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Simple Summary: In this position paper, we aim to summarize state-of-the-art treatments for patients with leiomyosarcomas in order to identify knowledge gaps and current unmet needs, thereby guiding the community to design innovative clinical trials and basic research and close these research gaps. This white paper arose from a leiomyosarcoma research meeting in October 2020 hosted by the National LeioMyoSarcoma Foundation (NLMSF) and Sarcoma Patients EuroNet (SPAEN). As leiomyosarcoma patients are challenged by the development of metastatic disease, effective systemic therapies are the cornerstone of outcome. However, the overall activity of the currently available conventional systemic treatments and the prognosis of patients with advanced or metastatic disease are still poor, making the treatment of this patient group challenging. Therefore, in a joint effort together with patient networks and organizations, namely Sarcoma Patients EuroNet (SPAEN), the international network of sarcoma patients organizations, and the National LeioMyoSarcoma Foundation (NLMSF) in the United States, we aim to summarize state-of-the-art treatments for leiomyosarcoma patients in order to identify knowledge gaps and current unmet needs, thereby guiding the community to design innovative clinical trials and basic research and close these research gaps. This position paper arose from a leiomyosarcoma research meeting in October 2020 hosted by the NLMSF and SPAEN. [ABSTRACT FROM AUTHOR]

Background: This study involved a scoping review to explore factors influencing dental hygienist demand and supply in high-income countries. Methods: A six-stage scoping review was conducted with separate search strategies tailored to four databases (MEDLINE, CINAHL, Google Scholar, and Google) plus a targeted scan of dental hygienist organization websites. This yielded 2,117 unique citations, leading to 148 articles included in the review. Results: Nearly half of the articles (47%) focused on the United States, with 11% on Canada. Most articles (91%) were in English, alongside 13 in Korean and one in French. Journal articles comprised 62% of the publications, followed by reports/working papers (11%) and websites (11%). Other types included conference abstracts, policy briefs, and presentation slides. Content-wise, 47% were original research, with analysis articles (14%), commentaries (11%), and reviews (8%) also present. The articles were coded into three main categories: workforce characteristics/projections, factor-specific analyses, and workforce opportunities. The articles on workforce characteristics covered demographic, geographic, and employment aspects of dental hygienists, along with projections for supply and demand using simulation modelling and geospatial analyses. Factor-specific articles investigated the (1) working environment, (2) policy/regulatory/training environment, (3) job/career satisfaction and related human resource issues, and (4) scope of practice. The third key category of articles highlighted opportunities for expanding the workforce through alternative models in different sectors/settings (e.g., public health, primary care, long-term care, hospitals, mobile outreach, and non-clinical roles including research, education and leadership) and for a range of vulnerable or underserved populations (e.g., geriatric and pediatric populations, persons with disabilities, those living in rural/remote areas, Indigenous peoples, and incarcerated people). Conclusions: This review provides a comprehensive documentation of the current state of the dental hygienist workforce, compiling factors affecting demand and supply, and highlighting opportunities for the dental hygienist workforce in Canada and other high-income countries. The findings offer a foundation for future research, highlighting the need for more focused and rigorous reviews and underscoring the necessity of high-quality studies to verify the effectiveness of various interventions and policies. This is crucial to address dental hygienist workforce challenges and ensure the sustainability and effectiveness of oral health care delivery. [ABSTRACT FROM AUTHOR]

Background: Immigrant Latinx transgender people often migrate to the United States because of a desire for increased safety and more opportunities. However, after migrating to the United States, immigrant Latinx transgender people often struggle to access basic needs, including health care, jobs, and stable finances. These struggles are exacerbated for undocumented immigrant Latinx transgender people. There is a gap in the literature regarding needed resources for immigrant Latinx transgender community members living in the United States. Aims: Utilizing a critical intersectionality framework, the aim of the present study was to investigate the resource needs of immigrant Latinx transgender community members living in the United States. Methods: A community sample of 18 immigrant Latinx transgender people living in a large metropolitan city in Florida participated in individual semi-structured interviews to explore their community resource needs. Results: Thematic analysis revealed five themes related to resources that participants needed including: 1) Transgender healthcare/resources, 2) Public education, 3) Financial aid resources, 4) Homelessness resources, and 5) Addictions care. Two resource need-related themes were identified that pertain specifically to undocumented immigrant Latinx transgender people, including: 1) Documentation papers for access, and 2) Legal aid. Conclusions: Findings suggest that immigrant Latinx transgender community members in this study provided guidance about broad resources needed to enhance their wellness and safety, and promote liberation of community members. Participants' resource needs suggest the importance of policy and structural level changes from institutions with power that consider and enhance the wellness of immigrant Latinx transgender people. Findings also suggest the need for more tailored interventions and case work to better support immigrant Latinx transgender people. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Oncology Nursing Journal is the property of Pappin Communications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To assess rates of traversing barriers to care to access optimal clinical outcomes in people with migraine internationally. Background: People in need of medical care for migraine should consult a health care professional knowledgeable in migraine management, obtain an accurate diagnosis, and receive an individualized treatment plan, which includes scientific society guideline-recommended treatments where appropriate. Methods: The Chronic Migraine Epidemiology and Outcomes-International (CaMEO-I) Study was a cross-sectional, web-based survey conducted from July 2021 through March 2022 in Canada, France, Germany, Japan, the United Kingdom, and the United States (US). Respondents who met modified International Classification of Headache Disorders, 3rd edition, criteria for migraine and had Migraine Disability Assessment Scale (MIDAS) scores of ≥ 6 (i.e., mild, moderate, or severe disability) were deemed to need medical care and were included in this analysis. Minimally effective treatment required that participants were currently consulting a health care professional for headache (barrier 1), reported an accurate diagnosis (barrier 2), and reported use of minimally appropriate pharmacologic treatment (barrier 3; based on American Headache Society 2021 Consensus Statement recommendations). Proportions of respondents who successfully traversed each barrier were calculated, and chi-square tests were used to assess overall difference among countries. Results: Among 14,492 respondents with migraine, 8,330 had MIDAS scores of ≥ 6, were deemed in need of medical care, and were included in this analysis. Current headache consultation was reported by 35.1% (2926/8330) of respondents. Compared with the US, consultation rates and diagnosis rates were statistically significantly lower in all other countries except France where they were statistically significantly higher. Total appropriate treatment rates were also statistically significantly lower in all other countries compared with the US except France, which did not differ from the US. All 3 barriers were traversed by only 11.5% (955/8330) of respondents, with differences among countries (P < 0.001). Conclusions: Of people with migraine in need of medical care for migraine, less than 15% traverse all 3 barriers to care. Although rates of consultation, diagnosis, and treatment differed among countries, improvements are needed in all countries studied to reduce the global burden of migraine. Trial registration: NA. [ABSTRACT FROM AUTHOR]

