Scholarly Commons @ Baystate Health
Not a member yet
8474 research outputs found
Sort by
Changes in Children\u27s Receipt of Fluoride Varnish During Medical Visits and the COVID-19 Pandemic
No full textObjective: Primary care medical providers are recommended to apply fluoride varnish to the teeth of young children to prevent tooth decay. The COVID-19 pandemic interrupted care delivery in health care settings and may have differentially impacted patients with different types of insurance. The objective of this study was to examine changes in children\u27s receipt of fluoride varnish in the medical office during 2014-2022.
Methods: Using all-payer claims data from Massachusetts (2014-2022), we examined children\u27s receipt of fluoride varnish during medical visits over time overall and by insurance-type. Because rates were highest in 2019, this was used as the reference year. We examined if results were driven by receipt (or non-receipt) of medical visits.
Results: Following growth from 2014 to 2019, the probability of a child receiving fluoride varnish in 2022 compared to 2019 was 2.4 (95% confidence interval (CI)= -3.5 to -1.3) percentage points (pp) lower for a child with private insurance and 6.0 (95% CI= -8.0 to -4.0) pp lower for a child with Medicaid, representing declines of 15% and 37%, respectively. We did not observe a similar decline in children\u27s receipt of medical visits during this time and our findings on fluoride varnish receipt were similar when we controlled for receipt of medical visits.
Conclusions: Fluoride varnish receipt among young children declined precipitously during the COVID-19 pandemic and was not explained by declines in well-child medical visits. Declines were greater for children with Medicaid, erasing nearly a decade of progress in promotion of this evidence-based preventive service.
Keywords: COVID-19; health care access; oral health; pediatrics; preventive care
Adapting an Anxiety Sensitivity Intervention for Perinatal Mental Health: Development of a Digital Intervention
No full textIntroduction: The goal of this study was to adapt an anxiety sensitivity intervention for mobile health delivery to perinatal populations experiencing economic marginalization.
Methods: A community-engaged and user-centered design approach informed the prototype of Reaching Calm. We conducted think-aloud interviews with perinatal individuals (n=15) experiencing elevated anxiety and economic stressors. Acceptability and usability were assessed with the Treatment Evaluation Inventory Short Form (TEI-SF) and System Usability Scale (SUS), respectively. We used rapid qualitative analysis to analyze interviews and the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to characterize adaptations.
Results: Mean TEI-SF and SUS scores were 4.3 and 88.0, respectively. Participants reported the content was helpful, values consistent, addressed cultural norms, and elicited feelings of reassurance. Recommendations included additions to content and options for customization. Adaptations included modifications to context and content.
Conclusions: Findings suggest high acceptability and usability. Community-engaged, user-centered design may enhance digital intervention acceptability for perinatal individuals.
Keywords: Perinatal anxiety; anxiety sensitivity; mobile health; pregnancy
Evaluation of Anti-HPV18 Antibody Titers Preceding an Incident Cervical HPV18/45 Infection
No full textBackground: The Human Papillomavirus (HPV) vaccine generates high antibody titers against targeted HPV types. This study investigated vaccine-induced anti-HPV18 immunoglobulin (IgG) antibody titers and subsequent HPV18/45 infections. Methods: We performed a nested matched case-control study leveraging a prospective longitudinal cohort of adolescent and young adult women (AYW) vaccinated with the quadrivalent HPV vaccine (4vHPV) attending the Mount Sinai Adolescent Health Center (MSAHC) in Manhattan, NY. The case individuals included AYW who had an incident detection of cervical HPV18 (n = 3) or HPV45 (n = 34) DNA after vaccination and were compared to two vaccinated control individuals (HPV18/45-negative); one random control (RC, n = 37) and one high-risk control (HRC, n = 37) selected from the upper quartile of a sexual risk behavior score. Serological titers against HPV18 were measured by end-point dilution and enzyme-linked immunosorbent assay (ELISA) in serum collected before the incident detection of HPV. Matching was performed based on age at first dose, follow-up time, and sexual risk behavior score. Conditional logistic regression was used to assess the association between case-control status and anti-HPV antibody titers, consistent with the matched-pair design. Results: Antibody titers for HPV18 were most different between AYW who developed an HPV18/45 infection compared to high-risk controls OR = 1.66, 95% CI: 0.96-2.85 (p = 0.1629). Analyses of pooled data from vaccinated recipients including who developed HPV16/31 or HPV18/45 infections demonstrated that the odds of a one-log unit increase in anti-HPV16 or 18 antibody titers, respectively, were 40% higher in the combined control groups (RC + HRC, n = 160) (OR = 1.40, 95% CI: 1.09-1.79, p = 0.0135) and 73% higher in the HRC (n = 80) (OR 1.73, 95% CI: 1.34, 2.52, p = 0.0117) compared to HPV16/18/31/45 cases (n = 80). Conclusions: Overall, these findings suggest that higher IgG antibodies to HPV16/18 after vaccination represent an increased likelihood of protection from homologous and cross-reactive HPV types (HPV16/18/31/45). These results show that differences in antibody titers are associated with breakthrough infection after vaccination, suggesting that further study of long-term antibody titers and infection should be pursued.
