95038 research outputs found
Sort by
Psychological Distress in Older Adults Living in Puerto Rico during COVID-19
Get PDFFew studies have addressed the impact of COVID-19 on mental health in low resource settings. This study examines the association of COVID-19-related stressors with psychological distress in older adults in Puerto Rico. Data are from a 2021 Knowledge, Attitudes and Practices survey about COVID-19 with adults aged 60 + in Puerto Rico (n = 213). We used the Self-Reporting Questionnaire-20 (SRQ-20) to assess distress. Stressors included COVID-19 diagnosis, hospitalization, or death of someone close, treatment delays, and loneliness. We used negative binomial regression with a log linear link function to model the effects of demographics and pandemic-related social and health stressors on distress. Almost one-third (31%) of participants reported clinically significant distress; 44.3% reported a loved one diagnosed with COVID-19, 32.4% had lost someone close, 25.8% reported treatment delays, and 39.4% experienced loneliness. A COVID-19 diagnosis of someone close without hospitalization [Adjusted Incidence Rate Ratio (AIRR) = 1.55; 95% CI 1.08, 2.22] and loneliness [AIRR = 1.20; 95% CI 1.09, 1.32] were associated with greater SRQ-20 scores. We consider the nexus of cultural and contextual factors (e.g., outmigration, under-resourced healthcare system, fatalism etc.) that are likely to influence short- and longer-term effects of COVID-19-related distress among older adults in Puerto Rico. Interdisciplinary collaborations are needed to enhance Covid-19-related support and to implement culturally appropriate and contextually feasible evidence-based interventions that will reduce high rates of mental health challenges and prevent their long-term effects
Exploring Vaccine Hesitancy, Structural Barriers, and Trust in Vaccine Information Among Populations Living in the Rural Southern United States
Get PDFIntroduction: In the United States, vaccine hesitancy is higher among rural and racially and ethnically diverse communities, and messaging from trusted individuals may increase vaccine acceptance. The purpose of this study is to understand vaccine hesitancy, messaging from trusted individuals, and vaccine acceptance strategies among racially and ethnically diverse, medically underserved rural populations. Methods: The researchers conducted 12 in-person focus groups, each consisting of 5 to 12 participants, with community members and trusted leaders from three rural counties in Eastern North Carolina (n = 119). Thematic analysis was used to synthesize insights from the discussions, allowing for the identification of recurring patterns and community-specific considerations regarding vaccine perceptions and messaging. Results: The researchers identified seven key themes within the primary focus areas of the study: factors influencing vaccine hesitancy, messaging from trusted individuals, and strategies to improve vaccine acceptance. Participants reported differences in trust based on how long a vaccine has been available, concerns about becoming sick after a vaccine, seeing the symptoms of vaccine-preventable diseases, and misinformation on social media. Overall, participants reported trust in messages from medical providers. Trusted leaders advised people to conduct their own research on vaccines when determining whether to receive vaccinations. Lastly, social determinants such as cost, education, and transportation were identified as key barriers to vaccination. Conclusions: Our findings indicate that medical providers are trusted messengers for vaccine information and the promotion of vaccine uptake. However, distrust linked to fear, misinformation, and structural barriers persist. Public health efforts to increase vaccination confidence among rural, racially and ethnically diverse populations in the United States Southeast should address these factors in future vaccine interventions and educational efforts
How Immunization Information Systems Inform Age-Based HPV Vaccination Recommendations in the United States: A Mixed-Methods Study
Get PDFBackground: Immunization information systems (IISs) in the United States forecast vaccine due dates, which can inform when providers recommend vaccines to patients. IIS forecasting for HPV vaccination at 9 years, the minimum age of licensure, and when vaccination is likely most effective is not documented or well-understood. Methods: We documented characteristics of HPV vaccination forecasts in jurisdictional IISs through Internet searches and requests to immunization program managers. Next, we conducted focus groups with stakeholders from seven jurisdictions to elucidate their processes for determining and implementing HPV vaccination forecasts. Results: Forecast data were available from 49 out of 64 CDC-funded jurisdictions, of which 14 (29%) recommended HPV vaccination at age 9 and 35 (71%) recommended HPV vaccination starting at ages 11 through to 15. Jurisdictions that recommended HPV vaccination at age 9 cited the positions of the American Cancer Society and American Academy of Pediatrics and reported little or no provider opposition to this recommendation. Jurisdictions reported variable flexibility in programming their forecasts. Those that changed their HPV vaccination forecast from 11 to 9 years did so easily while some experienced limitations. Other jurisdictions adhered strictly to the CDC’s routine recommendation at age 11–12 years and would only update the forecast in tandem with updated CDC guidance. The impact of IISs and electronic health record interoperability on how providers view and utilize IIS forecasting is unclear. Conclusions: Jurisdictions can share best practices for forecasting at 9 and future studies can evaluate the effects of forecasting age on the vaccination rates, providing evidence for nationwide vaccination recommendations