Background: Children with medical complexity (CMC) often face significant barriers to accessing care, obtaining appropriate insurance coverage for medical devices, technology, supplies, home nursing and social services. These challenges, when viewed through the lens of social determinants of health, highlight concerns about healthcare inequity. These inequities can impact CMC by limiting access to follow‐up appointments, leading to disproportionate use of emergency department services, restricting support services, reducing the quality of medical products and increasing the likelihood of adverse events. Addressing these concerns requires comprehensive policy changes at both state and federal levels. Achieving successful collaborations between states and federal agencies is particularly challenging and may take months or even years to accomplish. Objectives: Through an exploratory qualitative approach, this study facilitates a nuanced inquiry into the experiences and systemic challenges encountered by medical professionals and primary caregivers managing CMC who require a paediatric tracheostomy. Methods: Qualitative interviews were conducted with 17 health professionals and primary caregivers residing in the United States. A thematic analysis was used to analyse the transcribed interview data. Results: Using exploratory thematic analysis, we identified challenges and opportunities for improvement regarding (a) access to health insurance, (b) procurement of essential medical supplies, (c) logistical constraints and (d) identifying interim solutions. Conclusion: Building on our findings, we discuss how socioecological factors impact health and quality of life of CMC and families. Additionally, we address the growing gap in quality of care through a comprehensive approach that considers patient needs, regulatory frameworks and affordability. Patient or Public Contribution: Medical practitioners and healthcare professionals were actively involved in the development, production and implementation of the research project. These individuals were given the opportunity to review their statements and review the manuscript before publishing. While caregivers did not engage in member checking, each provided their consent before data collection. [ABSTRACT FROM AUTHOR]

This paper presents longitudinal data representing federal funding for health services research and discusses the observed trends in the larger context of overall funding for research and development in the United States. By putting into context public and private funding trends, the authors examine how these trends effect the supply and demand of the health services research workforce. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Transgender, non-binary, and/or gender expansive (TNG) individuals experience disproportionately high rates of mental illness and unique barriers to accessing psychiatric care. Integrating TNG-specific psychiatric care with other physical health services may improve engagement, but little published literature describes patient and clinician perspectives on such models of care. Here we present a formative evaluation aiming to inform future projects integrating psychiatric care with physical health care for TNG individuals. Methods: In this qualitative pre-implementation study, semi-structured interview guides were developed informed by the Consolidated Framework for Implementation Research to ensure uniform inclusion and sequencing of topics and allow for valid comparison across interviews. We elicited TNG patient (n = 11) and gender-affirming care clinician (n = 10) needs and preferences regarding integrating psychiatric care with other gender-affirming clinical services. We conducted a rapid analysis procedure, yielding a descriptive analysis for each participant group, identifying challenges of and opportunities in offering integrated gender-affirming psychiatric care. Results: Participants unanimously preferred integrating psychiatry within primary care instead of siloed service models. All participants preferred that patients have access to direct psychiatry appointments (rather than psychiatrist consultation with care team only) and all gender-affirming care clinicians wanted increased access to psychiatric consultations. The need for flexible, tailored care was emphasized. Facilitators identified included taking insurance, telehealth, clinician TNG-competence, and protecting time for clinicians to collaborate and obtain consultation. Conclusions: This health equity pre-implementation project engaged TNG patients and gender-affirming care clinicians to inform future research exploring integration of mental health care with primary care for the TNG community and suggests utility of such a model of care. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare organizations are under increasing pressure from policymakers, payers, and advocates to screen for and address patients’ health-related social needs (HRSN). The emergency department (ED) presents several challenges to HRSN screening, and patients are frequently not screened for HRSNs. Predictive modeling using machine learning and artificial intelligence, approaches may address some pragmatic HRSN screening challenges in the ED. Because predictive modeling represents a substantial change from current approaches, in this study we explored the acceptability of HRSN predictive modeling in the ED. Methods: Emergency clinicians, ED staff, and patient perspectives on the acceptability and usage of predictive modeling for HRSNs in the ED were obtained through in-depth semi-structured interviews (eight per group, total 24). All participants practiced at or had received care from an urban, Midwest, safety-net hospital system. We analyzed interview transcripts using a modified thematic analysis approach with consensus coding. Results: Emergency clinicians, ED staff, and patients agreed that HRSN predictive modeling must lead to actionable responses and positive patient outcomes. Opinions about using predictive modeling results to initiate automatic referrals to HRSN services were mixed. Emergency clinicians and staff wanted transparency on data inputs and usage, demanded high performance, and expressed concern for unforeseen consequences. While accepting, patients were concerned that prediction models can miss individuals who required services and might perpetuate biases. Conclusion: Emergency clinicians, ED staff, and patients expressed mostly positive views about using predictive modeling for HRSNs. Yet, clinicians, staff, and patients listed several contingent factors impacting the acceptance and implementation of HRSN prediction models in the ED. [ABSTRACT FROM AUTHOR]

Introduction. New Zealand's health care system faces significant shortages in health care workers. To address workforce challenges and meet the population's health needs, health care systems around the world have introduced new clinical roles, such as physician associates/assistants (PAs) into existing health care teams. Aim. This article aims to examine the benefits, challenges, and broader implications of regulating PAs in the context of New Zealand's primary care sector, with a specific emphasis on how it may impact general practice. Methods. A range of literature surrounding the role, impact, and perception of PAs were selected and included in this article. Results. The PA profession can significantly strengthen New Zealand's primary care workforce, improving patient access and continuity of care. However, the global deployment of PAs has faced scrutiny due to concerns about its potential risks to patient safety and the overall viability of such a role. Discussion. If regulated, the PA profession can reshape New Zealand's primary care, offering a partial solution to current medical staff shortages. Trained under a generalised medical model similar to doctors, PAs possess the necessary skills to perform both routine and non-routine medical tasks. This dual capability can significantly improve primary care service provision, reduce existing workloads, and allow for a more efficient deployment of doctor expertise. However, medico-legal issues and the supervisory burden can impede widespread integration into general practice. Despite challenges, the success of the PA role relies on mutual trust, respect, and support from other clinical team members within primary health care. [ABSTRACT FROM AUTHOR]

