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Factors Associated with COVID-19 Testing in Structurally Vulnerable Populations: An Exploratory Study in Southern Maine
No full textIntroduction: The COVID-19 pandemic disproportionately affected structurally vulnerable populations in the United States. COVID-19 testing was instrumental in controlling viral spread and linking people to treatment; however, testing rates were lower among racial and ethnic minority groups. Our objective was to identify factors associated with desired COVID-19 testing behavior among vulnerable populations.
Methods: We conducted an exploratory cohort study of at-home COVID-19 testing between March 2022 and November 2023 in Portland, Maine. Partnering with trusted community organizations, we engaged participants from immigrant, housing-unstable, substance-using, and low-income/uninsured communities. Participants received 5 at-home COVID-19 tests every 8 weeks for 48 weeks. Participants completed a baseline survey and follow-up surveys every 4 weeks on COVID-19 exposures and symptoms, as well as use of COVID-19 tests, with additional questions every 8 weeks on behavioral factors (ie, risk perceptions, attitudes, norms) around COVID-19 testing. The primary outcome was “desired testing behavior score,” or the proportion of instances a participant tested when they should have based on guidance from the Centers for Disease Control and Prevention.
Results: We enrolled 93 participants, of whom 39 (42%) were immigrants, 30 (32%) were unhoused or had a history of chronic homelessness, 28 (30%) reported substance use, and 60 (65%) were low income and/or uninsured. Overall, participants tested 66% of the recommended times. In bivariate regression, 4 factors (age, confidence in ability to use a COVID-19 test, perceived usefulness of testing, and commitment to testing) were significantly associated with desired testing behavior. However, these associations were not statistically significant in multivariable linear regression.
Discussion and Conclusions: Participants from vulnerable communities engaged with COVID-19 testing when provided with at-home tests, but more research is needed to understand what factors drive testing behavior
Predictors of job turnover among home health versus hospital nurses: An observational study using the National Sample Survey of Registered Nurses
No full textBACKGROUND: The need for skilled in-home nursing care is growing, but the home health nursing workforce faces challenges with job turnover, fueling the concern that the supply of these nurses will be inadequate to meet demand. OBJECTIVE: To compare rates and predictors of turnover among registered nurses working in home health compared to hospital settings. STUDY DESIGN: This was a secondary, cross-sectional analysis using data from the National Sample Survey of Registered Nurses (NSSRN) from survey years 2008, 2018, and 2022. POPULATION: Registered nurses in the US labor market (n = 3,381,768 in the 2008/2018 surveys; 1,625,288 from the 2022 survey). METHODS: Data for the 2008 and 2018 surveys were pooled and analyses were conducted separately with the 2022 data due to sample frame changes prohibiting pooled analyses. The primary outcome was job turnover and the independent variable was employment in either a hospital or home health setting. Covariates included sociodemographic, labor and workplace characteristics. We conducted descriptive statistics of sample characteristics and multivariate logistic regression models to estimate marginal effects of predictors on the probability of turnover from the hospital or home health setting. We then assessed interactions between setting and labor/workplace variables to assess predictors of turnover for home health versus hospital registered nurses. RESULTS: Overall, home health registered nurses reported longer career tenures and less advanced educational preparation than hospital nurses. Rates of turnover were comparable between home health and hospital registered nurses. Longer career tenure was generally protective against job turnover, but home health registered nurses were more likely than hospital registered nurses to turnover later in their career. Predicted probability of turnover at 11 to 20 years in nursing was 14.7 % for home health registered nurses (95 % CI 11.2, 18.2) versus 12.1 % for hospital registered nurses (95 % CI 10.9, 13.3). At 21 to 30 years, it was 16.3 % for home health registered nurses (95 % CI 12, 20.5) and 11 % for hospital registered nurses (95 % CI 9.6, 12.4). Interaction terms were also significant for work setting and weekly hours, demonstrating increased likelihood of turnover for home health registered nurses past the 40-h mark. There were no significant interactions identified in the 2022 data. CONCLUSIONS: Our results suggest that attracting nurses earlier in their careers and schedule stabilization may be of particular importance for growth and retention efforts in the home health registered nurse workforce
Malignant peripheral nerve sheath tumors: a report from children\u27s oncology group study ARST0332