Keywords: HPV18; VLP; antibody titer; papillomavirus; quadrivalent vaccine
Making the case for value of acute care surgery: American Association for the Surgery of Trauma panel on overcoming local challenges
No full textAbstract: Acute care surgery (ACS) provides critical functions for hospitals through the provision of a diverse array of services including trauma, critical care, emergency and elective general surgery, burn, and surgical rescue. Health care facilities with established ACS programs have shorter hospitalizations, fewer adverse events, and optimized resource allocation compared with conventional models. Because of ACS\u27s expansive clinical scope, diverse service offerings, and behind-the-scenes role in supporting the success of other departments, hospital leadership often struggles to fully appreciate the service\u27s complete value. An important skill for the ACS leader is to effectively advocate for the ACS service and the patients served by the service to hospital leadership, armed with a data-driven understanding of the value of the service. A panel session at the American Association for the Surgery of Trauma 2024 annual meeting sponsored by the American Association for the Surgery of Trauma Healthcare Economics Committee was held to discuss how to make the case for the value of ACS locally and how to effectively communicate the value to hospital leadership. Experiences, perspectives, and propositions for new research needed were discussed
Human T-Lymphotropic Virus Type 1-Associated Myelopathy With Autoimmune Cholangiopathy: An Unusual Immune Conundrum in a Young Patient
No full textHuman T-lymphotropic virus type 1 (HTLV-1), the first oncogenic retrovirus discovered in humans, is primarily associated with two disease entities: adult T cell leukemia-lymphoma and HTLV-1-associated myelopathy-tropical spastic paresis. HTLV-1 has also been implicated in the pathogenesis of various autoimmune rheumatic diseases, and its association with the autoimmune disorders of the gastrointestinal track is less well understood. Our patient, a 26-year-old previously healthy female, presented with recurrent, progressively worsening chronic abdominal pain and persistent liver test abnormalities. Initially diagnosed with acute acalculous cholecystitis and autoimmune hepatitis (AIH), her liver tests continued to exhibit a predominantly cholestatic pattern. This prompted further advanced imaging, and magnetic resonance cholangiopancreatography ultimately confirmed a diagnosis of primary sclerosing cholangitis (PSC). Complicating her condition further, she developed lower extremity weakness, initially attributed to axonal Guillain-Barré syndrome, which unfortunately did not respond to standard treatment. After a year marked by progressive clinical decline with repeated and prolonged hospitalizations due to fever of unknown origin, an extensive diagnostic workup ultimately led to a diagnosis of HTLV-1 myelopathy, along with AIH-PSC overlap syndrome. This case highlights the diagnostic challenges associated with the multisystem involvement of HTLV-1. Notably, our patient\u27s presentation was not consistent with classic HTLV-1 myelopathy rather a subtype with rapidly progressive symptoms and flaccid as opposed to spastic paresis. The association between HTLV-1 infection and autoimmune cholangiopathy is exceptionally rare. To the best of our knowledge, our case represents only the second reported instance of autoimmune cholangiopathy associated with HTLV-1 myelopathy and the first reported case of AIH-PSC overlap syndrome associated with HTLV-1 myelopathy. This underscores the need for heightened clinical awareness of potential hepatic immune manifestations in patients with HTLV-1 infection, even in the absence of classic neurologic symptoms at initial presentation.
Keywords: HTLV-1; HTLV-1 myelopathy; autoimmune cholangiopathy; autoimmune hepatitis-primary sclerosing cholangitis overlap syndrome; fever of unknown origin
Physicians\u27 Experiences Using Secure Messaging for Diabetes Management: A Qualitative Study
No full textBackground: The COVID-19 pandemic led to increased demand for remote management of type 2 diabetes using secure messaging, or patient-provider text-based communication. Prior research on secure messaging has described the content of messages sent for type 2 diabetes management and demonstrated its impact on clinical outcomes. However, there is a gap in knowledge about how secure messaging performs as a communication medium for specific tasks in clinical care (eg, prescription management and discussing medical questions). Additional research is needed to understand physicians\u27 experiences using secure messaging to communicate with patients about clinical tasks that support diabetes management.