In this paper we argue the importance of including gender and sexually diverse populations in policy development towards a more inclusive form of health promotion. We emphasize the need to address the broad health and wellbeing issues and needs of LGBT people, rather than exclusively using an illness-based focus such as HIV/AIDS. We critically examine the limitations of population health, the social determinants of health (SDOH), and public health goals, in light of the lack of recognition of gender and sexually diverse individuals and communities. By first acknowledging the unique health and social care needs of LGBT people, then employing anti-oppressive, critical and intersectional analyses we offer recommendations for how to make population health perspectives, public health goals, and the design of public health promotion policy more inclusive of gender and sexual diversity. In health promotion research and practice, representation matters. It matters which populations are being targeted for health promotion interventions and for what purposes, and it matters which populations are being overlooked. In Canada, current health promotion policy is informed by population health and social determinants of health (SDOH) perspectives, as demonstrated by Public Health Goals for Canada. With Canada's multicultural makeup comes the challenge of ensuring that diverse populations are equitably and effectively recognized in public health and health promotion policy. [ABSTRACT FROM AUTHOR]

In the United States, patients with end-stage liver disease must join a waiting list to be eligible for cadaveric liver transplantation. Due to privacy concerns, the details of the composition of this waiting list are not publicly available. This paper considers the benefits associated with creating a more transparent waiting list. We study these benefits by modeling the organ accept/reject decision faced by these patients as a Markov decision process in which the state of the process is described by patient health, quality of the offered liver, and a measure of the rank of the patient in the waiting list. We prove conditions under which there exist structured optimal solutions, such as monotone value functions and control-limit optimal policies. We define the concept of the patient's price of privacy, namely, the number of expected life days lost due to the lack of complete waiting list information. We conduct extensive numerical studies based on clinical data, which indicate that this price of privacy is typically on the order of 5% of the optimal solution value. [ABSTRACT FROM AUTHOR]

Background: Pregnant individuals in incarcerated settings have unique healthcare needs. Rates of mental health, infectious diseases, and chronic disease are higher among nonpregnant incarcerated women compared with those who are not, but the prevalence of these conditions among pregnant people in custody has not been documented. Objectives: The objective of this study is to describe the prevalence of metabolic, infectious, and mental health conditions in pregnant people to identify the medical needs of high-risk pregnancies in US state prisons and local jails. Study Design: This was a prospective epidemiologic surveillance of a convenience sample of state prisons (n = 20) and local jails (n = 3). Methods: We used purposive and snowball sampling to recruit a national sample of prisons and jails of a range of sizes and geographies. Reporters submitted to our study database monthly data on selected pregnancy comorbidities for 6 months between 2016 and 2017. Screening, diagnosis, and tracking of these conditions are derived from each facility's medical record and health care delivery systems. Results: Of the 445 newly admitted pregnant people in prisons and 243 in jails, the most prevalent conditions were mental health conditions and hepatitis C. Specifically, 34.1% (n = 152) in prison and 23.5% (n = 57) in jail had a substance use disorder, and 27.4% (n = 122) of those in prison and 17.7% (n = 43) in jail had a psychiatric diagnosis. Finally, 20.2% (n = 91) in prison and 6.6% (n = 16) in jail had hepatitis C. Conclusions: This study demonstrates that chronic medical and mental health conditions are prevalent among pregnant people in US prisons and jails. However, significant variability in the reported number of cases of these conditions from state to state and between facility types implies a lack of or inadequate screening practices. These data indicate the need for comprehensive screening and appropriate care for the complex needs of pregnant incarcerated people. Plain Language Summary: Health care conditions among pregnant persons in US state prisons and local jails 2016–2017 Background: Pregnant individuals in incarcerated settings have unique health care needs. Rates of mental health, infectious diseases, and chronic disease are higher among nonpregnant incarcerated women compared with those who are not, but the prevalence of these conditions among pregnant people in custody has not been documented. Objectives: The objective of this study is to describe the prevalence of these conditions in pregnant people to identify the medical needs of high-risk pregnancies in US state prisons and local jails. Study Design: The study involved ongoing systematic data collection, analysis and interpretation of pregnancy data from a convenience sample of state prisons (n = 20) and local jails (n = 3). Methods: We intentionally recruited a national sample of prisons and jails of a range of sizes and geographies that house pregnant individuals. Some study facilities were referred from others. Reporters submitted to our study database monthly data on selected pregnancy comorbidities for 6 months between 2016 and 2017. Screening, diagnosis, and tracking of these conditions derived from each facility's medical record and health care delivery systems. Results: Of the 445 newly admitted pregnant people in prisons and 243 in jails, the most prevalent conditions were mental health conditions and hepatitis C. Specifically, 34.1% (n = 152) in prison and 23.5% (n = 57) in jail had a substance use disorder and 27.4% (n = 122) of those in prison and 17.7% (n = 43) in jail had a psychiatric diagnosis. Finally, 20.2% (n = 91) in prison and 6.6% (n = 16) in jail had hepatitisc. Conclusions: This study demonstrates that chronic medical and mental health conditions are prevalent among pregnant people in US prisons and jails. However, significant variability in the reported number of cases of these conditions from state to state and between facility types implies a lack of or inadequate screening practices. These data indicate the need for comprehensive screening and appropriate care for the complex needs of pregnant incarcerated people. [ABSTRACT FROM AUTHOR]

Background: Health care organizations need to be responsive to the needs of increasingly diverse patient populations. We compared the contents of six publicly available approaches to organizational responsiveness to diversity. The central questions addressed in this paper are: what are the most consistently recommended issues for health care organizations to address in order to be responsive to the needs of diverse groups that differ from the majority population? How much consensus is there between various approaches?Methods: We purposively sampled six approaches from the US, Australia and Europe and used qualitative textual analysis to categorize the content of each approach into domains (conceptually distinct topic areas) and, within each domain, into dimensions (operationalizations). The resulting classification framework was used for comparative analysis of the content of the six approaches.Results: We identified seven domains that were represented in most or all approaches: organizational commitment, empirical evidence on inequalities and needs, a competent and diverse workforce, ensuring access for all users, ensuring responsiveness in care provision, fostering patient and community participation, and actively promoting responsiveness. Variations in the operationalization of these domains related to different scopes, contexts and types of diversity. For example, approaches that focus on ethnic diversity mostly provide recommendations to handle cultural and language differences; approaches that take an intersectional approach and broaden their target population to vulnerable groups in a more general sense also pay attention to factors such as socio-economic status and gender.Conclusions: Despite differences in labeling, there is a broad consensus about what health care organizations need to do in order to be responsive to patient diversity. This opens the way to full scale implementation of organizational responsiveness in healthcare and structured evaluation of its effectiveness in improving patient outcomes. [ABSTRACT FROM AUTHOR]

The Affordable Care Act provides for a program of risk adjustment in the individual and small group health insurance markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge. The risk adjustment methodology includes the risk adjustment model and the risk transfer formula. This article is the third of three in this issue of the Medicare & Medicaid Research Review that describe the ACA risk adjustment methodology and focuses on the risk transfer formula. In our first companion article, we discussed the key issues and choices in developing the methodology. In our second companion paper, we described the risk adjustment model that is used to calculate risk scores. In this article we present the risk transfer formula. We first describe how the plan risk score is combined with factors for the plan allowable premium rating, actuarial value, induced demand, geographic cost, and the statewide average premium in a formula that calculates transfers among plans. We then show how each plan factor is determined, as well as how the factors relate to each other in the risk transfer formula. The goal of risk transfers is to offset the effects of risk selection on plan costs while preserving premium differences due to factors such as actuarial value differences. Illustrative numerical simulations show the risk transfer formula operating as anticipated in hypothetical scenarios. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of an International Association of Gerontology and Geriatrics (IAGG) workshop on nursing homes. One of the paper presented in the workshop focused on the state of nursing homes within long-term care in Catalonia, Spain. The event also addressed the challenges posed by the increasing elderly population in China, as well as the occupancy rate in Chinese nursing homes. Another topic addressed in the workshop was chronic pain in long-term care facilities.