Out-of-Sequence Allocation of Deceased Donor Kidneys—When Discretion Undermines Equity
Get PDFKidney transplant for end-stage kidney disease significantly reduces mortality and morbidity and improves quality of life. Organ allocation uses a systematic algorithm to ensure equitable access for wait-listed candidates and optimize the use of donor organs, with policies periodically revised to maximize these end points. Policy revisions in 2021 aimed to enable broader sharing and reduce geographic disparitie
Student perceptions of GenAI as a virtual tutor to support collaborative research training for health professionals
Get PDFBackground Research and evaluation skills are essential in healthcare education. Instructors frequently employ collaborative learning models to teach these competencies; however, delivering timely and personalized feedback to multiple groups can be a significant challenge. This study aimed to investigate the potential of generative artificial intelligence (GenAI) as a tool for providing feedback on students’ research ideas. Methods We employed GenAI tools to provide personalised formative feedback during a small-group activity focused on helping students formulate research plans. The activity was implemented within two university courses designed for working health professionals. Students were grouped into groups of 5–7 students and provided clear instructions for how to prompt the GenAI for feedback on their research ideas. Participants completed an evaluation survey at the end of the activity that assessed frequency of use, perceived value, utility, and overall satisfaction. Results Half of the participants (n = 64, 85.3% response rate) had never used GenAI before (n = 32). Participants agreed or strongly agreed that the feedback provided by the GenAI was valuable (n = 54, 85%), helped them improve their plan (n = 50, 78%), and increased their interest in GenAI (n = 55, 86%). Participant comments described the feedback as favourable, specified an interest in adapting their plan, and rarely indicated a lack of trust or disagreement with the feedback provided. Conclusions GenAI offers an efficient and satisfactory approach to providing feedback to students for their research ideas. As a supportive tool, GenAI may foster student learning while enabling educators to rethink how and what they focus their time on, with an eye toward helping students understand more nuanced and complex research concepts. This study highlights the potential of GenAI as a virtual tutor, and the need for additional research to explore its benefits and challenges
Stability of cytokine and immunoglobulin concentrations in the general population: prepandemic basal concentrations and intraindividual changes until the COVID-19 pandemic
Get PDFWhile there is wide evidence on concentrations of cytokines in patients attending health care facilities, evidence is scant on physiological, basal concentrations of cytokines in the general population and across sociodemographic groups, as well as on their potential stability over time. Furthermore, from a public health perspective it is remarkable that no studies have analyzed intraindividual changes in such concentrations from before the COVID-19 pandemic until its outbreak. To investigate: (a) prepandemic concentrations of cytokines and immunoglobulins to viral exposures in a general, non-institutionalized population, and their associated sociodemographic variables; (b) the intraindividual change in such concentrations between a prepandemic period (2016–17) and the initial pandemic period (2020–21); and (c) whether such change was similar in participants who in 2020–21 were SARS-CoV-2 seronegative and seropositive, and between participants who did and did not develop COVID-19. We conducted a prospective cohort study in 240 individuals from the general population of Barcelona, Spain. Thirty cytokines and 31 immunoglobulins were measured in paired serum samples collected in 2016–17 and 2020–21 in the same individuals. The median value of the relative intraindividual change in cytokine concentrations between 2016 and 2020 was <15% for 29 of the 30 cytokines. A substantial number of participants had an intraindividual increase or decrease ≥15% in some cytokines. No major differences in intraindividual changes of cytokine and immunoglobulin levels between 2016 and 2020 were observed between participants who did and did not develop COVID-19. We provide novel information on physiological, basal ex-vivo concentrations of cytokines and immunoglobulins in a general population, which should be relevant for clinical practice and public health. Intraindividual changes in cytokines and immunoglobulins during the 4 years from 2016–17 to 2020–21 were moderate, and they did not differ between participants who in 2020–21 were SARS-CoV-2 seropositive and seronegative, nor between participants who did and did not develop COVID-19 disease. These findings are also novel and relevant for medicine and public health. In particular, the stability in the biomarkers is relevant to assess the role of the immunological and inflammatory state (measured through baseline levels of cytokines and immunoglobulins) in the development of SARS-CoV-2 seropositivity and COVID-19 disease, as well as in the susceptibility to other infections and pathologies
COVID-19 and Cognitive Change in a Community-Based Cohort
