Health Needs Assessment of Unhoused Youth in Charleston, South Carolina.

BACKGROUND: Over 35 000 youth experience homelessness on any given night in the United States (US). Unhoused youth experience unique physical and mental health challenges and face barriers in every social determinant of health (SDoH), which may be amplified in the LGBTQ+ population. OBJECTIVE: The objective of this study was to define characteristics of the unhoused youth population and their utilization of healthcare to inform programs to meet their needs. METHODS: Secondary analysis of data from the College of Charleston's YOUth Count survey was conducted, focusing on health-related characteristics, challenges, healthcare utilization, and SDoH of youth aged 18 to 25 experiencing homelessness in Charleston, SC. RESULTS: Almost three-quarters of respondents (74.6%) reported mental health challenges and 35% reported physical health challenges. A significantly higher proportion of those who engaged in survival sex were LGBTQ+ . More than half (68.4%) visited the emergency department (ED) and 29.3% were admitted to the hospital in the past 12 months. Housing status, safety, food insecurity, sexual orientation, prior foster care, and survival sex were all significantly associated with ED utilization. Housing status and survival sex were significantly associated with hospital admission. CONCLUSIONS: Addressing SDoH is essential to improving health outcomes and healthcare utilization among unhoused youth, particularly in the LGBTQ+ population.

Electronic Health Record-Based Screening for Intimate Partner Violence: A Cluster Randomized Clinical Trial.

Importance: Intimate partner violence (IPV) is a significant public health issue, with a 25% lifetime prevalence. Screening for IPV in primary care is a recommended practice whose effectiveness is debated. Objective: To assess the effect of an electronic health record (EHR)-based multifactorial intervention screening on the detection of IPV risk in primary care practice. Design, Setting, and Participants: This cluster randomized clinical trial used a stepped-wedge design to assign 15 family medicine primary care clinics in the Medical University of South Carolina Health System in the Charleston region to 3 matched blocks from October 6, 2020, to March 31, 2023. All women aged 18 to 49 years who were seen in these clinics participated in this study. Intervention: A noninterruptive EHR alert combined with confidential screening by computer questionnaire using the EHR platform followed by risk assessment and a decision support template. Main Outcomes and Measures: The main outcomes were the rate at which patients were screened for IPV across the clinics and the rate at which patients at risk for IPV were detected by screening procedures. Results: The study clinics cared for 8895 unique patients (mean [SD] age, 34.6 [8.7] years; 1270 [14.3%] with Medicaid or Medicare and 7625 [85.7%] with private, military, or other insurance) over the study period eligible for the screening intervention. The intervention had significant effects on the overall rate of screening for IPV, increasing the rate of screening from 45.2% (10 268 of 22 730 patient visits) to 65.3% (22 303 of 34 157 patient visits) when the noninterruptive alert was active (relative risk, 1.46 [95% CI, 1.44-1.49]; P < .001). The confidential screening process was more effective than baseline nurse-led oral screening at identifying patients reporting past-year IPV (130 of 8895 patients [1.5%] vs 9 of 17 433 patients [0.1%]). Conclusions and Relevance: The intervention was largely effective in increasing screening adherence and the positive detection rate of IPV in primary care. A highly private approach to screening for IPV in primary care may be necessary to achieve adequate detection rates while addressing potential safety issues of patients experiencing IPV. Trial Registration: ClinicalTrials.gov Identifier: NCT06284148.

Atención del personal de enfermería al enfermo terminal: una mirada desde el cuidador Instituto Autónomo Hospital Universitario de Los Andes Mérida / Nursing care to terminally ill: a view from the caregiver Instituto Autonomo Hospital Universitario of Los Andes Mérida

Con el objeto de conocer la percepción que tienen los familiares como cuidadores, sobre la atención que presta el personal de enfermería al enfermo terminal, se realizó un estudio trasversal y comparativo. La muestra fue no probabilística, conformada por 32 personas, 16 familiares cuidadores de enfermos con criterios de SIDA en etapa terminal y 16 de enfermos con otras patologías, en el Instituto Autónomo Hospital Universitario de Los Andes (IAHULA) del Estado Mérida-Venezuela. Los resultados reportan que las personas cuidadoras son mujeres, hermanas, progenitoras, hijas y parejas con edades entre 28 a 59 años. Más de la mitad de los individuos cuidadores de los pacientes terminales con SIDA están en las etapas de aceptación (31.25 por ciento) y desesperanza (31.25 por ciento), mientras que en las personas cuidadoras de enfermos terminales con otras patologías resalta la ira (31.25 por ciento) y depresión (25.00 por ciento). Al establecer la relación entre las percepciones cognoscitiva, afectiva y conductual apreciamos que en ambos grupos en estudio se observó una alta significancia estadística en las dimensiones afectiva (p=0.000) y conductual (p=0.013).