The article discusses studies on chronic pain selected by the members of the Society of General Internal Medicine. It says that the papers were chosen for their potential to change generalist care of patients with chronic pain. The articles include one on the assessment of pain intensity and interference, a randomized trial on optimized antidepressant therapy and pain self-management to improve pain and depression outcomes, and one on the trends in opioid use in patients with non-cancer pain.

The extent to which the moral hazard caused by health insurance represents economic inefficiency has been the subject of much debate. This paper incorporates health status in a model of moral hazard, and finds that seriously ill patients are likely to exhibit greater moral hazard than healthier patients but the proportion of moral hazard that is inefficient declines with the severity of illness. Because of these competing tendencies, the cost of resource misallocation is parabolic in the severity of illness. The effect of the consumer's initial wealth endowment is also considered. [ABSTRACT FROM AUTHOR]

The expansion of women in the military is reshaping the veteran population, with women now constituting the fastest growing segment of eligible VA health care users. In recognition of the changing demographics and special health care needs of women, the VA Office of Research & Development recently sponsored the first national VA Women's Health Research Agenda-setting conference to map research priorities to the needs of women veterans and position VA as a national leader in Women's Health Research. This paper summarizes the process and outcomes of this effort, outlining VA's research priorities for biomedical, clinical, rehabilitation, and health services research. [ABSTRACT FROM AUTHOR]

Refugee newcomers resettled in the United States face numerous challenges impacting their mental health and overall well-being. Despite extensive research on clinical interventions, multimodal interventions with peer-based group models in resettlement contexts remain scarce. Adopting a realist evaluation approach, this study aims to conduct a comprehensive implementation evaluation of a complex community-based mental health and psychosocial support (CB-MHPSS) group intervention, examining its mechanisms and processes while considering the interplay among context, implementing agents, and community settings. Qualitative and quantitative data on the implementation process were collected from 11 refugee agencies, involving trained resettlement staffers (n = 32) and refugee community facilitators (n = 31) who implemented the 31 CB-MHPSS psychosocial groups in 2021. The analysis included fidelity reports, process reflections, and follow-up survey responses, utilizing a structured template based on the CB-MHPSS Theory of Change (ToC) and Medical Research Council (MRC) guidance. Results of an in-depth exploration of complex relations between context and implementation processes reveal the vital role that adaptability to socio-ecological circumstances during the global coronavirus pandemic played in achieving successful implementation of psychosocial group interventions. Striking a balance between fidelity and refinement of intervention of the intervention curriculum emerged as crucial factors for aligning facilitation goals with newcomer needs. This approach maintained the integrity and appropriateness of the intervention, requiring implementers to utilize local knowledge of community resources and their understanding of lived experience of forced migrants and their within the community. Furthermore, exploring intervention barriers and facilitators revealed merits aligned with program change theories and areas for adjustment, while cataloged guidelines addressed community needs, showcasing competence beyond standard checkboxes. Strategic dissemination guidance provided by the central office in a supportive and nonintrusive manner facilitated uptake in a participatory and context-specific manner. This study emphasizes the importance of leveraging community partnerships and local knowledge to result in sustained improvements in the mental health and well-being of refugees. [ABSTRACT FROM AUTHOR]

As pharmacy practice shifts its focus toward population health care needs that serve public health, there is a need to understand community-based pharmacies' contributions to the reduction in health disparities. A scoping review was conducted to identify what community-based pharmacies in the United States are doing to target racial and ethnic disparities in community-based pharmacies. Forty-two articles revealed that community-based pharmacy services addressed racial and ethnic inequities in a variety of ways, including the types of interventions employed, as well as the ethnicities and conditions of the sample populations. Future work should focus on ensuring interventions are carried out throughout pharmacy practice and accessible to all racial and ethnic minoritized populations. [ABSTRACT FROM AUTHOR]

Objective: Disaggregated data on the mental health of Asian/Asian American people are needed to inform public health interventions related to reports of racism during the COVID-19 pandemic. We describe the prevalence of psychological distress and unmet mental health needs among Asian/Asian American adults during the COVID-19 pandemic across various sociodemographic subgroups. Methods: We used cross-sectional, weighted data from the US-based 2021 Asian American and Native Hawaiian/Pacific Islander COVID-19 Needs Assessment Study (unweighted n = 3508) to estimate prevalence rates of psychological distress and unmet mental health needs, overall and by nativity status. We conducted population-weighted multivariable logistic regression analyses to examine sociodemographic factors associated with these mental health outcomes. Results: About one-third (1419 of 3508) of Asian/Asian American adults (32.9%; 95% CI, 30.6%-35.2%) reported psychological distress; odds of psychological distress were increased among adults who were female, trans, and nonbinary; aged 18-44 years; US-born; Cambodian; multiracial; and low income. Of those reporting psychological distress (638 of 1419), 41.8% (95% CI, 37.8%-45.8%) reported unmet mental health needs; unmet mental health needs were highest among Asian/Asian American adults who were aged 18-24 years; Korean, Japanese, and Cambodian; US-born female; non–US-born young adults; and non–US-born with ≥bachelor's degree. Conclusions: The mental health of Asian/Asian American people is an important public health concern, with some groups more vulnerable and in need of services than others. Mental health resources need to be designed for vulnerable subgroups, and cultural and systemic barriers to mental health care need to be addressed. [ABSTRACT FROM AUTHOR]