Get PDFImportance: SARS-CoV-2 infection has been linked to neurotoxic effects and cognitive deficits. Objective: To determine whether decreases in cognitive function were accelerated after SARS-CoV-2 infection compared with individuals not infected. Design, Setting, and Participants: Multicenter, prospective cohort study from 2016 to 2022 among 3525 participants alive on March 1, 2020, and enrolled in The Atherosclerosis Risk in Communities (ARIC) study and the Collaborative Cohort of Cohorts for COVID-19 Research study who completed a prepandemic cognitive assessment and a pandemic-era assessment of SARS-CoV-2 infection. Final analyses performed in November 2024. Exposure: SARS-CoV-2 infection determined via self-report of a positive SARS-CoV-2 test or health care professional diagnosis of COVID-19, a positive SARS-CoV-2 antinucleocapsid antibody response, or presence of an administrative code for COVID-19 on medical records. Main outcomes and measures: A neuropsychological battery assessed multiple cognitive domains, and a cocalibrated confirmatory factor analysis generated factor scores for global cognitive function. The primary outcome was the rate of excess change in cognitive function. Results: The 3525 eligible participants had a mean (SD) age of 80.8 (4.7) years, 2085 (59.1%) were female, 752 (21.4%) were Black, and 2773 (78.6%) were White. SARS-CoV-2 infection was detected among 307 participants (8.7%), 103 of whom (33.6%) were hospitalized. Among uninfected participants, the mean annualized change in cognitive function was -0.09 (95% CI, -0.13 to -0.04). Compared with this rate, change was faster (β = -0.06; 95% CI, -0.09 to -0.02) among participants hospitalized for infection, but not different from participants who were infected but not hospitalized (β = 0.00; 95% CI, -0.02 to 0.03). The association among participants hospitalized for infection was evident in the cognitive domains of memory and executive function, but not language. Conclusions and relevance: This cohort study of older participants found accelerated decreases in cognition among individuals hospitalized for SARS-CoV-2 infection, but not nonhospitalized infection, in comparison with individuals not yet infected
Do Gender-Role Violations in Initiating Structure and Consideration Help or Harm Employee Stress and Well-Being?
Get PDFAlthough prior research has noted the stress-reducing effects of leaders’ initiating structure and consideration, these behaviors are often gendered, with initiating structure as agentic, masculine behavior and consideration as communal, feminine behavior. Given these gender-role expectations, we examine whether there are different implications of women and men leaders’ initiating structure and consideration in relation to employee stress and well-being. Integrating expectancy violation theory and stress appraisal theory, we argue that perceived leader behaviors that violate gender roles (i.e., initiating structure by women leaders and consideration by men leaders) will be more powerful in reducing employee threat appraisals, which then reduces self-regulation depletion and in turn enriches employee well-being. Two studies—a time-separated field study and a set of experiments—support our proposals. Implications for theory and practice are discussed
Large-scale multi-omics analyses in Hispanic/Latino populations identify genes for cardiometabolic traits
Get PDFHere, we present a multi-omics study of type 2 diabetes and quantitative blood lipid and lipoprotein traits conducted to date in Hispanic/Latino populations (nmax = 63,184). We conduct a meta-analysis of 16 type 2 diabetes and 19 lipid trait GWAS, identifying 20 genome-wide significant loci for type 2 diabetes, including one novel locus and novel signals at two known loci, based on fine-mapping. We also identify sixty-one genome-wide significant loci across the lipid/lipoprotein traits, including nine novel loci, and novel signals at 19 known loci through fine-mapping. Next, we analyze genetically regulated expression, perform Mendelian randomization, and analyze association with transcriptomic and proteomic measure using multi-omics data from a Hispanic/Latino population. Using this approach, we identify genes linked to type 2 diabetes and lipid/lipoprotein traits, including TMEM205 and NEDD9 for HDL cholesterol, TREH for triglycerides, and ANXA4 for type 2 diabetes
A Narrative and Case-Illustrated Review on Dental Autotransplantation Identifying Current Gaps in Knowledge
Get PDFBackground: Permanently replacing missing teeth in the younger population is a clinical challenge. However, dental autotransplantation offers a viable treatment option in this demographic. To be performed predictably, it requires proper diagnoses, planning, and adherence to established guidelines in a multidisciplinary approach. Such guidelines should use evidence-based dentistry to anticipate and limit complications. The aim of this study is to evaluate the current literature on dental autotransplantation, discuss an evidence-based protocol, highlight steps for minimizing complications, and present a case report on two autotransplantations conducted at the Graduate Periodontology clinic at the University of North Carolina at Chapel Hill, Adams School of Dentistry, in the context of representative cases. Methods: A literature search using PubMed was conducted with the goal of constructing a comparative table on both survival and success rates of autotransplantation, providing a comparison of protocols and clinical studies and informing this narrative review. This review is illustrated by cases with the intention to highlight critical steps, limitations, and strengths of this mode of treatment. Results and Conclusions: Given the information presented, it is concluded that autotransplantation is a valuable treatment option provided established guidelines are followed. It is particularly useful for the younger population where implants or other options are not appropriate or feasible. This study also highlights some of the gaps in knowledge in autotransplantation which present opportunity for further studies to be developed