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Self-Care Among Black African Immigrants with Hypertension
No full textPURPOSE:
The purpose of this study was to explore the self-care behaviors of Black African Immigrants (BAIs) living in the United States who are managing hypertension, with the goal of informing culturally sensitive healthcare strategies.
SPECIFIC AIMS:
1. To explore cultural beliefs and practices that influence hypertension self-care behaviors.
2. To examine BAIs’ understanding of hypertension and its associated risks.
3. To describe self-care maintenance, monitoring, and management strategies used by BAIs and assess their impact on health outcomes.
FRAMEWORK:
The Middle-Range Theory of Self-Care of Chronic Illness guided this study.
DESIGN:
A qualitative descriptive design was used. Eighteen BAIs with hypertension were recruited and participated in semi-structured interviews conducted via Zoom, telephone, or in person. Interviews were audio-recorded, professionally transcribed, and analyzed using conventional content analysis.
RESULTS:
Five major themes emerged: 1)Bridging the Divide: The Role of Effective and Ineffective Communication in HTN Care; 2) Routine and Resilience: The Importance of HTN Management; 3) The Weight of Responsibility: Family, Work, and Spirituality in HTN Control; 4) The Struggle with Hypertension Symptom Recognition: From Awareness to Action; 5) What Self-Care Really Means: A Journey Toward Well-Being. These findings support the influence of cultural, structural, and interpersonal factors on hypertension self-management.
CONCLUSION:
Black African Immigrants navigate complex cultural and systemic factors in their hypertension self-care. Understanding these lived experiences is essential to developing interventions that are culturally informed, supportive, and accessible. Nurses are critical in promoting education, advocacy, and culturally informed care.2 years2027-04-2
Creating Opioid Response Specialists: A Harm Reduction Initiative
Get PDFEach year, more than 100,000 Americans die from an overdose. Most of these deaths are attributed to high-potency opioids, including fentanyl. People who use drugs face multiple barriers to treatment including access, knowledge of options, and adverse medical experiences. In 2022, Worcester County, Massachusetts saw a sharp increase in overdose deaths. In response, our team, based in Central Massachusetts developed and implemented an Opioid Response Specialist (ORS) Program, under the auspices of a mobile addiction service which has been operating in our area since 2021. The Mobile Addiction Service is composed of physicians and advanced practice providers to facilitate low-barrier access to medications for opioid use disorder (MOUD) and harm reduction resources and the ORS service includes two care givers with emergency medical services (EMS) experience, currently also working as paramedics in the area. A model curriculum for the ORS role was developed and then the pilot testing of this role within the existing mobile addiction service was performed. These specialists were trained to the paramedic level and added extensive experience with overdose reversal, phlebotomy, wound care, and additional touch points with high-risk patients to the mobile service. As a result, we saw increases in naloxone and clean syringe distribution, and hepatitis C and human immunodeficiency virus screening. The integration of these personnel within the mobile addiction service also facilitated the uptake of opioid use disorder treatment interventions by our city's EMS which resulted in further improvements to city-wide naloxone distribution and the use of buprenorphine/naloxone after overdose reversal. Based on our initial work, the concept of an ORS, especially when embedded with a mobile addiction service, has the potential to improve access to harm reduction as well as form the basis of a training program to extend the skills and scope of personnel with a background in EMS practice.1 year2026-03-0
Long COVID after SARS-CoV-2 during pregnancy in the United States
