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Public health officials promoted COVID-19 vaccines to limit burdens placed on the U.S. healthcare system and end the pandemic. People in some closed religious communities refused to vaccinate and likely acquired temporary immunity through infection. This paper compares the death rates in Amish, Old Order Mennonites, and conservative Mennonite groups to a rate estimated for the U.S. population. Approximately two-thirds of the U.S. population was immunized against COVID-19, while few in the Amish/Mennonite community were. We find divergent patterns. Once vaccines became available, excess deaths declined in the general population and remained elevated among Amish and Mennonites. Vaccination campaigns must consider and value the cultural beliefs of closed religious communities to be effective. [ABSTRACT FROM AUTHOR]

Aim: Long-term invasively ventilated patients exhibit exceptional and resource-intensive healthcare needs. However, major knowledge gaps in Germany complicate appropriate approaches to best address these demands. This paper evaluates available information on the patient group and their healthcare needs from German data sources and derives implications for healthcare planning and regulation by national/federal self-governing bodies, political decision-makers, and specialized providers. Methods: Based on the concept of needs, we addressed the normative dimension typically characterized by epidemiological data. Based on existing German health system data resources, an explorative approach was utilized to identify and characterize available databases providing information on the patient group and/or their healthcare. Results: To date, no available database provides information on the healthcare needs of this patient group. As of the reporting year 2017, the diagnosis-related groups (DRG) statistics will provide hospital-specific data on home invasive ventilation interventions, but the data do not provide information on long-term care. Claims data may be a promising source for cross-sectoral evaluation of healthcare needs but feature methodological challenges. These results call for efforts to address limited data eligibility, adopt a broader understanding of healthcare needs, and identify actions needed to evidence informed and needs-oriented healthcare. Conclusion: Future approaches on needs-oriented specialized healthcare should close the existing knowledge gap based on reliable data. In addition to normative information, they should consider subjective dimensions on a life course perspective and quantitative and qualitative service performance characteristics across multiple sectors and professions. [ABSTRACT FROM AUTHOR]

Caring for children with mental and behavioral health conditions can lead to family strain. Research indicates that Latino children are less likely to adhere to recommended treatment for their mental health diagnoses, increasing the potential for family strain. Little research has focused on understanding the different predictors of family strain among white and Latino families of children with mental health or behavioral health diagnoses. This paper uses a model of family strain to understand how stressors, resources, and perceptions predict family strain for white and Latino parents of children with a mental or behavioral health condition. Data from a telephone survey of 268 parents of children with a mental or behavioral health condition were analyzed to understand predictors of strain using the Family Strain Index scale. Findings indicate that family strain does differ between white and Latino families. Latino families' strain was predicted by age of parent (β = −0.381, P < 0.001), perceptions of treatment quality (β = 0.306, P < 0.001), and child's current symptom burden (β = −0.390, P < 0.001). White family strain was related to their child's health status (β = −0.240, P < 0.001), symptom burden (β = −0.339, P < 0.001), and parent's level of education (β = −0.315, P < 0.001). [ABSTRACT FROM AUTHOR]

Aim: We examined predictors of trust in the healthcare system during the COVID-19 pandemic in 27 European countries. Subjects and methods: We used population-based data drawn from the Living, working and COVID-19 survey (N = 21,884, 52% female, ages 18 to 92 years) covering 27 European countries dated June and July 2020. Multilevel linear regression, linear regression, and regression-tree analyses were conducted. Results: We found that most participants tended to trust the healthcare system, although a substantial part could still be classified as distrusting (approx. 21%). Multiple variables, including being middle-aged or of older age, being female, lower levels of education, unemployment, worse general health status, having income difficulties, having unmet needs for healthcare, no healthcare contact during the COVID-19 pandemic, higher mental distress, and loneliness, were significantly associated with lower levels of trust. Among these variables mental distress, income difficulties, and unmet needs for healthcare emerged as especially important and, across European regions and countries, consistent predictors for lower trust in the healthcare system during the COVID-19 pandemic. Conclusions: Medically vulnerable subgroups, such as individuals with unmet healthcare needs, higher levels of mental distress, and older age, as well as people living in socially and economically vulnerable situations, such as higher levels of loneliness and financial difficulties, were the least trusting of the healthcare system during the COVID-19 pandemic. As these vulnerable subgroups are also at highest risk for contracting COVID-19 and experiencing negative COVID-19-related outcomes, more targeted prevention and intervention efforts should be implemented in these groups. [ABSTRACT FROM AUTHOR]

The SAVA syndemic is frequently used to describe the co-occurrence of HIV, gender-based violence (GBV), and substance use. In this study we determine the extent to which the typologies of the SAVA syndemic can be described and utilized for intervention strategies among youth living in the slums of Kampala, Uganda. We analyzed the "Kampala Youth Survey 2014," a cross-sectional survey conducted in the spring of 2014, consisting of a convenience sample (N = 1134) of urban youth (12–18 years of age). Descriptive statistics were computed for hypothesized risk factors and demographic variables among the 8 typologies of GBV, HIV, and alcohol use. Multinomial logistic regression was conducted to determine statistically significant correlates with each typology. The overall prevalence of GBV was 31.7%, whereas the overall prevalence of alcohol use in the past 12 months was 31.2%. HIV-Positive youth comprised 10.5% of the total sample. Females comprised the majority of the typology with no SAVA components compared to males (55% vs. 45%, respectively), as well as the SAVA syndemic typology (GBV + HIV + ALC +) (58% vs. 42%, respectively). Engaging in commercial sex work (36%), witnessing parental abuse (61%), and depression/suicidality (81%) were all highly prevalent among youth in the SAVA syndemic typology (GBV, HIV, and alcohol use). Sex work and observing parental abuse were associated with the SAVA syndemic typology in the multivariable model. In our study, alcohol rarely coexisted without GBV among the typologies. Therefore, prevention efforts including structural interventions may be particularly warranted in vulnerable populations to address alcohol use, which may directly or indirectly impact GBV and HIV. [ABSTRACT FROM AUTHOR]

The article focuses on HIV service provision for priority populations during the COVID-19 pandemic in Seattle, Washington. Topics include the number of programs in Seattle has dedicated to HIV prevention and care, including the Maximum Assistance (Max) Clinic, Safe.Healthy.Empowered. (S.H.E.) Clinic, and Gay City, and the Max Clinic provides services for people living with HIV (PLWH) who have not engaged in conventionally organized HIV care.

Over the past 50 years, programs serving intimate partner violence (IPV) survivors have expanded nationally. However, despite IPV program growth service gaps remain, particularly for the most marginalized and vulnerable survivor populations. Emerging practice models call for reimagining current IPV service delivery within an intersectional feminist, trauma-informed framework. An overview of intersectional (e.g. survivor-centered, full-frame, culturally specific) and trauma-informed IPV service approaches will be presented highlighting their shared emphasis on power sharing, authentic survivor-advocate relationships, individualized services, and robust systems advocacy. These approaches have the potential to transform IPV services and narrow service gaps if organizations can embed key elements into program design, implementation and evaluation processes. Recommendations for moving the IPV field forward include: 1) expanding survivors' roles/input; 2) strengthening funding streams and organizational commitment to anti-oppressive, survivor-defined, trauma-informed services; 3) forging cross-sector advocacy relationships; and 4) building knowledge through research and evaluation. [ABSTRACT FROM AUTHOR]

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