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PURPOSE/OBJECTIVE: This study aims to explore the perspectives of rehabilitation professionals regarding the barriers to spinal cord injury (SCI) rehabilitation services in Nepal. RESEARCH METHOD/DESIGN: A qualitative study involved 15 rehabilitation professionals working in the Spinal Injury Rehabilitation Center in Nepal. After obtaining informed consent, in-depth semistructured interviews were conducted using Zoom and phone calls between June and July 2023. Braun and Clarke's thematic analysis approach was utilized to analyze the interviews and generate themes from the participants' responses. RESULTS: The participants represented nine different rehabilitation professions. Over half of them were female (53.33%), and 86.67% had one to 10 years of experience in SCI rehabilitation. From in-depth interviews, four themes depicting barriers to rehabilitation were identified: (a) resource constraints within the rehabilitation centers, (b) concerns related to finance, awareness, and support mechanisms, (c) systemic problems coupled with geographical and physical barriers, and (d) beliefs and practices influencing access and adherence to rehabilitation. CONCLUSIONS AND IMPLICATIONS: Delivering effective rehabilitation services for people with SCI presents a range of barriers. Considering the critical importance of rehabilitation for this population, the findings underscore the necessity of engaging stakeholders at multiple levels, individuals, communities, and government agencies to address the identified barriers and improve rehabilitation services in Nepal. The implications of the findings are further discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Assistência Odontológica para a Pessoa com Deficiência , Deficiências do Desenvolvimento , Deficiência Intelectual , Medicaid , Humanos , Estados Unidos , Adulto , Assistência Odontológica para a Pessoa com Deficiência/estatística & dados numéricos , Cobertura do Seguro , Seguro Odontológico , Acessibilidade aos Serviços de SaúdeRESUMO
OBJECTIVE: We sought to measure the association of dental provider density and receipt of dental care among Medicaid-enrolled adults. METHODS: We used four years of Indiana Medicaid claims and enrollment data (2015 to 2018) and the Area Health Resources File to examine the relationship between any dental visit (ADV) or any preventive dental visit (PDV) and three county-level measures of dental provider density (the total number of Medicaid-participating dentists, a binary indicator of a federally qualified health center (FQHC) with a Medicaid-participating dentist, and the overall county dentist-to-population ratio). RESULTS: The likelihood of ADV or PDV increased with greater density of Medicaid-participating dentists as well as dentists accepting Medicaid working at an FQHC within the county. The overall dentist-to-population ratio was not associated with dental care use among the adult Medicaid population. CONCLUSION: Dentist participation in Medicaid program may be a modifiable barrier to Medicaid-enrolled adults' receipt of dental care.
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Assistência Odontológica , Odontólogos , Medicaid , Humanos , Medicaid/estatística & dados numéricos , Estados Unidos , Adulto , Feminino , Masculino , Assistência Odontológica/estatística & dados numéricos , Pessoa de Meia-Idade , Odontólogos/estatística & dados numéricos , Indiana , Adulto Jovem , AdolescenteRESUMO
Objective: Very little is known about the association between poor mental health and poor oral health outcomes in the United Sates. This study investigated the prevalence of complete tooth loss among those with and without perceived poor mental health in a nationally representative sample of noninstitutionalized U.S. adults. Methods: Using a cross-sectional study design, we analyzed the 2019 Medical Expenditures Panel Survey to determine the unweighted and weighted prevalence of complete tooth loss among adults. Chi-squared and multivariate logit regression with marginal effects were used to measure the association between complete tooth loss and perceived poor mental health, controlling for respondent characteristics. Results: The prevalence of adults (ages 18 and older) experiencing complete tooth loss was 6% (95% CI: 5.6-6.4). Individuals who have perceived poor mental health were 1.90 percentage points (pps) more likely to report missing all their natural teeth (P = 0.006: 95% CI: 0.5-3.3). Other relevant predictors of complete tooth loss included current smoking status (5.9â pps; 95% CI: 4.5 to 7.2) and secondary education (-6.4â pps (95% CI: -7.0 to -4.8). Conclusions: Overall, self-reported poor mental health was found to be associated with a greater likelihood of reporting complete tooth loss. Findings from this study underscore the need for greater integration of care delivery between behavioral health specialists and dental providers.
