Recent publications
Objective
To describe the prevalence of and trends in practices that interfere with the exchange of patient health information (potential information blocking) 2 years after implementation of information-blocking regulations.
Materials and Methods
Drawing from the American Hospital Association Information Technology (IT) Supplement and a national survey of health information organizations (HIOs), we described rates and methods of potential information blocking from these organizations’ perspectives in 2023 and compared them to prior years.
Results
Twenty-seven percent of hospitals sometimes or often observed potential information blocking by any actor in 2023, down from 42% in 2021 and 33% in 2022. Thirty percent of HIOs routinely observed potential information blocking by health IT developers, down from 50% in 2015. 13% of HIOs routinely observed potential information blocking by hospitals and health systems, down from 25% in 2015. According to both hospitals and HIOs, the most prevalent method of potential information blocking by developers in 2023 was through price, while the most prevalent by healthcare providers/health systems was by focusing exchange on strategic affiliations. Few hospitals and HIOs that experienced potential information blocking said that they had reported it to the Department of Health and Human Services.
Discussion
Hospitals and HIOs perceived lower rates of potential information blocking in 2023 than in prior years indicating some impact of regulations addressing information blocking. However, both respondent types reported that substantial potential information blocking persisted in 2023 and negatively impacted the exchange of information.
Conclusion
While potential information-blocking practices have decreased, they have not been eliminated, indicating the value of continued and robust enforcement of information-blocking regulations.
Antimicrobial resistance (AMR) is among the top 10 public health threats, with nearly 5 million deaths in 2019 linked to AMR-related bacterial infections. (1) A One Health approach is needed to combat AMR.
Healthcare-based surveillance (HBS) of AMR provides incomplete information about the scope of the AMR threat. HBS screens only patients seeking medical attention, lacking community-level representativeness, and suffers from underreporting. (2) Consequently, researchers are turning to wastewater-based surveillance (WBS) to complement HBS. (3) WBS can provide information about AMR circulating within communities and hospitals, offering a comprehensive understanding of AMR prevalence. However, the surveillance targets and data obtained from WBS are distinct from those derived from HBS, creating uncertainty regarding their utility to the public health sector and ability to yield policy relevant information. In May 2024, participants in a workshop during the 7th Environmental Dimension of Antimicrobial Resistance (EDAR7) conference (Montréal, Canada) sought to answer four questions aimed at advancing the policy relevance of AMR data generated by WBS.
Background
An important mental health concern is Post-Traumatic Stress Disorder (PTSD), especially for Internally Displaced Persons (IDPs) in the Horn of Africa. Limited access to psychosocial support and primary health care exacerbates mental health issues.
Aim
This study was to examine the prevalence of post-traumatic stress disorder and factors associated with IDPs in Mogadishu.
Methods
A cross-sectional study was conducted from Sep 25 to Oct 20, 2023, employing analytical design. The study population included individuals aged 18 and older directly exposed to forced displacement due to conflicts and disasters. A multistage random sampling method was used, with a final sample size of 364 participants from over 20 different camps in Daynile and KAHDA. Post-Traumatic Stress Disorder (PTSD) was assessed using Questionnaire of Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5).
Results
The prevalence of PTSD among participants was 60%. The PTSD prevalence was highest among male respondents at 75% compared to 54% among the females with over half (63%) of the PTSD cases being females, while 37% were males. Only 0.3% reported the availability of mental health services, emphasizing the lack of adequate support.
Conclusion
The study highlights a significant prevalence of PTSD among Mogadishu’s IDPs, underscoring the immediate need for mental health prioritization to address challenges in conflict-affected areas. The lack of mental health integration into primary care requires urgent intervention for enhanced services in the Horn of Africa. Recommendations propose targeted mental health interventions, especially for females, addressing gender-based violence and loss. Programs should consider those with multiple displacements, addressing cumulative trauma impact. Providing comprehensive support for those facing property destruction is crucial. Collaborative efforts among humanitarian organizations, local authorities, and mental health professionals are vital for an effective response to the mental health challenges faced by IDPs in conflict-affected areas.
