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Supporting the Journey: A Scoping Review of Healthcare Transition Programs for Adolescents with Congenital Heart Disease
No full textThe growing adult CHD population has created a demand for formalized transition programs from pediatric to adult cardiac care. Despite global implementation, these programs vary widely in structure, and there is limited understanding of which elements best improve clinical outcomes and quality of life. This scoping review of the literature on healthcare transition programs for children and adolescents with CHD examined various program models, identified common key concepts, and highlighted gaps in the field, providing future directions for research and program development. A comprehensive search of PUBMED/Medline, Scopus, CINAHL, and Cochrane Library (2017-2023) identified English-language original research on CHD transition programs reporting qualitative or quantitative outcomes. Outcomes were grouped into themes: medical knowledge, self-management, and successful transfer. Ten studies met the inclusion criteria. All seven studies reporting medical knowledge outcomes found an increase in patients\u27 medical knowledge following program completion, though methods of measurement varied. Four studies reported successful transfer outcomes, while five demonstrated improvements in self-management skills. Several studies also included patient reported outcomes. While various healthcare transition models exist, each with distinct strengths and weaknesses, it is important to customize the program to the needs of the local CHD patient population and the institution providing care. Advancing care for this group requires increased resources, improved reimbursement models, stronger infrastructure, and comprehensive education and training to encourage institutions to develop programs that meet patient needs
Guselkumab for Moderate to Severe Psoriasis Across All Skin Tones: Cohort A of the VISIBLE Randomized Clinical Trial
No full textIMPORTANCE: Data and educational gaps in populations with skin of color contribute to racial and ethnic disparities in psoriasis treatment. Cohort A of the VISIBLE study includes participants with psoriasis who self-identify as belonging to a racial or ethnic category other than White, across the entire skin-tone spectrum. OBJECTIVE: To evaluate efficacy, quality of life, and adverse event outcomes among participants with moderate to severe psoriasis and skin of color who received guselkumab, 100 mg, for up to 48 weeks. DESIGN, SETTING, AND PARTICIPANTS: This ongoing phase 3b, randomized clinical trial at 39 sites in the US and Canada enrolled adults with skin of color and moderate to severe psoriasis (body surface area [BSA] ≥10%; Psoriasis Area and Severity Index [PASI] ≥12; Investigator\u27s Global Assessment [IGA] ≥3). Data were collected from August 2022 to June 2024. INTERVENTIONS: Randomized participants (3:1) received guselkumab, 100 mg, at weeks 0 and 4, then every 8 weeks, or placebo with crossover to guselkumab at weeks 16 and 20, then every 8 weeks. MAIN OUTCOMES AND MEASURES: Coprimary end points were IGA score of 0 or 1 (IGA 0/1) and PASI improvement of 90% or more (PASI 90) at week 16 (guselkumab vs placebo). Major secondary end points included IGA 0; PASI 100; percentage changes from baseline in PASI and BSA; changes from baseline in Dermatology Life Quality Index (DLQI) and Psoriasis Symptoms and Signs Diary (PSSD) symptoms; and at least a 4-point reduction in PSSD itch. RESULTS: Of 103 participants (77 randomized to guselkumab; 26 randomized to placebo), 94 (91.3%) completed 48 weeks of treatment. The mean (SD) age overall was 44.1 (12.9) years, and 74 participants (71.8%) were male. At week 16, coprimary end points were achieved by greater proportions of guselkumab- vs placebo-treated participants (IGA 0/1: 57 of 77 [74.0%] vs 0 of 26; P \u3c .001; PASI 90: 44 of 77 [57.1%] vs 1 of 26 [3.8%]; P \u3c .001); 25 of 77 (32.5%) vs 0 of 26 achieved IGA 0 (P \u3c .001), and 23 of 77 (29.9%) vs 0 of 26 achieved PASI 100 (P = .002). DLQI and PSSD symptoms score least-squares mean changes from baseline were -12.1 (95% CI, -13.1 to -10.9) vs -2.5 (95% CI, -4.4 to -0.6) (P \u3c .001), and -49.4 (95% CI, -54.0 to -44.9) vs -8.2 (95% CI, -15.8 to -0.6) (P \u3c .001), respectively. A 4-point or greater reduction in PSSD itch score was achieved by 48 (66.7%) vs 4 (16.7%) participants with a baseline score of at least 4 (P \u3c .001). Efficacy increased and was maintained through week 48, with guselkumab-randomized participants achieving mean percentage improvements in PASI and BSA of more than 94%, and more than 50% of participants achieving complete clearance. Infections were the most common adverse events in the guselkumab (16 [20.8%]) and placebo (3 [11.5%]) groups through week 16, predominantly upper respiratory tract infection and nasopharyngitis. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, after 3 doses of guselkumab, significant skin clearance and quality of life improvements were observed in this cohort of participants with moderate to severe psoriasis and skin of color across the range of objectively measured skin tones. Improvements increased and were maintained through week 48. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05272150
Screening for Intimate Partner Violence and Caregiver Abuse of Older or Vulnerable Adults: US Preventive Services Task Force Recommendation Statement