Objective: This study aims to investigate physicians\u27 experience using secure messaging to communicate with patients about specific clinical tasks for type 2 diabetes management.
Methods: We interviewed a sample of endocrinologists and internists from 2 different medical facilities who have used secure messaging to communicate with adult patients about type 2 diabetes management. Semistructured interviews were used to solicit physicians\u27 experience using secure messaging for 6 specific tasks that support diabetes management: refilling prescriptions, answering nonurgent medical questions, scheduling appointments, discussing test results, making referral requests, and discussing visit follow-up. Interviews were conducted until we achieved saturation of themes for these tasks. Interview data were collected between 2021 and 2023. Qualitative data were analyzed using the framework method for thematic analysis.
Results: We interviewed 6 internists and 4 endocrinologists (n=10). Physicians reported spending between 2 and 5 hours per day messaging with patients. They observed that secure messaging increased the frequency and timeliness of communication, which improved care coordination and facilitated care delivery between visits. This served as a time-efficient way to iterate specific components of treatment plans, including discussing test results, visit follow-up, scheduling, and prescription refill. Physicians were frustrated with the unstructured nature of secure messages. Patients wrote messages that were often disorganized, confusing, or did not have enough information for the provider to take action. This often made answering nonurgent medical questions difficult. In many cases, poorly structured secure messages resulted in lengthy back-and-forth communications between patients and physicians, which sometimes required a phone call or an office visit to resolve.
Conclusions: Physicians reported that secure messaging supports a longitudinal model of care, where patients can iterate their treatment plan between visits. For tasks with well-defined information boundaries, such as scheduling and prescription refill, physicians reported that secure messaging improved the time efficiency of care delivery. Providers experienced challenges using secure messaging for more complex tasks and often reported not receiving sufficient clinical information. We identified a demand for workflow technologies to process incoming secure messages to improve clarity and ensure that messages have sufficient information to inform decisions on the best course of action.
Keywords: care coordination; diabetes; digital health; endocrinology; patient portals; primary care; secure messaging
Clinical characteristics, management, and outcomes of acute myocardial infarction-related cardiogenic shock patients with and without out-of-hospital cardiac arrest: a Gulf region registry analysis
No full textBackground: Out-of-hospital cardiac arrest (OHCA) in the setting of acute myocardial infarction-related cardiogenic shock (AMI-CS) represents a particularly high-risk subgroup. The Cardiac Arrest Hospital Prognosis (CAHP) score is a prognostic tool used in post-arrest care; however, its utility in predicting in-hospital mortality among OHCA survivors with AMI-CS in the Gulf region remains unclear. This study assessed differences in clinical characteristics and outcomes between AMI-CS patients with and without OHCA and evaluated the discriminative ability of the CAHP score.
Methods: A retrospective analysis was performed using data from the Gulf-CS registry, including 1513 patients diagnosed with AMI-CS from 2020 to 2022. Patients were stratified by the presence of OHCA at presentation.
Results: Among the cohort, 138 patients (9.1 %) experienced OHCA and survived to hospital presentation. These patients were younger and with fewer comorbidities. ST-elevation myocardial infarction (STEMI) was significantly more common in the OHCA group (89.1 % vs. 72.3 %, P \u3c 0.001). Despite the severity of OHCA, in-hospital mortality was lower in this group compared to those without arrest (34.8 % vs. 46.5 %, P = 0.009), although they had a higher incidence of cerebrovascular accidents (9.4 % vs. 5.2 %, P = 0.042). The CAHP score was strongly associated with in-hospital mortality (OR: 1.067, P \u3c 0.001), with the highest risk observed in those with scores \u3e200 (64.6 % mortality).
Conclusion: Among AMI-CS patients, those with OHCA who survive to hospital presentation exhibit lower in-hospital mortality. The CAHP score demonstrated good discriminative ability for in-hospital mortality in this population.