No full textBACKGROUND: The cornerstone of the treatment of malignant peripheral nerve sheath tumors (MPNST) is surgical resection. Radiation and chemotherapy are variably employed. The optimal treatment remains uncertain, particularly for unresectable or metastatic disease and patients with neurofibromatosis type-1 (NF-1). METHODS: We present data for fifty-eight patients with newly diagnosed MPNST enrolled on the Children\u27s Oncology Group study ARST0332. Patients were treated with risk-adapted therapy including surgery with or without radiotherapy and ifosfamide and doxorubicin chemotherapy. RESULTS: Most patients had primary tumors that were greater than 5 cm (86%), deep (95%), and invasive (74%), and 10% had distant metastases. Thirty-two (55%) patients had germline NF-1 and 26 (45%) did not. Thirty-one patients received neoadjuvant therapy and 22 were evaluable for response with 5 (23%) attaining an objective response, 10 (45%) stable disease, and 7 (32%) progressive disease. Estimated 5-year event-free survival (EFS) was 87%, 52% and 0% for the low- (n = 8), intermediate- (n = 44) and high-risk (n = 6) patients, respectively. In univariate analysis, EFS and overall survival (OS) differed by sex, presence or absence of metastatic disease, risk group, and achievement of upfront or delayed R0/R1. There was no difference in EFS or OS based on germline NF-1 status. CONCLUSION: The treatment strategy in ARST0332 achieved excellent outcomes for low-risk MPNST. Patients with high risk (metastatic) MPNST have poor outcomes and novel treatments are needed. (NCT00346164)
Assessing Physician Assistant Student Attitudes and Confidence: The Results of a Substance Use Disorder Curriculum Module Pilot Project
No full textINTRODUCTION: Delivery of physician assistant (PA) substance use disorder (SUD) curricula varies across educational programs. This study aims to examine the effectiveness of a standardized SUD curriculum and to explore PA student attitudes toward and confidence in treating patients with SUD. METHODS: PA Education Association developed and implemented an 8-hour online SUD module for PA students. Curriculum was designed by a faculty consortium and piloted by students from 20 pilot PA programs (N = 1280, across 2 cohorts). Surveys were administered to all students before starting the curriculum and after completion to collect demographic information, measure attitudes toward SUD, and assess curriculum quality. RESULTS: A total of 1280 PA students completed the precurriculum survey and 819 completed the postcurriculum survey. Attitudes toward diagnosis and treatment of SUD and toward patients with SUD improved after module completion on 9 of 12 Likert survey questions. Three Likert questions that infer a reluctance to treat SUD patients decreased slightly in score from precurriculum to postcurriculum surveys. DISCUSSION: Physician assistant student attitudes and confidence improved regarding diagnosis, treatment, and perception of those with SUD. The pilot modular curriculum was well received by students and supports distribution of curriculum to a larger population of PA students, and additional data will improve generalizability. Additional studies may include the types of SUD curricula currently offered and impact of curriculum sequencing on effectiveness and attitudinal change
December 3rd, 2025: Genomics, precision health, and caring for populations
No full texthttps://knowledgeconnection.mainehealth.org/medicine_gr/1054/thumbnail.jp
PCP/Specialist Collaboration in Autism Diagnosis and Care in Maine
No full textCME available for 1 year after presentation
CME Text Code: 97008
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1067/thumbnail.jp
A Pilot Randomized Control Trial of Holding During Hypothermia and Effects on Maternal and Infant Salivary Cortisol Levels
No full textBACKGROUND: The lack of physical contact during therapeutic hypothermia (TH) is challenging for parents of newborns with hypoxic ischemic encephalopathy. Holding is often avoided due to concerns for effects on infant temperature and for dislodging equipment. PURPOSE: We assessed the effect of holding during TH on maternal and infant salivary cortisol levels and on infant vital signs. METHODS: Prospective crossover study with infants randomized to a 30-minute session of holding on day-2 versus day-3 of TH. No-holding occurred on the alternate day at the same time. Pre- and post-holding salivary cortisol levels were compared between holding and no-holding conditions. Vital signs were collected at 2-minute intervals. Data was analyzed using mixed-effects models. RESULT: Thirty-four mothers and infants were recruited. The median gestational age was 39 weeks, 16 (94%) had moderate encephalopathy and all were on morphine during TH. Salivary cortisol levels decreased after holding for infants on day-2 (P = .02) and mothers on day-2 and day-3 (P = .01). Infants held on day-2, but not on day-3, had lower heart rates, respiratory rates, and mean arterial pressures. Temperature and oxygen saturations were stable on both days. IMPLICATIONS FOR PRACTICE AND RESEARCH: We demonstrate positive effects of holding during TH as evidenced by lower salivary cortisol for both mother and infant and decreased heart rate, respiratory rate, and blood pressure for the infant on day-2. Further research is needed to replicate these results, to understand the lack of infant response on day-3 and to assess correlation with cumulative morphine exposure
It Takes a Village (and Sometimes a Ventilator): Partnering with Parents in an ICU Setting
No full textCME available for 1 year after presentation
CME Text Code: 97018
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1075/thumbnail.jp