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OBJECTIVES: To examine the relationship between preventive dental visits (PDVs) and medical expenditures while mitigating bias from unobserved confounding factors. STUDY DESIGN: Retrospective data analysis of Indiana Medicaid enrollment and claims data (2015-2018) and the Area Health Resources Files. METHODS: An instrumental variable (IV) approach was used to estimate the relationship between PDVs and medical and pharmacy expenditures among Medicaid enrollees. The instrument was defined as the number of adult enrollees with at least 1 nonpreventive dental claim per total Medicaid enrollees within a Census tract per year. RESULTS: In naive analyses, enrollees had on average greater medical expenditures if they had a prior-year PDV (ß = $397.21; 95% CI, $184.23-$610.18) and a PDV in the same year as expenditures were measured (ß = $344.81; 95% CI, $193.06-$496.56). No significant differences in pharmacy expenditures were observed in naive analyses. Using the IV approach, point estimates of overall medical expenditures for the marginal enrollee who had a prior-year PDV (ß = $325.17; 95% CI, -$708.03 to $1358.37) or same-year PDV (ß = $170.31; 95% CI, -$598.89 to $939.52) were similar to naive results, although not significant. Our IV approach indicated that PDV was not endogenous in some specifications. CONCLUSIONS: This is the first study to present estimates with causal inference from a quasi-experimental study of the effect of PDVs on overall medical expenditures. We observed that prior- or same-year PDVs were not related to overall medical or pharmacy expenditures.
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Gastos em Saúde , Medicaid , Adulto , Estados Unidos , Humanos , Estudos Retrospectivos , Assistência OdontológicaRESUMO
Importance: There is a paucity of systematically captured data on the costs incurred by society-individuals, families, and communities-from untreated mental illnesses in the US. However, these data are necessary for decision-making on actions and allocation of societal resources and should be considered by policymakers, clinicians, and employers. Objective: To estimate the economic burden associated with untreated mental illness at the societal level. Design, Setting, and Participants: This cross-sectional study used multiple data sources to tabulate the annual cost of untreated mental illness among residents (≥5 years old) in Indiana in 2019: the US National Survey on Drug Use and Health, the National Survey of Children's Health, Indiana government sources, and Indiana Medicaid enrollment and claims data. Data analyses were conducted from January to May 2022. Main Outcomes and Measures: Direct nonhealth care costs (eg, criminal justice system, homeless shelters), indirect costs (unemployment, workplace productivity losses due to absenteeism and presenteeism, all-cause mortality, suicide, caregiver direct health care, caregiver productivity losses, and missed primary education), and direct health care costs (disease-related health care expenditures). Results: The study population consisted of 6â¯179â¯105 individuals (median [SD] age, 38.0 [0.2] years; 3â¯132â¯806 [50.7%] were women) of whom an estimated 429â¯407 (95% CI, 349â¯526-528â¯171) had untreated mental illness in 2019. The economic burden of untreated mental illness in Indiana was estimated to be $4.2 billion annually (range of uncertainty [RoU], $2.1 billion-$7.0 billion). The cost of untreated mental illness included $3.3 billion (RoU, $1.7 billion-$5.4 billion) in indirect costs, $708.5 million (RoU, $335 million-$1.2 billion) in direct health care costs, and $185.4 million (RoU, $29.9 million-$471.5 million) in nonhealth care costs. Conclusion and Relevance: This cross-sectional study found that untreated mental illness may have significant financial consequences for society. These findings put into perspective the case for action and should be considered by policymakers, clinicians, and employers when allocating societal resources and funding. States can replicate this comprehensive framework as they prioritize key areas for action regarding mental health services and treatments.