No full textIMPORTANCE: Intimate partner violence (IPV) affects millions of US residents across the lifespan and is often unrecognized. Abuse of older or vulnerable adults by a caregiver or someone else they may trust is common and can result in significant injury, death, and long-term adverse health consequences. OBJECTIVE: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for IPV, abuse of older adults, and abuse of vulnerable adults. POPULATION: The recommendation on screening for IPV applies to adolescents and adults who are pregnant or postpartum, and women of reproductive age. The recommendation on screening in older and vulnerable adults applies to persons without recognized signs and symptoms of abuse or neglect. EVIDENCE ASSESSMENT: The USPSTF concludes that screening for IPV in women of reproductive age, including those who are pregnant and postpartum, and providing or referring those who screen positive to multicomponent interventions has a moderate net benefit. The USPSTF concludes that the benefits and harms of screening for caregiver abuse and neglect in older or vulnerable adults are uncertain and that the balance of benefits and harms cannot be determined. RECOMMENDATION: The USPSTF recommends that clinicians screen for IPV in women of reproductive age, including those who are pregnant and postpartum. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for caregiver abuse and neglect in older or vulnerable adults. (I statement)
Defining On-Treatment Remission in Plaque Psoriasis: A Consensus Statement From the National Psoriasis Foundation
No full textIMPORTANCE: Defining on-treatment remission in plaque psoriasis is important for benchmarking patient responses to therapies. This also helps to facilitate shared understanding, align treatment expectations, and enable more effective psoriasis management. OBJECTIVE: To establish a consensus-based definition of on-treatment remission for plaque psoriasis through a multistage Delphi initiative. EVIDENCE REVIEW: The Remission Workgroup from the medical board and scientific advisory board of the National Psoriasis Foundation engaged various stakeholders, both US based and international, to participate in the consensus process. Following a working group meeting to determine the overall consensus approach, a systematic review of remission definitions in the current literature was performed. This review helped to inform the content of consensus materials. The consensus effort involved 2 stages: pre-Delphi interviews and surveys to inform the Delphi questions, followed by a Delphi exercise with physicians to define on-treatment remission for plaque psoriasis. Outcome measures considered included body surface area (BSA), Investigator Global Assessment (IGA), the product of the Physician Global Assessment and body surface area (PGA × BSA), and Psoriasis Area and Severity Index (PASI) score at various cutoff levels and time points. FINDINGS: The consensus process involved 92 stakeholders, including dermatologists, rheumatologists, researchers, patients, payers, and life sciences professionals. In the pre-Delphi interviews and surveys, patients emphasized that on-treatment remission meant the absence of psoriasis signs and symptoms while recieving therapy. Payers expressed that defining remission is important for long-term treatment coverage. Following the Delphi exercise and discussion with participating physicians specializing in psoriatic disease management, on-treatment remission in plaque psoriasis was defined as patients maintaining a BSA of 0% or IGA of 0 for at least 6 months while on treatment. CONCLUSIONS AND RELEVANCE: Through a Delphi consensus process, on-treatment remission for plaque psoriasis was defined as patients maintaining a BSA involvement of 0% or IGA of 0 for at least 6 months while on treatment. This clear and standardized benchmark is applicable to both research and practice settings
Focused update: Guidelines of care for the management of atopic dermatitis in adults
No full textBACKGROUND: In 2023 and 2024, the American Academy of Dermatology published guidelines on the use of topical and systemic therapies for the management of atopic dermatitis (AD) in adults. Since the publication of these guidelines, several novel therapies have emerged to treat AD. OBJECTIVE: To update previous guidelines on the management of AD in adults by providing evidence-based recommendations on the use of additional Food and Drug Administration-approved topical and systemic therapies. METHODS: A multidisciplinary workgroup conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. RESULTS: The workgroup developed 4 new recommendations for the management of AD in adults. LIMITATIONS: This analysis is based on the best available evidence at the time it was conducted. Most randomized controlled trials of the considered therapies for AD are of short duration, limiting comparative long-term efficacy and safety conclusions. CONCLUSIONS: The workgroup developed strong recommendations for the use of tapinarof cream, roflumilast cream, lebrikizumab, and nemolizumab with concomitant topical therapy
HIV Clinic Visit Attendance Among People With HIV Aged 50+ Years: Exploring the Role of Increasing Age, Comorbidity Burden, and the COVID-19 Pandemic
No full textOBJECTIVE: To evaluate the impact of advancing age, comorbidity burden, and the COVID-19 pandemic on HIV clinic visit attendance. STUDY SETTING AND DESIGN: We implemented a repeated cross-sectional study using an ongoing longitudinal cohort of people with HIV (PWH) receiving care in Washington, DC. DATA SOURCES AND ANALYTIC SAMPLE: Our primary exposures of interest were older age categories (60-69 and 70+ compared with 50-59 years), Veterans Aging Cohort Study (VACS) Index (surrogate for comorbidity burden), calendar year (with the three time points of 2018, 2020, and 2022 representing pre-, peri- and post-COVID). Our outcome was the number of HIV clinic visits (including telehealth) in 2018, 2020, and 2022. Associations were assessed using zero-inflated negative binomial modeling. PRINCIPAL FINDINGS: 4041 (72.7% men, 59.3% ages 50-59; 78.8% Black) DC Cohort participants aged 50+ years were included. In 2018, mean VACS indices for participants aged 50-59, 60-69, and 70+ years were 27.5 (standard deviation [SD] 15.8), 36.9 (SD 17.8), and 50.7 (SD 15.5) respectively. Increase in VACS Index was associated with increase in HIV clinic visits (Rate ratio: 1.03, 95% CI 1.01, 1.05). A VACS Index-calendar year interaction term was significant, indicating the relationship between VACS Index and visits was attenuated in the post-COVID time period. All age groups experienced a decrease in visits from 2018 to 2022. HIV RNA suppression remained stable. CONCLUSIONS: These findings underscore the pandemic\u27s impact on accessing healthcare among the most vulnerable, that is, the oldest participants with the most comorbidities. Developing differential care models for PWH to target services to their local context, clinical status, and preferences may point to a broader public health approach to mitigate post-pandemic changes in HIV care utilization