To address vaccine hesitancy, the U.S. Department of Health and Human Services (HHS) launched the “We Can Do This” COVID-19 public education campaign (the Campaign) in 2021 to promote vaccine confidence and increase vaccine uptake. The Campaign introduced a heavy-up media strategy to enhance its reach and engagement with its vaccine hesitant audience. This approach complemented the Campaign’s national media strategy while delivering an additional advertising dose to select priority designated market areas (DMAs) – that is, media markets – each month. We examine the relationship between the Campaign’s heavy-up strategy and initial COVID-19 vaccine uptake from August to December 2021. A stacked difference-in-differences (DID) analysis com-pared initial COVID-19 vaccine uptake between DMAs that received heavy-up (treatment) and DMAs that did not (control). The Campaign’s short-term heavy-up advertising strategy was associated with increased initial vaccine uptake in treatment DMAs. These results provide valuable insights for public health campaign strategy and evaluation, highlighting the effectiveness of increasing campaign dose in select markets to address vaccine hesitancy and improve public health outcomes.
Background
Federal policy impact analyses in the United States do not incorporate the potential economic benefits of adolescent mental health policies. Understanding the extent to which economic benefits may offset policy costs would support more effective policymaking. This study estimates the relationship between adolescent psychological distress and later health and economic outcomes and uses these estimates to determine the potential economic effects of a hypothetical policy.
Methods and findings
This analysis estimated the relationship between psychological distress in those aged 15 to 17 years in 2000 and economic and health outcomes approximately 10 years later, accounting for an array of explanatory variables using machine learning–enabled methods. The cohort was from the National Longitudinal Study of Youth 1997 and nationally representative of those aged 12 to 18 years in 1997. The cohort included 3,343 individuals under age 18 years in round 4 who completed the Mental Health Inventory-5 (MHI-5). Round 1 captured 50 explanatory variables that covered domains of potential confounders, including basic demographics, neighborhood environment, family resources, family processes, physical health, school quality, and academic skills. The exposure included a binary variable of clinically significant psychological distress (MHI-5 score of less than or equal to 3) and a categorical variable of symptom severity on the MHI-5. Outcomes covered domains of employment, income, total assets at age 30 years, education, and health approximately 10 years later.
Forty-seven percent of the cohort were black and Hispanic, and 4.4% had past-month clinically significant psychological distress. Past-month clinically significant psychological distress in adolescence led to a 6-percentage-point (95% confidence interval [CI] [−0.08, −0.03]) reduction in past-year labor force participation 10 years later and 52 (95% credible interval [51,54]) billion USD in federal budget benefits over 10 years from labor supply impacts alone. This study faced limitations, including potential unmeasured confounding, missing data, and challenges to generalizability.
Conclusions
Our findings showed the impacts of adolescent mental health policies on the federal budget and found potentially large effects on the economy if policies achieve population-level change.
This cross-sectional study aimed to assess the demographic and geographic variations in the visit rate for first-episode psychosis (FEP), identify trends and diagnostic patterns, and explore factors associated with FEP visits in Nebraska. Inpatient and emergency department data spanning 2017–2021 were collected by the Nebraska Hospital Association (NHA). The study focused on Nebraska residents aged 14–35 admitted for FEP, identified through specific ICD-10 codes. The sample was derived using a multi-step process, and the data included patient demographics, Behavioral Health Regions, rural vs. urban residency, and neighborhood characteristics. Mann–Kendall tests were used to test for significant trends over time. T-tests and chi-squared tests were used to assess differences in each of the measures between patients with and without psychotic disorders. The study findings revealed a significant increase in visits related to psychotic disorders from 2017 to 2021. In 2021, the FEP visit rate was 116 per 100,000 individuals, varying considerably by age, gender, and Behavioral Health Region. Schizoaffective disorder bipolar type was the most frequent psychotic disorder. Patients with psychotic disorders tended to be older, predominantly male, and treated in acute care settings. The rising trend underlines the need for continued investment in early intervention programs and highlights challenges in rural areas, necessitating targeted interventions. The findings provide valuable insights to inform planning, advocate for funding, and address the specific needs of diverse populations. Future research should explore additional influencing factors and extend the study period to understand FEP trends comprehensively.
This Viewpoint discusses the rising rates of syphilis cases in the US and how the federal government is leading a coordinated response to address this resurgence involving enhancing testing, treatment, and education.
Global health security in the Biden-Harris Administration has been a dynamic area of engagement, starting with the COVID-19 response, to strengthening and reforming the World Health Organization, to bolstering regional partnerships, and securing financing for pandemic preparedness. Sustained commitment to bilateral, regional, and multilateral cooperation will ensure that the United States stands ready to address any future health challenges.