Get PDFPregnancy alters immune responses and clinical manifestations of COVID-19, but its impact on Long COVID remains uncertain. This study investigated Long COVID risk in individuals with SARS-CoV-2 infection during pregnancy compared to reproductive-age females infected outside of pregnancy. A retrospective analysis of two U.S. databases, the National Patient-Centered Clinical Research Network (PCORnet) and the National COVID Cohort Collaborative (N3C), identified 29,975 pregnant individuals (aged 18-50) with SARS-CoV-2 infection in pregnancy from PCORnet and 42,176 from N3C between March 2020 and June 2023. At 180 days after infection, estimated Long COVID risks for those infected during pregnancy were 16.47 per 100 persons (95% CI, 16.00-16.95) in PCORnet using the PCORnet computational phenotype (CP) model and 4.37 per 100 persons (95% CI, 4.18-4.57) in N3C using the N3C CP model. Compared to matched non-pregnant individuals, the adjusted hazard ratios for Long COVID were 0.86 (95% CI, 0.83-0.90) in PCORnet and 0.70 (95% CI, 0.66-0.74) in N3C. The observed risk factors for Long COVID included Black race/ethnicity, advanced maternal age, first- and second-trimester infection, obesity, and comorbid conditions. While the findings suggest a high incidence of Long COVID among pregnant individuals, their risk was lower than that of matched non-pregnant females.The UMass Center for Clinical and Translational Science (UMCCTS), UL1TR001453, helped fund this study.No embarg
Care Integration, Housing Supports, and Outcomes for Medicaid Accountable Care Organization Enrollees with Behavioral Health Conditions
No full textIntroduction: The increasing incidence of behavioral health conditions (BHCs) and worsening barriers to accessing comprehensive care highlight the need to integrate physical health, behavioral health, and social supports. This dissertation examines the facilitators and barriers to obtaining integrated care and to launching the Massachusetts Medicaid (MassHealth) Flexible Services (FS) Program (i.e., an integrated health-related social needs program), and assesses the effect of FS housing service receipt on healthcare utilization.
Methods: Data sources include semi-structured interview data obtained from MassHealth members and staff who launched the FS Program; FS documents; and administrative, eligibility, claims, and encounter files. Analytic methods include thematic analyses of interview transcripts, descriptive statistics, and overlap propensity score weighted regression modeling.
Results: MassHealth members with BHCs reported that limited social service and provider availability hindered care integration, but interdisciplinary collaborations and telehealth improved care. Staff emphasized that leveraging community-based expertise, data-driven referrals, and program flexibility facilitated the launch of the FS Program. Over the FS Program’s first three years, 93 nutrition and housing programs served nearly 30,000 MassHealth members. Members with BHCs who received FS housing supports had approximately 15% fewer hospitalizations, 17% fewer emergency department visits, and $2,200 lower costs while receiving services versus comparators.
Conclusions: These findings demonstrate that Medicaid programs can implement an integrated social support program, improving healthcare costs and utilization for adults with BHCs experiencing housing instability or homelessness. Programs may be more successful when leveraging interdisciplinary teams, telehealth platforms, risk stratification reports, expanding service availability, and allowing flexibility in program design.Population Health Sciences2 years2027-05-0
Degree of Behavioral Health Integration and Patient Outcomes
No full textBACKGROUND: Primary care practices with greater integration of behavioral health care have better patient-reported outcomes. We sought to identify whether there is a threshold effect in the relationship between the degree of Integrated Behavioral Health (IBH) and patient-reported outcomes.
METHODS: Secondary analysis of survey results from Integrating Behavioral Health and Primary Care, a multistate longitudinal randomized, controlled study of 3,929 adults with multiple chronic medical and behavioral conditions. Patient outcomes included Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) functional status (PROMIS-29), depression (PHQ-9), anxiety (GAD-7), the Duke Activity Status Index, Consultation and Relational Empathy (CARE), patient centeredness, and utilization. IBH was measured by the Practice Integration Profile (PIP) version 1.0. The optimal threshold was identified by examining the relationship of PIP to PROMIS-29. The discriminatory power of the threshold was examined using multilevel linear regression with adjustment for potential confounders.