Assessing the potential impacts of California Senate Bill 27 (SB27) on the antimicrobial susceptibility of Escherichia coli from raw meat
No full textBACKGROUND: Antimicrobial use in food-animal production selects for antimicrobial-resistant Escherichia coli (E. coli) that can be transmitted to humans via contaminated meat products. California Senate Bill 27 (SB27), which took effect on January 1, 2018, restricts the use of medically important antimicrobials in California food-animal production. Over time, SB27 could reduce the prevalence of antimicrobial-resistant E. coli on meat produced in California. OBJECTIVES: We aimed to assess whether the implementation of SB27 was associated with significant decreases in resistance to medically important antimicrobials among E. coli strains contaminating raw chicken produced in California. METHODS: We purchased raw chicken products in Southern California, including those produced in and outside of California, from 2017 to 2021 and cultured them for E. coli. Susceptibility to 19 antimicrobials was determined using the disk diffusion method. Changes in antimicrobial susceptibility over the course of the study were evaluated using the Mann-Kendall test. RESULTS: We observed significant decreases in resistance to multiple classes of antimicrobials in E. coli isolated from retail chicken meat from 2017 to 2021. Resistance to penicillins had a relative decrease of 14-18% annually in E. coli from chicken raised in California but not from chicken raised outside California, potentially indicating that SB27 was effective. Resistance to multiple other classes of antimicrobials saw an absolute decrease of up to 8% in chicken produced both inside and outside California. DISCUSSION: Our findings suggest that the downward trends in antimicrobial resistance among E. coli populations from California-produced chicken products reflect national trends. It is possible that the California SB27 legislation helped motivate industry-wide decreases in antimicrobial use among broiler chicken producers. Alternatively, the changes observed in California may have been driven by industry-wide trends independent of SB27. The lack of publicly available data regarding actual antimicrobial use in California and non-California broiler chicken production limits our ability to make stronger conclusions about our observations. https://doi.org/10.1289/EHP16115
Diversifying the health workforce in Israel and the United States: a comparison
No full textMinority populations in many countries, including Israel and the US, experience significant health disparities compared to the majority population. A health workforce that reflects the characteristics of the population including race/ethnicity, language and socioeconomic backgrounds, can help address these disparities. Over the years, Isreal and the US have implemented a variety of programs and policies to promote greater representation of minority populations in medicine and other health professions. This paper compares some of the efforts and outcomes in the 2 countries to support a more diverse health workforce. While progress has been made in both countries, they now face significant challenges which are likely to put recent progress at risk
Protocol for a randomized controlled trial of the Mommy&Me study: A multi-modal approach to address social determinants of health and mental health among low-income Black perinatal populations
No full textBACKGROUND: Mental health disorders, including stress, anxiety, and depression, are the most common complications during pregnancy, with significant racial disparities in prevalence and access to care. Low-income Black/African American/of African descent (Black) individuals are at greater risk for perinatal mental health issues and face more obstacles to care due to a variety of barriers, including poor implementation of screening protocols, stigma, adverse experiences of social determinants of health, and distrust of healthcare systems. These disparities are particularly striking in Washington, DC, and worsened during the COVID-19 pandemic. METHODS: This study has two aims: (1) to refine an individualized plan to integrate patient navigation and a culturally adapted cognitive-behavioral (CBT) prevention and treatment intervention for low-income Black pregnant women; and (2) to determine the effectiveness of multiple interventions: patient navigation, culturally adapted CBT, and/or peer support groups versus usual care for pregnant individuals at subthreshold and threshold risk for prenatal stress, depression and/or anxiety in a two-arm prospective longitudinal randomized controlled study. Outcomes will be tracked from pregnancy through 12 months postpartum, assessing maternal mental health, engagement with the intervention, healthcare experiences and utilization, and infant outcomes. CONCLUSIONS: If found to be efficacious, results will help develop scalable, culturally relevant interventions aimed at reducing racial disparities in maternal mental health care and improving health outcomes for both mothers and infants. Trial registration: ClinicalTrials.gov ID NCT05345834