Over the past few decades, the world has seen a considerable uptick in the number of new and emerging infectious disease outbreaks. The development of new vaccines, vaccine technologies, and platforms are critical to enhance our preparedness for biological threats and prevent future pandemics. Viral vectors can be an important tool in the repertoire of technologies available to develop effective vaccines against new and emerging infectious diseases. In many instances, vaccines may be needed in a reactive scenario, requiring technologies than can elicit rapid and robust immune responses with a single dose. Here, we discuss how viral vector vaccines are utilized in a vaccine portfolio for priority biological threats, some of the challenges in manufacturing viral vector vaccines, the need to strengthen live virus manufacturing capabilities, and future opportunities to capitalize on the use of viral vectors to improve the sustainability of the Biomedical Advanced Research and Development Authority’s vaccine portfolio.
Widespread surveillance for SARS-CoV-2 was conducted across wildlife, captive animals in zoological collections, and domestic cats in Nebraska from 2021 to 2023. The goal of this effort was to determine the prevalence, phylogenetic and spatial distribution characteristics of circulating SARS-CoV-2 variants using various diagnostic methodologies that can utilize both antemortem and postmortem samples, which may be required for wildlife such as white-tailed deer. Statewide surveillance testing revealed high variation in SARS-CoV-2 prevalence among species, with white-tailed deer identified as the primary reservoir. In 2021, seroprevalence in white-tailed deer was 63.73% (n = 91) and 39.66% (n = 237) in 2022, while virus detection in retropharyngeal lymph nodes (RLN) was 16.35% (n = 483) in 2021 and 3.61% (n = 277) in 2022. Phylogenetic analysis was conducted on 11 positive samples from 2021. This analysis revealed the presence of four lineages of the Delta variant: AY.100, AY.119, AY.3, and AY.46.4. Conversely, other species showed no virus detection, except domestic cats, which had a low seroprevalence of 2.38% (n = 628) in 2022, indicating minimal exposure. The detection of SARS-CoV-2 in white-tailed deer and the identification of multiple Delta lineages underscores the need for ongoing surveillance and the importance of using different diagnostic methodologies. These efforts are critical for understanding virus circulation and evolution in wildlife and domestic animals, informing public health strategies, and mitigating the risks of zoonotic transmission of SARS-CoV-2 and other emerging infectious diseases.
Objective
Timely access to data is needed to improve care for substance-exposed birthing persons and their infants, a significant public health problem in the United States. We examined the current state of birthing person and infant/child (dyad) data-sharing capabilities supported by health information exchange (HIE) standards and HIE network capabilities for data exchange to inform point-of-care needs assessment for the substance-exposed dyad.
Material and Methods
A cross-map analysis was performed using a set of dyadic data elements focused on pediatric development and longitudinal supportive care for substance-exposed dyads (70 birthing person and 110 infant/child elements). Cross-mapping was conducted to identify definitional alignment to standardized data fields within national healthcare data exchange standards, the United States Core Data for Interoperability (USCDI) version 4 (v4) and Fast Healthcare Interoperability Resources (FHIR) release 4 (R4), and applicable structured vocabulary standards or terminology associated with USCDI. Subsequent survey analysis examined representative HIE network sharing capabilities, focusing on USCDI and FHIR usage.
Results
91.11% of dyadic data elements cross-mapped to at least 1 USCDI v4 standardized data field (87.80% of those structured) and 88.89% to FHIR R4. 75% of the surveyed HIE networks reported supporting USCDI versions 1 or 2 and the capability to use FHIR, though demand is limited.
Discussion
HIE of clinical and supportive care data for substance-exposed dyads is supported by current national standards, though limitations exist.
Conclusion
These findings offer a dyadic-focused framework for electronic health record-centered data exchange to inform bedside care longitudinally across clinical touchpoints and population-level health.
The goal is to share policy implications of sensitive, specific internet-based tests in place of current approaches to lowering violence, namely fewer mass murders, suicides, homicides. When used, internet-based tests save lives and money. From 2009-2015, a Chicago field test had 324 fewer homicides (saving 100/test, require 2-4 hrs.
Objectives
This study examined the association of social determinants of health (SDOH) domains on oral health status.
Methods
We used the nationally representative 2022 Health Center Patient Survey and the 2021–2022 Area Health Resource File. We constructed seven domains on burden of SDOH disadvantage: (1) oral health behavior, (2) dental service use and access, (3) general health service use and access, (4) social, (5) economic, (6) contextual or physical environment, and (7) health condition indicators, and calculated a score per domain. We assessed the association between SDOH domains and four oral health measures: (1) poor self‐assessed oral health, (2) low functional dentition, (3) acute dental need, and (4) chronic symptoms in logistic regressions.