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Estresse Financeiro , Transtornos Mentais , Criança , Estados Unidos/epidemiologia , Humanos , Feminino , Adulto , Pré-Escolar , Masculino , Indiana/epidemiologia , Estudos Transversais , Efeitos Psicossociais da Doença , Transtornos Mentais/epidemiologiaRESUMO
This study represents the first known research addressing the impact of the COVID-19 pandemic on women with spinal cord injury (SCI) in the United States. Women in this population face unique barriers that put them at elevated risk for compromised quality of life, risk that was magnified by physical and social restrictions imposed during the pandemic. This qualitative study examined the perceptions of women with SCI and the effect of the pandemic on their lives. The predominantly White and relatively well-educated sample of 105 women with traumatic SCI was diverse in age, injury characteristics, and geographic representation. Recruited across the USA, participants in an online psychological health intervention trial were asked to respond to the item, "Please tell us how COVID-19 has affected you and your life", administered May-October, 2020. An overall sentiment rating of impact was coded as well as the impact of COVID-19 on eight individual themes: Physical Health, Mental Health, Social Health, Activities of Daily Living, Exercise, Work, Activities Outside the Home, and Activities at Home. Sentiment responses were rated as positive, negative, a mixture of positive and negative impacts, or neutral impact. Participants described the overall impact of COVID-19 as negative (54%), positive (10%), mixed (21%) or neutral (15%). Sentiment ratings to individual themes were also described. Our findings highlight the importance of providing access to disability-sensitive and affordable support, resources, and interventions for women with SCI, especially during a public health crisis.
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COVID-19 , Traumatismos da Medula Espinal , Feminino , Humanos , Atividades Cotidianas , COVID-19/epidemiologia , Pandemias , Qualidade de Vida , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/psicologia , Estados Unidos/epidemiologiaRESUMO
Background: Mounting empirical evidence suggests that, compared to women without disabilities, women with disabilities are more likely to experience interpersonal violence (IPV). However, there is extremely limited research attention on IPV against women with spinal cord injury (SCI), a particularly understudied and underserved population. Objectives: To conduct the first known examination of lifetime IPV experience in women with SCI, to explore demographic and disability-related correlates of IPV, and to examine the health impacts of IPV. Methods: The sample included 175 women with traumatic SCI from across the United States who enrolled in a randomized controlled trial of an online psychological health promotion intervention. The data, which included a brief measure of lifetime abuse, were collected as part of the baseline survey administered prior to randomization to the intervention or control conditions. Results: The majority (55%) of the women described experiencing some abuse in their lifetime, with 43% reporting physical abuse, 32% reporting sexual abuse, and 23% reporting disability-related abuse. Sixteen percent of the women indicated that they had experienced all three (physical, sexual, disability) types of abuse. Few demographic and disability characteristics were related to overall lifetime IPV experience; however, disability characteristics were associated with disability-related IPV victimization. In addition, those with a history of IPV had poorer self-reported health and greater depression. Conclusion: This study suggests that IPV is common among women with SCI. More research is needed to understand the prevalence, risk factors, and consequences of IPV against women with SCI to help inform policy and practice.