RESULTS: Fifteen of 44 practices with 1,237 patients were highly integrated (PIP ≥ 65). All outcomes tended to be better in patients from practices with high integration. After adjustment for potential confounders, the relationship remained beneficial for all outcomes, with Pain Intensity (-0.51 [95% CI -0.97, 0.04]), patient centeredness (2.52 [0.88, 4.16]), and CARE (1.62 [0.62, 2.61]) statistically significant.
CONCLUSIONS: Patients in high integration practices report better outcomes. A measurable target for IBH, such as a PIP total score ≥ 65, provides a focus for practice leadership and guidance on the time and resources needed to achieve integration associated with positive patient outcomes. The results of this analysis provide further evidence of the broad, beneficial impacts of integrating behavioral health and primary care services.No embarg
Characteristics differentiating near-term multiple, distal multiple, and single suicide attempters during the 12-months post-discharge from the emergency department
Get PDFA history of repeated suicide attempts increases risk for subsequent attempts. Further, individuals with multiple prior attempts exhibit higher suicidal intent and make more lethal recent attempts than those with single attempt histories. However, prior research has not studied whether individuals who make multiple suicide attempts within a short time frame, ≤30-day period ("near-term attempters"), differ clinically from those who make multiple suicide attempts occurring more than 30 days apart ("distal attempters") or a single attempt in the period following an emergency department (ED) visit. Exploratory secondary analyses were conducted using data from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study. Clinical telephone interviews were administered at 6, 12, 24, 36, and 52 weeks after the index ED visit, supplemented by chart reviews at 6 and 12 months. Participants (N = 283) who reported at least one suicide attempt during follow-up were included and grouped based upon frequency and timing of follow-up attempts. Near-term attempters were compared to distal and single attempters on socio-demographic and clinical characteristics. Results indicated that near-term attempters had more suicide attempts prior to baseline, a higher incidence of nonsuicidal self-injury in the week before baseline, a higher prevalence of lifetime depressive disorder, and were more likely to have a primary care provider. They were also less likely to think about reasons for living and made earlier, more frequent attempts after the index ED visit. These findings could inform predictive models and interventions aimed at identifying and treating those at high risk for suicide.No embarg
Efficacy and safety of nerinetide in acute ischaemic stroke in patients undergoing endovascular thrombectomy without previous thrombolysis (ESCAPE-NEXT): a multicentre, double-blind, randomised controlled trial
No full textBackground: In the ESCAPE-NA1 trial, treatment with nerinetide, an eicosapeptide that interferes with post-synaptic density protein 95, was associated with improved functional outcome among patients with acute ischaemic stroke due to large vessel occlusion undergoing endovascular thrombectomy without co-treatment with an intravenous thrombolytic agent. There was no benefit when intravenous thrombolytic agent co-treatment was used. We sought to confirm the clinical benefit of nerinetide in the absence of previous intravenous thrombolytic drug treatment.
Methods: In this multicentre, randomised, double-blind, placebo-controlled study, done in 77 centres in Canada (16), the USA (16), Germany (21), Italy (four), the Netherlands (three), Norway (four), Switzerland (three), Australia (eight), and Singapore (two), we enrolled patients with acute ischaemic stroke due to anterior circulation large vessel occlusion within 12 h from onset. Eligible patients were aged 18 years or older with a disabling ischaemic stroke at the time of randomisation (baseline National Institutes of Health Stroke Scale [NIHSS] score >5), who had been functioning independently in the community (Barthel Index score >90) before the stroke, had Alberta Stroke Program Early CT Score (ASPECTS) greater than 4, and who were not treated with a plasminogen activator. Patients were randomly allocated (1:1) to receive intravenous infusion of nerinetide in a single dose of 2·6 mg/kg, up to a maximum dose of 270 mg, based upon estimated or actual weight (if known) or saline placebo using a real-time, dynamic, internet-based, stratified randomised minimisation procedure. All patients underwent endovascular thrombectomy. The primary outcome was a favourable functional outcome 90 days from randomisation, defined as a modified Rankin Scale (mRS) score of 0-2. The analysis was by intention to treat and adjusted for time from stroke onset to randomisation (≤4·5 h [yes or no]), age, sex, baseline NIHSS score, occlusion location, time from qualifying imaging to randomisation, baseline ASPECTS, and region. Secondary outcomes were measures of mortality, worsening of stroke, improved functional independence, and measures of neurological disability. This trial is registered with ClinicalTrials.gov, NCT04462536.
