Data on the Mobility, Finger Dexterity, and Mental Health of People With Rheumatic and Musculoskeletal Diseases.

Rheumatic and Musculoskeletal Diseases (RMDs) are very common and can negatively impact patients' quality of life. The current care of patients with RMDs is episodic, based on a few yearly doctor visits, which may not provide an adequate picture of the patient's condition. Researchers have hypothesized that RMDs could be passively monitored using smartphones or sensors, however, there are no datasets to support this development. We introduce the COTIDIANA Dataset: a holistic, multimodal, multidimensional, and open-access resource that gathers data on mobility and physical activity, finger dexterity, and mental health, key dimensions affected by RMDs. We gathered smartphone and self-reported data from 31 patients and 28 age-matched controls, including inertial sensors, keyboard metrics, communication logs, and reference tests/scales. A preliminary analysis showed the potential for extracted metrics to predict RMD diagnosis and condition characteristics. Our dataset shall enable the community to create mobile and wearable-based solutions for patients with RMDs.

An exploratory study of resettled Rohingya refugees: Healthcare access and preventive cancer screenings.

Research suggests that preventive healthcare needs are high among U.S. refugees from Myanmar; yet no studies have examined healthcare patterns among U.S. Rohingya refugees. We examined participation in preventive cancer screening, healthcare access barriers, and facilitators in a community-based sample of 308 Rohingya refugees in Chicago, Illinois. Descriptives were conducted for the participation rates to preventive cancer screenings, indicated by age and gender. Chi-square tests were used to examine gender differences in barriers and facilitators in healthcare. Participants reported low participation in preventive screenings (e.g. 89.2% never received a Papanicolaou (pap) test). Healthcare access barriers were observed: 82.8% uninsured, 81.2% not knowing where to go for healthcare needs, and 55.1% needed interpretation, with men less likely to have had a doctor's visit in the past year or a regular provider. Findings highlight the urgent need to further develop or tailor interventions to address the healthcare needs for resettled Rohingya refugees.

How do employees feel their health is valued? a descriptive case study

PurposeA descriptive case study approach was adopted to examine employees' perceptions of the prevalence and usefulness of wellness programs. Relying on Centers for Disease Control and Prevention Health ScoreCard (CDC HSC), this study aims to assess the prevalence of worksite wellness programs, policies and benefits in general and incorporated employee perspectives to contextualize the CDC HSC wellness assessments.Design/methodology/approachThe authors first compared the CDC HSC assessments to evaluate the effectiveness of wellness programs in 20 select organizations. Follow-up employee interviews (n = 25) were conducted to contextualize the CDC HSC assessments.FindingsA variety of wellness programs are likely to increase employee engagement and participation when organizations adopt a bundling approach to combine wellness policies, incentives and an array of wellness programming opportunities that encourage and incentivize employees’ health promotion behaviors.Research limitations/implicationsFuture researchers might examine health metrics, in terms of dollars, doctor visits or biometrics before and after the implementation of a wellness program or paid wellness coordinator. Because this study interviewed employees and not members of executive leadership or finance and accounting, financial metrics were not available or the focus of this study. The inclusion of leaders and directors of wellness initiatives would offer additional ways for examining the impact of wellness initiatives on employee behaviors on organizational outcomes.Practical implicationsNutrition, weight management and chronic disease management were identified as major challenges impacting the health of employees. Even when organizations reported robust scores in their CDC HSC assessments, employers identified these three areas as critical for sustaining the health and well-being of their employees. Finally, the issue of employee safety was a top priority for all organizations regardless of how they scored on their CDC HSC assessments.Social implicationsThe authors suggest that when high-impact wellness practices are linked to organizational supports in the workplace, these efforts are likely to have more positive effects on both employee outcomes and organizational outcomes. A regular routine of checking on wellness issues can help keep potential problems from going unnoticed. An example of this is a reminder to stretch at a morning meeting or during work hours as a reminder to stay focused on health and well-being.Originality/valueThe authors aggregated the organizational assessments for different wellness interventions and compared the scores (falling above or below) with standardized CDC wellness scores. The incorporation of the CDC scorecard ensured a standardized and evidence-based evaluation of workplace wellness programs. This additional step informed the interview guide and follow-up with employees who offered recommendations for how organizations could enhance their wellness programs and policies.

Ostracism Experiences Are Associated With More Frequent Doctor Visits Over Time

Abstract: Background: Individuals generally see doctors to get physically well, with potential benefits but also costs. We investigate ostracism (feeling ignored and excluded) as one possible factor for frequently seeing doctors. Aims: We test three different conceptual accounts: (1) Ostracism may impact health through stress and social pain processes (i.e., sickness account). (2) Seeing doctors may satisfy psychological needs that are typically threatened by ostracism, constituting a way of coping (i.e., coping account). (3) In the reverse direction, individuals who see doctors more frequently may be ostracized out of health stigmatization (i.e., stigmatization account). Method. Ostracism experiences, number of doctor visits, and medical diagnoses were assessed in a longitudinal, nationally representative panel survey of German adults ( N = 2,001, two waves). Results: In cross-lagged panel analyses, ostracism predicts more frequent doctor visits 3 years later, even when controlling for medical diagnoses, suggesting doctor visits as a way of coping with ostracism. Number of medical diagnoses, but not doctor visits, longitudinally predict ostracism reports, potentially as an expression of health stigmatization. Limitations: The present results have been accrued in one context (Germany). We used retrospective recall of doctor visits, although we do not expect systematic recall biases based on ostracism experiences that could have altered the results. Conclusion: Ostracism leads to more frequent health care utilization. We conclude that seeing doctors more frequently may be a response to ostracism and call for efforts to develop ostracism-specific treatments and interventions.