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Pessoas com Deficiência , Traumatismos da Medula Espinal , Humanos , Feminino , Estados Unidos , Família , Inquéritos e Questionários , PrevalênciaRESUMO
PURPOSE: Few studies have examined the impacts of the COVID-19 pandemic on the lives of people with spinal cord injury (SCI), a population uniquely vulnerable to pandemic-related stressors. This study examines the impact of the pandemic on three life domains (psychosocial health, health and health behavior, and social participation) and identifies risk factors for adverse psychosocial health impacts in a sample of people with SCI. METHOD: A diverse sample of 346 adults with SCI completed a survey assessing demographic, disability, health, and social characteristics, and perceived impacts of the pandemic. RESULTS: Many respondents reported no change on items reflecting psychosocial health, health and health behavior, and social participation; however, among those reporting change, more reported negative than positive impacts. Negative impacts were most striking with regard to psychosocial health and social engagement, with approximately half reporting a worsening of stress, depression, anxiety, and loneliness and a reduction in face-to-face interactions and participation in life roles. Regression analyses revealed that those at greater risk of adverse psychosocial impacts were women, were non-Black, were in poorer health, had greater unmet care needs, and were less satisfied with their social roles and activities. CONCLUSIONS: Although not universal, negative impacts were reported by many respondents 9-15 months into the pandemic. Future research should examine the impacts of the pandemic over time and on a wider range of outcomes. Such research could generate substantial benefits in understanding, preventing, or minimizing the adverse effects of the evolving pandemic and future public health emergencies in people with SCI. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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COVID-19 , Traumatismos da Medula Espinal , Adulto , Humanos , Feminino , Masculino , Pandemias , Inquéritos e Questionários , Ansiedade/epidemiologia , Traumatismos da Medula Espinal/psicologiaRESUMO
BACKGROUND: Few, if any estimates of cost-effectiveness for locomotor training strategies following spinal cord injury (SCI) are available. The purpose of this study was to estimate the cost-effectiveness of locomotor training strategies following spinal cord injury (overground robotic locomotor training versus conventional locomotor training) by injury status (complete versus incomplete) using a practice-based cohort. METHODS: A probabilistic cost-effectiveness analysis was conducted using a prospective, practice-based cohort from four participating Spinal Cord Injury Model System sites. Conventional locomotor training strategies (conventional training) were compared to overground robotic locomotor training (overground robotic training). Conventional locomotor training included treadmill-based training with body weight support, overground training, and stationary robotic systems. The outcome measures included the calculation of quality adjusted life years (QALYs) using the EQ-5D and therapy costs. We estimate cost-effectiveness using the incremental cost utility ratio and present results on the cost-effectiveness plane and on cost-effectiveness acceptability curves. RESULTS: Participants in the prospective, practice-based cohort with complete EQ-5D data (n = 99) qualified for the analysis. Both conventional training and overground robotic training experienced an improvement in QALYs. Only people with incomplete SCI improved with conventional locomotor training, 0.045 (SD 0.28), and only people with complete SCI improved with overground robotic training, 0.097 (SD 0.20). Costs were lower for conventional training, $1758 (SD $1697) versus overground robotic training $3952 (SD $3989), and lower for those with incomplete versus complete injury. Conventional overground training was more effective and cost less than robotic therapy for people with incomplete SCI. Overground robotic training was more effective and cost more than conventional training for people with complete SCI. The incremental cost utility ratio for overground robotic training for people with complete spinal cord injury was $12,353/QALY. CONCLUSIONS: The most cost-effective locomotor training strategy for people with SCI differed based on injury completeness. Conventional training was more cost-effective than overground robotic training for people with incomplete SCI. Overground robotic training was more cost-effective than conventional training for people with complete SCI. The effect estimates may be subject to limitations associated with small sample sizes and practice-based evidence methodology. These estimates provide a baseline for future research.
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Procedimentos Cirúrgicos Robóticos , Robótica , Traumatismos da Medula Espinal , Humanos , Análise de Custo-Efetividade , Estudos Prospectivos , CaminhadaRESUMO
CONTEXT/OBJECTIVE: Spinal cord injury (SCI) often results in a significant loss of mobility and independence coinciding with reports of decreased quality of life (QOL), community participation, and medical complications often requiring re-hospitalization. Locomotor training (LT), the repetition of stepping-like patterning has shown beneficial effects for improving walking ability after motor incomplete SCI, but the potential impact of LT on psychosocial outcomes has not been well-established. The purpose of this study was to evaluate one year QOL, community participation and re-hospitalization outcomes between individuals who participated in a standardized LT program and those who received usual care (UC). DESIGN/SETTING/PARTICIPANTS: A retrospective (nested case/control) analysis was completed using SCI Model Systems (SCIMS) data comparing one year post-injury outcomes between individuals with traumatic motor incomplete SCI who participated in standardized LT to those who received UC. OUTCOME MEASURES: Outcomes compared include the following: Satisfaction with Life Scale (SWLS™), Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF™), and whether or not an individual was re-hospitalized during the first year of injury. RESULTS: Statistically significant improvements for the LT group were found in the following outcomes: SWLS (P = 0.019); and CHART subscales [mobility (P = <0.001)]; occupation (P = 0.028); with small to medium effects sizes. CONCLUSION: Individuals who completed a standardized LT intervention reported greater improvements in satisfaction with life, community participation, and fewer re-hospitalizations at one year post-injury in comparison to those who received UC. Future randomized controlled trials are needed to verify these findings.