The National Health Interview Survey (NHIS) data on self-reported trouble hearing and the use of hearing aids were examined for the 12 recent surveys from 2007 to 2018 for adults from 18 to 85+ years of age. The aggregate dataset for all years included data from 357,714 adult respondents. Sample size for annual data ranged from 22,058 (2008) to 36,798 (2014). The prevalence of self-reported trouble hearing and hearing aid use, both current use and ever-using hearing aids, are reported for males and females for each age decade. Measures of unmet hearing healthcare (HHC) need were derived from estimates of the prevalence of hearing aid use among those with self-reported trouble hearing. Logistic-regression analyses identified variables affecting the odds of having self-reported trouble hearing, of using or rejecting hearing aids, and of having unmet HHC needs. The results largely corroborate and extend the findings of recent analyses of data from the National Health and Nutrition Examination Survey (NHANES) for a similar period (2011–2020). Overall, for males, 18.5% (95% CI [18.2%–18.8%]) had self-reported trouble hearing and 76.6% [76.0%–77.2%] of these individuals had never used hearing aids and, for females 13.1% [12.9%–13.4%] had trouble hearing and 79.5% [78.9%–80.1%] of these individuals had never used hearing aids. Unmet HHC needs are highly prevalent in the United States and have been so for many years. [ABSTRACT FROM AUTHOR]

Background: This study examined self-reported physical activity (PA) participation, well-being, and perceived needs of Canadians with disabilities during the COVID-19 pandemic. In addition, we assessed physical and mental health and the extent to which pre-identified needs were being met or unmet. Methods: Two iterations of the COVID-19 Disability Survey were conducted during two pandemic timeframes: June–December 2020 (iteration 1, n = 599) and December 2020–September 2021 (iteration 2, n = 528). PA participation was assessed with the International Physical Activity Questionnaire. Physical and mental health were assessed with the PROMIS Global-10 questionnaire. A needs assessment was conducted on 11 needs pre-identified in partnership with community organizations. Results: Approximately 50% of respondents to both iterations reported that they did not do any moderate-vigorous intensity PA. While physical health was not different between timeframes, mental health was worse during iteration 2 than iteration 1 (p = 0.028). During both timeframes, access to recreation and leisure facilities was the greatest unmet need. Conclusion: These data highlight the low levels of PA and the perceived changes in PA, mental health, and recreational needs of Canadians with disabilities during the pandemic. The findings of the Survey were used to support policy change to remove barriers to PA participation for people with disabilities in Ontario. [ABSTRACT FROM AUTHOR]

Although people who go through the prison and jail system in the United States have significant health care needs, many leave it with no health insurance and, as a result, they experience gaps in access to care. Exploiting variation in Medicaid eligibility policies for incarcerated individuals across states and using administrative prison release data, we find that suspending rather than terminating Medicaid upon incarceration decreases the probability of returning to prison within 1 and 3 years of release by 2.91 and 4.58 percentage points, respectively. These effects are observed among different types of prisoners, but are greater for Black and repeat offenders. Our results suggest that faster and easier reinstatement of Medicaid benefits upon prison release decreases recidivism rate and are directly relevant to ongoing policy debates on the health care coverage of vulnerable populations. [ABSTRACT FROM AUTHOR]

Among Veterans, it is estimated that 110,000 are living with Parkinson's disease (PD) in the United States. Whether or not Veterans living with PD are enrolled in the Veterans Health Administration (VHA), they may require special considerations when it comes to their care. We administered a survey to Parkinson's Foundation constituents with PD who had previously reported their Veteran status. Our goal was to identify areas where intervention can lead to improved health outcomes for Veterans living with Parkinson's disease. We specifically wanted to examine 1) the proportion of our Veteran constituents receiving services through the VHA, 2) the comprehensive care services that were utilized by Veterans living with PD, and 3) self-reported mental health and mobility status. We also wanted to compare those receiving care within and outside the VHA to see where there may be areas for improvement. With a response rate of 29.8% we received surveys from 409 United States Veterans with PD. As expected, mental health (MH) concerns in the previous 12 months were common with 36.0% of Veterans reporting concerns. Only 22.1% of respondents received care through VHA. Respondents with more falls and mental health concerns as well as those with higher levels of education and younger age were more likely to be seen at a VHA facility. In this sample, education level, household income, marital status, and VHA status were positively associated with increased health care utilization among Veterans. Those seen within the VHA were more likely to utilize MH and speech and language pathology consultation. This study highlights the importance of targeting educational outreach about care best practices for Veterans living with PD beyond VHA's current reach as well as the importance of access to good MH resources. [ABSTRACT FROM AUTHOR]

Introduction: Good preconception and interconception health are fundamental to optimizing women's health and reducing risk factors for adverse maternal–infant outcomes. Although rural women in the United States tend to experience health disparities, no published qualitative studies have focused on their preconception/interconception health. The purpose of this study was to determine what rural, Midwestern women perceive to be their most pressing health needs and effective ways to provide outreach and education regarding preconception/interconception health and care. Methods: Non-pregnant, reproductive-age women in Hardin County, Ohio, regardless of parity, were recruited through convenience sampling. Semi-structured interviews with four domains (beliefs and behaviors; perceived needs; knowledge and information sources; barriers to care) were conducted in May–June 2021 until saturation was reached. Qualitative methods were used to analyze data and determine themes. Binomial tests were used to compare selected demographic characteristics of participants to the county's reproductive-age residential female population. Results: Nineteen women aged 20–44 years were individually interviewed. Comparing race/ethnicity, education, and insurance status, participants appeared to be representative of the county population. Four themes were identified: (1) needs regarding healthcare and other resources; (2) lack of preconception/interconception care and perceived unimportance due to intergenerational knowledge transfer and paucity of healthcare providers; (3) difference in understanding of the term "women's health" and low health literacy; and (4) suggested interventions including education and outreach. Conclusion: Interviews with rural Midwestern women revealed needs regarding preconception/interconception health and care and potential ways to raise awareness. These findings can inform strategies to improve rural women's health and birth outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cognitive dysfunction is prevalent in multiple sclerosis (MS) and can have a negative effect on several aspects of the daily lives of individuals with MS. In 2010, members of the Consortium of Multiple Sclerosis Centers (CMSC) were surveyed to understand MS clinicians' screening, assessment, and treatment practices for cognitive problems. Given the advancements made in the field in the past decade, it was deemed time to reevaluate how cognitive dysfunction is managed in the clinical setting. METHODS: An online questionnaire was completed by 56 CMSC members. They were asked to describe their clinical practices, procedures for screening and further evaluation, and treatment recommendations for cognitive dysfunction. Participants were also asked whether their practice had changed in terms of the number of cognitive screenings, prescriptions for cognitive problems, and referrals for neuropsychological assessment and cognitive remediation in the past 5 years to allow for clinicians who had not been in practice for 10 years. RESULTS: Participants reported an increase in the number of cognitive screenings and referrals for neuropsychological assessments and cognitive remediation during the past 5 years. Compared with 2010, participants endorsed greater use of person-administered screening measures, such as the Symbol Digit Modalities Test, and fewer prescriptions for medications to improve cognitive functioning. CONCLUSIONS: Clinical practices are becoming more in line with the literature, with increased use of cognitive screening and remediation. Continued attention to cognitive problems will be an ongoing important component of MS-related care. [ABSTRACT FROM AUTHOR]