Results
SDOH domains had different degrees of association with outcomes. Oral health behavior, health condition, and economic indicators were positively associated with all outcomes. General health service use and access, and contextual or physical environment were positively associated with all outcomes except for low functional dentition. Dental service use and access indicators were associated with higher likelihood of poor oral health (7.3%) and low functional dentition (2.5%). Social indicators were associated with higher likelihood of poor oral health (3.1%).
Conclusions
Findings highlight the importance of measuring the burden of SDOH disadvantage and including it in care provision. Findings indicate the need for more access through better integration of oral health within primary care, provision of nonclinical services to link patients with social services to promote oral health, and further support of these approaches by payer.
Users dissatisfied with exposure to objectionable online content have begun to migrate en masse to new social media platforms. These new platforms share architectural features with legacy platforms, but offer content moderation services that legacy platforms no longer employ at scale. Such migrations assume that moderation interventions, such as deplatforming and content removal, are efficacious; however, this claim has not been evaluated based on evidence. We therefore evaluated the efficacy of Twitter’s attempts to curtail vaccine misinformation during the COVID-19 pandemic. We found that vaccine skeptical accounts generated a larger share of tweets about vaccines, increased in virality, and became more misinformative after Twitter began removing content and accounts. We also found evidence that Twitter’s mass deplatforming of 70,000 accounts on January 8, 2021 preceded an increase in misinformation, calling into question the efficacy of these removals. Novel platforms that share Twitter’s architecture may therefore face similar moderation challenges.
Introduction: Many individuals with coronavirus disease 2019 (COVID-19) faced stigmatization, which may contribute to poor health. However, very few studies have explored the relationship between COVID-19 stigma and health, and even less is known about differences in the relationship by race and ethnicity. This article examines associations between COVID-19 stigma and mental health overall and by race and ethnicity.
Methods: We used a population-based probability sample of Michigan adults with SARS-CoV-2 infection between March 2020 and May 2022. We captured COVID-19 stigma based on perceived COVID-19 stigma, fear of COVID-19 disclosure to friends or family, and fear of COVID-19 disclosure at work. We conducted modified Poisson regression with robust standard errors to estimate associations of COVID-19 stigma with depressive and anxiety symptoms adjusting for confounding factors.
Results: Individuals who experienced perceived COVID-19 stigma had 1.44 times higher prevalence of depressive symptoms (95% confidence intervals [CIs]: 1.23–1.69) and 1.48 times higher prevalence of anxiety symptoms (95% CI: 1.30–1.69) compared with individuals who did not experience perceived stigma. Moreover, individuals who were afraid to disclose their COVID-19 diagnosis to friends or family, or who were afraid to disclose their diagnosis at work, had a higher prevalence of depressive symptoms and anxiety symptoms, compared with those who were not afraid. These associations were more pronounced among racial and ethnic minoritized individuals than non-Hispanic White individuals.
Discussion: COVID-19 stigma was associated with depressive and anxiety symptoms. There is a critical need to examine long-lasting effects of stigma, particularly among racial and ethnic minoritized individuals.
Background
Patient satisfaction in healthcare a crucial aspect of quality assessment, especially in resource-limited settings like Mogadishu, Somalia, where challenges in service quality persist due to socioeconomic and infrastructural constraints. It plays a significant role in evaluating the overall healthcare experience and provides valuable insights into healthcare system strengths and weaknesses.
Objective
This study aimed to assess patient satisfaction in primary health care facilities in Mogadishu to identify areas for improvement.
Methodology
A facility-based cross-sectional survey of 358 patients was conducted from August 2023 to November 2023; Data was collected through questionnaires and analyzed using SPSS software. Quantitative data was analyzed using appropriate statistical methods, such as descriptive statistics and chi-square tests, to examine the relationships between patient satisfaction and various factors the statistical significance was declared at p-value < 0.05. Ethical approval was obtained from the Ministry of health Somalia before data collection permission was also obtained from the health facility in charges.