Keywords: Acute myocardial infarction; CAHP score; Cardiogenic shock; Out-of-hospital cardiac arrest
Fractional flow reserve versus intravascular ultrasound to guide percutaneous coronary intervention: A systematic review and meta-analysis
No full textTranscatheter Versus Surgical Aortic Valve Replacement in Women of Childbearing Age in the United States
No full textBackground: Women of childbearing age occasionally require aortic valve replacement (AVR), sometimes performed with transcatheter AVR (TAVR). Outcomes of TAVR versus surgical AVR (SAVR) in women of childbearing age have not been evaluated. We aimed to evaluate the contemporary use and outcomes of TAVR versus SAVR in women of childbearing age in the United States.
Methods: Women aged 18-50 years hospitalized for isolated AVR were identified in the Nationwide Readmissions Database (2016-2022). In-hospital outcomes of TAVR versus SAVR were compared using propensity-score matching. Readmissions were compared using the Cox proportional hazards regression model.
Results: Of 6926 weighted hospitalizations for isolated AVR in women aged 18-50 years, 897 (13.0%) included TAVR, and 6029 (87.0%) included SAVR. From 2016-2022, the proportion of AVR performed using TAVR increased from 7.4% to 16.3% in women aged 18-50 years (ptrend\u3c 0.001). Compared with SAVR, TAVR was associated with lower in-hospital mortality (\u3c 1.4 vs. 3.5%, p = 0.03), acute kidney injury (9.0 vs. 16.8%, p = 0.002), and need for blood transfusion (7.1 vs. 19.1%, p \u3c 0.001), but higher heart block (23.5 vs. 9.7%, p \u3c 0.001) and vascular complications (5.0 vs. 2.1%, p = 0.03). Length of stay was shorter (2 vs. 7 days, p \u3c 0.001) and nonhome discharges were lower (16.2 vs. 56.7%, p \u3c 0.001) with TAVR compared with SAVR. Ninety-day all-cause readmissions were similar between TAVR and SAVR (12.6 vs. 13.3%, p = 0.78).
Conclusions: This nationwide observational analysis found that TAVR is increasingly performed among women aged 18-50 years with lower in-hospital mortality and resource utilization and similar readmissions compared with SAVR.
Keywords: Aortic stenosis; Outcomes; Readmissions; SAVR; TAVR; Women
Presenteeism Among Health Care Personnel With COVID-19
No full textImportance: Presenteeism-defined as continuing to work during an illness-poses a public health risk in the workplace and is especially hazardous within health care institutions where vulnerable patients may be exposed to nosocomial infections. Understanding the frequency and characteristics of health care personnel (HCP) who report presenteeism while ill with COVID-19 may help mitigate SARS-CoV-2 spread in hospitals and other health care institutions.
Objectives: To determine the frequency of presenteeism among HCP with symptomatic COVID-19, and to evaluate the demographic, occupational, and clinical factors associated with it.
Design, setting, and participants: This is an observational cohort study that uses data from the Preventing Emerging Infections Through Vaccine Effectiveness Testing (PREVENT) project: a test-negative, case-control vaccine effectiveness study that enrolled HCP who had COVID-19 symptoms at 24 academic medical centers from December 2020 through April 2024.
Exposure: Exposures include demographic, occupational, and clinical characteristics of participants.
Main outcomes and measures: Having confirmed symptomatic COVID-19 infection and reporting presenteeism; overall frequency of presenteeism through the study period and the association of the exposure characteristics with presenteeism, adjusting for confounders using 3 multivariable models. Presenteeism was defined as HCP who did not stop working during their illness, but the study did not differentiate whether they continued working remotely.
Results: A total of 3721 HCP were included in the analysis (2842 [76.4%] aged 18-49 years; 2993 [80.4%] female; 278 [7.5%] Asian, 406 [10.9%] Black, and 2912 [78.3%] White). Overall, 293 (7.9%) reported presenteeism during the study period, and the frequency of presenteeism increased each year of the study period (from 1 of 73 [1.4%] in 2020 to 16 of 105 [15.2%] in 2024). Presenteeism was associated with HCP who have minimal patient contact (adjusted odds ratio [aOR], 3.73; 95% CI, 2.39-4.37), a graduate or professional degree (aOR, 1.90; 95% CI, 1.45-2.50), and income over $100 000 (aOR, 1.74; 95% CI, 1.12-2.69).
Conclusion and relevance: In this observational cohort study of 3721 HCP, there was an increasing frequency of presenteeism from 2020 through 2024, and job role and socioeconomic factors were associated. More studies are needed to understand the rationale behind the decision to continue working and the exact causes of presenteeism\u27s rising incidence among HCP with COVID-19