Background: Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. Objectives: To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples' preferences, needs, opportunities and barriers to palliative care. Methods: A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly's hierarchy of evidence-for-practice in qualitative research. Results: Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples' experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. Conclusions: The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas. [ABSTRACT FROM AUTHOR]

Adolescent and young adults (AYAs) with chronic illnesses cope with complex issues that require unique psychological support and healthcare services to reduce psychosocial difficulties, improve disease management, and facilitate positive transitions to adult care. Engaging patients and caregivers can help providers understand the specific needs of this population and identify the perceived areas of support. The purpose of this quality improvement initiative is to assess the needs of AYAs with chronic medical conditions at a large government research hospital. Eighty-nine AYA patients (age = 23.5 years; range 13–34) with neurofibromatosis type 1, cancer, primary immunodeficiencies, or sickle cell disease, and a sample of caregivers (n = 37, age = 52 years; range: 41–65), completed an anonymized survey that assessed their preferences for a wide range of informational and service-related needs. The results indicate an overwhelming desire for information about general health and wellbeing and disease-specific medical knowledge. The most endorsed item was the need for more information about an individual's medical condition (72%), which was a primary concern across disease, racial, and gender groups. Demographic and disease-specific needs were also identified. Thus, providing information to AYA patients and caregivers is a critical and largely unmet component of care, which requires the development and implementation of targeted educational and psychosocial interventions. [ABSTRACT FROM AUTHOR]

Background: Patient-reported outcomes (PROs) are used increasingly in routine clinical care and inform policies, reimbursements, and quality improvement. Less is known regarding PRO implementation in routine clinical care for diverse and underrepresented patient populations. Objective: This review aims to identify studies of PRO implementation in diverse and underrepresented patient populations, elucidate representation of clinical specialties, assess implementation outcomes, and synthesize patient needs, concerns, and preferences. Methods: MEDLINE, Embase, Web of Science, CINAHL, and PsycINFO were searched September 2021 for studies aiming to study PRO implementation in diverse and underrepresented patient populations within the United States. Studies were screened and data extracted by three independent reviewers. Implementation outcomes were assessed according to Proctor et al. taxonomy. A descriptive analysis of data was conducted. Results: The search yielded 8,687 records, and 28 studies met inclusion criteria. The majority were observational cohort studies (n = 21, 75%) and conducted in primary care (n = 10, 36%). Most studies included majority female (n = 19, 68%) and non-White populations (n = 15, 54%), while fewer reported socioeconomic (n = 11, 39%) or insurance status (n = 9, 32.1%). Most studies assessed implementation outcomes of feasibility (n = 27, 96%) and acceptability (n = 19, 68%); costs (n = 3, 11%), penetration (n = 1, 4%), and sustainability (n = 1, 4%) were infrequently assessed. Conclusion: PRO implementation in routine clinical care for diverse and underrepresented patient populations is generally feasible and acceptable. Research is lacking in key clinical specialties. Further work is needed to understand how health disparities drive PRO implementation outcomes. Plain English summary: Patient-reported outcomes (PROs) allow doctors and researchers to understand the patient perspective, such as how they are doing physically, mentally, or socially. When used, PROs can improve health and increase satisfaction of patients. Many clinics and hospitals are interested in using PROs in everyday care. Doctors, hospitals, and insurance companies are also using information from PROs to decide if the care they give is good quality. Unfortunately, certain groups of patients, such as racial and ethnic minorities and patients with low income, report worse PROs. Because of these differences, it will be important to make sure that PROs are being collected from all people, but not much is known regarding how this has been done. This study demonstrates what is known so far with regard to using PROs in everyday clinical care for these diverse patient groups. Findings from this study show that PROs can be successfully collected, but more work is needed in certain medical fields, and some types of patients have specific needs, concerns, or preferences with regard to PRO collection. [ABSTRACT FROM AUTHOR]

The article discusses the study on the view of a primary care physician on the effect of insurance status of patients on their clinical decision making. The study is in accordance to the findings stating that American patients with fewer health services are said to have poorer health status. It has been concluded that physicians tend to incorporate their patients' insurance status into their clinical decision making and acknowledge they frequently alter their clinical management as a result.

Health economists use "willingness-to-pay" to assess the prospective value of novel interventions. The technique remains controversial, not least with respect to the formats under which values are elicited. The paper analyses the results of a series of studies of the same intervention valued by the same population, in which different elicitation formats were employed. The findings support the hypothesis that data collected using different formats give rise to different demand curves, from which different inferences about demand elasticity, profitability and consumer surplus will be derived. Judgements as to the relative merits of rival interventions depend crucially upon whichever format has been used to evaluate each intervention. [ABSTRACT FROM AUTHOR]

Pauly's analysis of the welfare effects of moral hazard assumes that consumption of health care does not increase with income, however, empirical evidence suggests it does. For health insurance contracts that pay off by reducing price, the income effect is represented by the additional health care consumed because of income transfers from those who remain healthy to those who become ill. This implies a different decomposition of demand than the standard Hicksian decomposition. When the effect of income transfers is removed, the price-related welfare loss is smaller than either the loss suggested by Pauly's analysis or a Hicksian decomposition. [ABSTRACT FROM AUTHOR]

Background. It is of the utmost importance to acknowledge the seriousness of unmet dental needs in children, which in return reflects the responsibility of underlying factors that lead to barriers to dental care. Objectives. The aim of this work is to study unmet dental needs in children and adolescents in the United States during the years 2009–2018 with the ultimate goal of finding statistically significant predictors for barriers to dental treatment. Material and methods. The statistical methods used to extract the results of this work are the chi-square test and one-way analysis of variance (ANOVA) to examine the statistical significance of socio-economic factors in the unmet dental needs of children. A multiple logistic regression analysis was used to find statistically significant prognostic factors for the barriers to dental treatment. Results. The prevalence of unmet dental needs in the United States during 2009–2018 was found to be 5.17%. According to multiple logistic regression analysis, female children from single-parent families with a low family income have a higher risk of developing unmet dental needs. In addition, the parents’ education and race proved to also be prognostic risks for unmet dental needs. Lastly, families with no health insurance coverage are more likely to have children with unmet dental needs. Conclusions. The results of this study highlight the significance of the family structure, the level of parents’ education and deprivation of financial support as the main prognostic risk factors for unmet dental needs. Moreover, children with barriers to dental care are six times more likely to visit a dentist every 2–5 years. [ABSTRACT FROM AUTHOR]