Results
While a majority of respondents, 71.5% express overall satisfaction with the healthcare services provided, there were significant concerns regarding empathy, privacy, facility cleanliness, and waiting times. There is a statistically significant association between patients’ visit frequency and their perceptions of various healthcare aspects. Patients who visited the healthcare facility 2–4 times expressed significantly more positive perceptions of healthcare providers’ competence (p < 0.020), empathy (p < 0.009), time spent (p < 0.001), pharmacy services (p < 0.001), and facility cleanliness (p < 0.001) when compared to those with first-time visits or more frequent visits.
Conclusion
The study highlights the importance of addressing communication gaps, enhancing facility hygiene, and reducing waiting times to improve patient satisfaction. To enhance patient satisfaction and overall healthcare quality, recommendations include healthcare provider training, facility hygiene upgrades, and the implementation of strengthened privacy protocols in Mogadishu’s primary healthcare facilities.
On September 29, 2023, the Republic of Ecuador convened a meeting to address surgical system strengthening and urge political leaders to invest in surgical infrastructure. The meeting included experts in health diplomacy, innovative financing, implementation strategy and national surgical plans. The event occurred in parallel with the Sixtieth Directing Council of the Pan American Health Organization, Seventy-fifth session of the World Health Organization Regional Committee for the Americas. The meeting centered around four major areas: (i) building surgical capacity as a means to develop universal health care and emergency preparedness; (ii) developing policies and strategies for strengthening surgical systems; (iii) developing models for financing, sustaining, and improving surgical systems in low- and middle-income countries; and (iv) evaluating implementation strategies for funding these endeavors. National surgical plans represent a critical opportunity to build resilient health care systems by establishing comprehensive and sustainable policies. This article highlights the key messages from the event, which focused on Latin America, to inform the broader global health community.
Keywords
Surgery; national health programs; health system resilience; Pan American Health Organization; Latin America
Background
Uptake of COVID-19 vaccines has stalled in the U.S. Some studies suggest that medical mistrust may be a barrier, but evidence is limited due to cross-sectional designs or convenience sampling.
Methods
We examined associations of medical mistrust with COVID-19 vaccine attitudes at baseline and vaccination uptake at follow-up using a population-based sample of Michigan adults with PCR-confirmed SARS-CoV-2 infection. We summed ratings for three items of the Medical Mistrust Index (MMI) to measure trust in healthcare providers. For vaccine attitudes, we averaged ratings for two items on importance of getting the COVID-19 vaccine. For vaccination uptake as ever receiving at least one dose of a COVID-19 vaccine. We conducted (1) linear regression models to examine cross-sectional associations between MMI and vaccine attitudes (n = 3865), (2) modified Poisson regression with robust standard errors to estimate prospective associations between MMI and vaccination uptake (n = 3741), and (3) effect modification and stratified analyses by race and ethnicity.
Results
The mean MMI score was 1.89. The mean of positive vaccine attitudes measure at baseline was 3.45 and the prevalence of receiving a vaccine at follow-up was 75.3 %. Higher MMI was associated with worse vaccine attitudes at baseline (coefficient = −0.64, 95 % confidence interval [CI]: −0.71, −0.56), and lower vaccine uptake at follow-up (adjusted risk ratio: 0.83, 95 % CI: 0.80, 0.86). Both associations were pronounced among non-Hispanic White and another non-Hispanic race and ethnicity individuals.
Conclusions
Understanding drivers of medical mistrust may help rebuild public trust in healthcare systems to promote vaccine uptake and improve public health.
Among the Filoviridae, Marburg virus (MARV) is a biological threat for which no licensed vaccines or therapeutics are currently available. In contrast, we have licensed products for Ebola virus (EBOV), another member of the Filoviridae family. The availability of licensed medical countermeasures (MCMs) for EBOV provides an opportunity to test a key objective of many pandemic preparedness plans, which is to apply some of the same technological approaches demonstrated to be successful for one agent, EBOV, to a second agent, MARV. This chapter will discuss (1) lessons learned from EBOV outbreak responses and MCM development that are applicable to MARV MCM development, (2) the likely concept of operations for using vaccines and therapeutics against MARV, and (3) target product profiles based on the concept of operations. Finally, we will discuss the current status of the MCM pipeline for MARV and next steps to advance these countermeasures to licensure.
Institution pages aggregate content on ResearchGate related to an institution. The members listed on this page have self-identified as being affiliated with this institution. Publications listed on this page were identified by our algorithms as relating to this institution. This page was not created or approved by the institution. If you represent an institution and have questions about these pages or wish to report inaccurate content, you can contact us here.
Information
Address
Washington, D.C., United States
Head of institution
Margaret Hamburg, Commissioner
Website