Findings: From Dec 6, 2020, to Jan 31, 2023, 850 patients were assigned to receive nerinetide (n=454) or placebo (n=396). 206 (45%) participants in the nerinetide group and 181 (46%) participants in the placebo group achieved an mRS score of 0-2 at 90 days (odds ratio 0·97, 95% CI 0·72-1·30; p=0·82). Serious adverse events occurred equally between groups.
Interpretation: While nerinetide did not improve outcomes in patients with acute ischaemic stroke, it was not associated with excess adverse events. Further study is needed to identify the ideal timing of treatment and the sub-population of stroke patients who might benefit from treatment combined with current reperfusion therapies.
Funding: Canadian Institutes for Health Research and NoNO.No embarg
Clinical outcomes of patients with unsuccessful mechanical thrombectomy versus best medical management of medium vessel occlusion stroke in the middle cerebral artery territory
No full textBackground: Current randomized controlled trials are investigating the efficacy and safety of mechanical thrombectomy (MT) in patients with medium vessel occlusion (MeVO) stroke. Whether best medical management (MM) is more efficient than unsuccessful vessel recanalization during MT remains unknown.
Methods: This was a retrospective cohort study using data from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. Only patients with occlusion of the distal branches (M2 and M3) of the middle cerebral artery territory were included. Unsuccessful MT was defined as a modified Thrombolysis in Cerebral Infarction score of 0-2a. Propensity score matching was used to control for confounders. The primary outcome was functional independence, defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days after treatment. Multivariable regression analysis was used to assess factors associated with the primary outcome.
Results: Of 2903 patients screened for eligibility, 532 patients were analyzed (266 per group) after propensity score matching. The MM group had superior functional outcomes, with 32% achieving mRS 0-1 at 90 days compared with 21% in the MT group (P=0.011). Patients in the MM group also had significantly lower rates of symptomatic intracranial hemorrhage (sICH) (3.4% vs 16%, P<0.001) and any hemorrhage (18% vs 48%, P<0.001). On multivariable regression, unsuccessful MT was associated with reduced odds of functional independence (OR 0.50, 95% CI 0.29 to 0.85, P=0.011) and increased odds of sICH (OR 4.32, 95% CI 1.84 to 10.10, P<0.001). Mortality rates were similar between groups (27% in MM vs 29% in MT, P=0.73).
Conclusion: Unsuccessful MT for MeVO was linked to worse outcomes than best MM. These findings highlight the risks of prolonged attempts and emphasize the importance of efficient procedural decision-making to reduce complications and improve patient outcomes.No embarg
Common peroneal neuropathy due to an anatomical variant course of the fibular nerve in a patient with an accessory gastrocnemius tertius muscle
No full textAn accessory head of the gastrocnemius muscle, known as the gastrocnemius tertius (GT), is the most common anatomical variation of the gastrocnemius muscle. While often asymptomatic, this variant can occasionally compress adjacent structures. We report the case of a 61-year-old man with chronic lower limb pain, found to have a unilateral GT muscle with a concurrent anatomical variant course of the common peroneal nerve. MRI revealed fascicular thickening and increased T2 signal intensity within the nerve, suggestive of neuritis. This is, to our knowledge, the first reported case of symptomatic common peroneal neuropathy caused by the combined presence of a GT muscle and an anatomically variant peroneal nerve course. Recognition of such variants is crucial for accurate diagnosis and clinical decision-making in patients with lower extremity neuropathy.No embarg