Background: The medical home (MH) model has been promoted by both the federal and state governments in the United States in recent years. To ascertain American children's MH status, many studies have relied on a large set of survey items, posing a considerable burden on their parents. We aimed to identify individual survey items or domains that best predict MH status for children and use them to develop brief markers of MH status. We also examined whether the identified items differed by status of special health care needs and by racial/ethnic group.Method: Using the 9-year data from Medical Expenditure Panel Survey, we examined associations between children's MH status and individual survey items or domains. We randomly split the data into two halves with the first half (training sample, n = 8611) used to identify promising items, and the second half (validation sample, n = 8779) used to calculate all statistical measures. After discovering significant predictors of children's MH status, we incorporated them into several brief markers of MH status. We also conducted stratified analyses by status of special health care needs and by racial/ethnic group.Results: Less than half (48.7%) of the 8779 study children had a MH. The accessibility domain has stronger association with children's MH status (specificity = 0.84, sensitivity = 1, Kappa = 0.83) than other domains. The top two items with the strongest association with MH status asked about after-hours primary care access, including doctors' office hours at night or on the weekend and children's difficulty accessing care after hours. Both belong to the accessibility domain and are one of several reliable markers for children's MH status. While each of the two items did not differ significantly by status of special health care needs, there were considerable disparities across racial/ethnic groups with Latino children lagging behind other children.Conclusion: Accessibility, especially the ability to access health care after regular office hours, appears to be the major predictor of having a MH among children. The ongoing efforts to promote the MH model need to target improving accessibility of health care after regular hours for children overall and especially for Latino children. [ABSTRACT FROM AUTHOR]

In the article, the authors leverage a public opinion survey to assess the differences between emergency department (ED) and urgent care (UC) users for low-acuity health needs. Also cited are how UC centers or retail clinics are better alternatives for low-acuity complaints than EDs, as well as the independent variables on the use of ED or UC like household income, health insurance, and chronic illnesses.

Objectives: Our objective was to estimate the emergency medicine board‐certified emergency physician (EMBC EP) workforce supply and demand by U.S. state. Methods: To estimate state demand, we applied the methodology from our 2005 analysis to calculate full‐time equivalent (FTE) EMBC EP demand for each emergency department (ED). The 2017 National Emergency Department Inventory–USA provided visit volumes for all EDs, while the American Board of Medical Specialties supplied the 2017 number of EMBC EPs per state. Assuming that at least one EMBC EP should be present 24/7 in each ED (requiring 5.35 FTEs minimum), we calculated the total FTEs required by dividing each ED's visit volume by the estimated average visits seen by an EMBC EP (3,548 visits per year) and then summed FTEs by state. The U.S. Census Bureau provided state demographic characteristics. We used multivariable linear regression to examine the association between state demographics and the density of EMBC EPs per state and compared 2017 results to our prior 2005 analysis. Results: There were 40,716 total EMBC EPs in 2017, fulfilling 77% of the estimated national demand. This was a substantial increase from 23,035 total EMBC EPs fulfilling 58% of demand in 2005. The 2017 supply ranged from 24% of demand in North Dakota to 142% in Hawaii. A lower density of EMBC EPs was associated with states in the Midwest and South (p < 0.001) and with a more rural population (p = 0.02). The absolute shortage of EMBC EPs worsened or remained the same in one‐fourth of states. Conclusion: While the total number of EMBC EPs nearly doubled between 2005 and 2017, a shortage of full‐time coverage persists. The supply and demand vary greatly by state. Worsening absolute shortages in several states show that the distribution of EMBC EPs is not meeting demand across the United States, particularly in rural areas. [ABSTRACT FROM AUTHOR]

The COVID-19 is disproportionally affecting the poor, minorities and a broad range of vulnerable populations, due to its inequitable spread in areas of dense population and limited mitigation capacity due to high prevalence of chronic conditions or poor access to high quality public health and medical care. Moreover, the collateral effects of the pandemic due to the global economic downturn, and social isolation and movement restriction measures, are unequally affecting those in the lowest power strata of societies. To address the challenges to health equity and describe some of the approaches taken by governments and local organizations, we have compiled 13 country case studies from various regions around the world: China, Brazil, Thailand, Sub Saharan Africa, Nicaragua, Armenia, India, Guatemala, United States of America (USA), Israel, Australia, Colombia, and Belgium. This compilation is by no-means representative or all inclusive, and we encourage researchers to continue advancing global knowledge on COVID-19 health equity related issues, through rigorous research and generation of a strong evidence base of new empirical studies in this field. [ABSTRACT FROM AUTHOR]

Objective: The Affordable Care Act and Medicare Access and CHIP Reauthorization Act are changing access to, and delivery of, health care in the United States, with potential implications for the field of health services research (HSR). We therefore investigated employers' perceptions of demand for individuals to conduct HSR, the competencies required for success, and implications for HSR training programs.Data Source: Interviews conducted in August 2016 with 21 key informants at a range of U.S.-based HSR organizations.Study Design: We conducted a semistructured, qualitative, telephone interview study to explore relevant topics.Data Collection/extraction Methods: Interviews with respondents were transcribed from recordings and then synthesized by respondent organization type and topic area.Principal Findings: Most respondents reported recently hiring health services researchers, and most anticipated hiring additional such researchers in the future. Most respondents emphasized the abilities to analyze data, work in teams, and engage with stakeholders. Finally, most respondents recommended that potential recruits gain real-world experience during their academic training.Conclusions: Our interviews indicated that current and future demand for health services researchers is strong. They also suggested that, as a field, HSR will continue to draw together individuals from a variety of backgrounds to inform a diverse array of decision makers. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Relatively little is known about outcomes after disposition among syncope patients assigned various diagnostic categories during emergency department (ED) evaluation. We sought to measure the outcomes among these groups within 30 days of the initial ED visit. Methods: We prospectively enrolled adult syncope patients at six EDs and excluded patients with presyncope, persistent mental status changes, intoxication, seizure, and major trauma. Patient characteristics, ED management, diagnostic impression (presumed vasovagal, orthostatic, cardiac, or other/unknown) at the end of the ED visit, and physicians’ confidence in assigning the etiology were collected. Serious outcomes at 30 days included death, arrhythmia, myocardial infarction, structural heart disease, pulmonary embolism, and hemorrhage. Results: A total of 5,010 patients (mean ± SD age = 53.4 ± 23.0 years; 54.8% females) were enrolled; 3.5% suffered serious outcomes—deaths (0.3%), arrhythmias (1.8%), nonarrhythmic cardiac (0.5%), and noncardiac (0.9%) including pulmonary embolism (0.2%). The cause of syncope was presumed as vasovagal among 53.3% and cardiac in 5.4% of patients. The proportion of patients with ED investigations (p < 0.001) and short‐term serious outcomes (p < 0.01) increased in each diagnostic category in the following order: presumed vasovagal, orthostatic hypotension, other/unknown cause, and cardiac. No deaths occurred in patients with presumed vasovagal syncope. A higher proportion of all serious outcomes occurred among patients suspected of cardiac syncope in the ED (p < 0.01). Confidence was highest among physicians for a presumed vasovagal syncope diagnosis and lowest when the cause was other/unknown. Conclusion: Short‐term serious outcomes strongly correlated with the etiology assigned in the ED visit. The importance of the physician's clinical judgment should be further studied to determine if it should become incorporated in risk‐stratification tools for prognostication and safe management of ED syncope patients. [ABSTRACT FROM AUTHOR]

Background: Ghana currently lacks a systematic method for identifying children with developmental delays, and there do not appear to be any culturally sensitive assessment tools available. The objectives of this mixed-methods research study were to explore normal developmental milestones and parental practices in the Ghanaian population. The study also aimed to identify and describe culturally specific factors that should be accounted for on assessments used in the Ghanaian culture. Methods: Twenty-eight Ghanaian parents were interviewed and asked to participate in a developmental milestone picture-identification task. Quantitative and qualitative data analyses were performed. Results: The interviews revealed several cultural factors that may need to be accounted for on a standardized assessment for Ghanaian children. Some gross motor and self-care skills (e.g., crawling and toilet training) were reported to develop earlier in Ghanaian children compared to children in the United States. Discussion: Developmental assessments normed on a U.S. sample may be inappropriate to use in the Ghanaian culture. Renorming of existing developmental assessments for the Ghanaian population is recommended. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of proxy survey responses on cancer care experience reports and quality ratings.Data Sources/study Setting: Secondary analysis of data from Cancer Care Outcomes Research and Surveillance (CanCORS). Recruitment occurred from 2003 to 2005.Study Design: The study was a cross-sectional observational study. The respondents were patients with incident colorectal or lung cancer or their proxies.Data Collection/extraction Methods: Analyses used linear regression models with an independent variable for proxy versus patient responses as well as study site and clinical covariates. The outcomes were experiences with medical care, nursing care, care coordination, and care quality rating. Multiple imputation was used for missing data.Principal Findings: Among 6,471 respondents, 1,011 (16 percent) were proxies. The proportion of proxy respondents varied from 6 percent to 28 percent across study sites. Adjusted proxy scores were modestly higher for medical care experiences (+1.28 points [95 percent CI:+ 0.05 to +2.51]), but lower for nursing care (-2.81 [95 percent CI: -4.11 to -1.50]) and care coordination experiences (-2.98 [95 percent CI: -4.15 to -1.81]). There were no significant differences between adjusted patient and proxy ratings of quality.Conclusions: Proxy responses have small but statistically significant differences from patient responses. However, if ratings of care are used for financial incentives, such differences could be exaggerated across practices or areas if proxy use varies. [ABSTRACT FROM AUTHOR]

Abstract: Background: Interest in social determinants of health (SDOH) has expanded in recent years, driven by a recognition that such factors may influence health outcomes, services use, and health care costs. One subset of SDOH is material needs such as housing and food. We conducted a systematic review of the literature on material needs among emergency department (ED) patients in the United States. Methods: We followed PRISMA guidelines for systematic review methodology. With the assistance of a research librarian, four databases were searched for studies examining material needs among ED patients. Two reviewers independently screened titles, abstracts, and full text to identify eligible articles. Information was abstracted systematically from eligible articles. Results: Forty‐three articles were eligible for inclusion. There was heterogeneity in study methods; single‐center, cross‐sectional studies were most common. Specific material needs examined included homelessness, poverty, housing insecurity, housing quality, food insecurity, unemployment, difficulty paying for health care, and difficulty affording basic expenses. Studies overwhelmingly supported the notion that ED patients have a high prevalence of a number of material needs. Conclusions: Despite some limitations in the individual studies examined in this review, the plurality of prior research confirms that the ED serves a vulnerable population with high rates of material needs. Future research is needed to better understand the role these needs play for ED patients and how to best address them. [ABSTRACT FROM AUTHOR]

Background: Women veterans in the United States, particularly those with posttraumatic stress disorder (PTSD) or a history of military sexual assault, have unique health care needs, but their minority status in the US Veterans Health Administration (VHA) has led to documented healthcare disparities when compared to men. This study's objective was to obtain a richer understanding of the challenges and successes encountered by women veterans with self-reported service-related trauma histories (particularly those with a history of military sexual assault and/or posttraumatic stress symptomology) receiving VHA care.Methods: Thirty-seven female Vietnam and post-Vietnam (1975-1998) era veterans were randomly selected from a cohort of PTSD disability benefit applicants to complete semi-structured interviews in 2011-2012. Grounded-theory informed procedures were used to identify interview themes; differences between veterans with and without a history of military sexual assault were examined through constant comparison.Results: At the time of the interviews, many women believed that VHA was falling short of meeting women veterans' needs (e.g., lack of women-only mental health programming). Also common, but particularly among those with a military sexual assault history, was the perception that VHA's environment was unwelcoming; being "surrounded by men" yielded emotions ranging from discomfort and mistrust to severe anxiety. A few veterans reported recent positive changes and offered additional suggestions for improvement.Conclusions: Findings suggest that while at the time of the interviews gains had been made in the delivery of gender-sensitive outpatient medical care, women veterans with a history of military sexual assault and/or posttraumatic stress symptomology perceived that they were not receiving the same quality of care as male veterans. [ABSTRACT FROM AUTHOR]

Objective: To compare health care planning models forecasting rheumatology workforce requirements in western countries.Methods: A systematic literature review was conducted through medical databases (Ovid MEDLINE, Embase, CINAHL, and Cochrane Library) and the grey literature. All articles reporting a rheumatology workforce model were included.Results: The search yielded 6,508 articles, and 14 publications (on 12 studies) were included. Workforce models were available for the US (n = 3), Canada (n = 3), the US plus Canada (n = 1), Germany (n = 2), Spain (n = 1), and the UK (n = 2). The number of rheumatologists required to serve a population of 100,000 people was calculated, with a range of 0.7 (UK, calculated for 1988) to 3.5 (Spain, calculated for 2021). Most models used a needs-based approach (n = 6); 3 studies each applied a supply- or demand-based method. The following variables were considered by ≥1 model: disease prevalence, patients' referral to rheumatologists, clinical visits/patient/year, population development, factors influencing performance of rheumatologists, patient flow/care sharing, and medical technologies/infrastructure development.Conclusion: Heterogeneity in methods used, the period or calendar years for which the estimates were projected, and heterogeneity of variables evaluated led to disparate estimates, with results ranging from 0.7 to 3.5 rheumatologists per 100,000 population. An international initiative is needed to agree upon a common approach for a reliable estimation of manpower requirements in rheumatology. [ABSTRACT FROM AUTHOR]