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Qualidade de Vida , Traumatismos da Medula Espinal , Humanos , Qualidade de Vida/psicologia , Traumatismos da Medula Espinal/terapia , Traumatismos da Medula Espinal/psicologia , Estudos Retrospectivos , HospitalizaçãoRESUMO
Given the ubiquity of electronic health records (EHR), health administrators should be formally trained on the use and evaluation of EHR data for common operational tasks and managerial decision-making. A teaching electronic medical record (tEMR) is a fully operational electronic medical record that uses de-identified electronic patient data and provides a framework for students to familiarize themselves with the data, features, and functionality of an EHR. Although purported to be of value in health administration programs, specific benefits of using a tEMR in health administration education is unknown. We sought to examine Master of Health Administration (MHA) students' perceptions of the use, challenges, and benefits of a tEMR. We analyzed qualitative data collected from a focus group session with students who were exposed to the tEMR during a semester MHA course. We also administered pre- and post-survey questions on students' self-efficacy and perceptions of the ease of use, usefulness, and intention to use health care data analysis in their future jobs. We found several MHA students valued their exposure to the tEMR, as this provided them a realistic environment to explore de-identified patient data. Scores for students' perceived ease of using healthcare data analysis in their future job significantly increased following use of the tEMR (pre-test score M=3.31, SD=0.21; post-test score M=3.71, SD=0.18; p=0.01). Student exposure and use of a tEMR may positively affect perceptions of using EHR data for strategic and managerial tasks typical of health administrators.
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This current study examines measures of work-life balance among health administration faculty prior to and during the COVID-19 pandemic. A repeated cross-sectional design is used to analyze data collected from a national survey in 2018 and 2021. Changes in six different outcome measures of work-life balance were examined using multivariable logistic regression, controlling for health administration faculty characteristics. Compared to 2018 respondents, faculty respondents in 2021 were more likely to report that family and personal matters were interfering with their ability to do their job (OR = 1.93, p=0.001). Females more frequently reported that their career had suffered because of personal issues/obligations (OR = 1.82, p=0.003) but were less likely to report having enough time to get their teaching (OR = 0.68, p=0.026). Respondents with children 18 years or younger reported higher rates of regularly having to miss a meeting or event at home (OR = 1.88, p<0.001) and an event at work (OR = 3.74, p<0.001). These faculty also more frequently reported that family or personal matters were interfering with their ability to do their job (OR = 3.04, p<0.001) and that their career suffered because of personal issues/obligations (OR = 2.09, p=0.001). Given the implications of work-life conflicts to organizational outcomes, academic leaders and university decision-makers should consider adopting strategies to mitigate the effects of these disruptions to the work-life equilibrium of academics.
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In this study, we provide updated information on salaries of academic health administration (HA) faculty members based on data collected in 2015, 2018, and 2021 and examine characteristics associated with earnings. We present mean inflation-adjusted salaries by demographic characteristics, education, experience, productivity, and job activities. We find that salaries of assistant, associate, and full professors have kept up with inflation and there have not been significant changes in salary by any characteristics over time. As in previous iterations of similar survey data, there remain differences in salary by both gender and race. Higher salaries were associated with having a 12-month contract, being tenured or tenure-track, having an administrative position, and being in a department whose focus is not primarily teaching. Findings from our study will be of interest to individuals on the HA job market, hiring committees, and doctoral students preparing for a position after graduation.
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BACKGROUND: Health care workers experience high stress. Accessible, affordable, and effective approaches to reducing stress are lacking. In-person mindfulness-based interventions can reduce health care worker stress but are not widely available or accessible to busy health care workers. Unguided, digital, mindfulness-based self-help (MBSH) interventions show promise and can be flexibly engaged with. However, their effectiveness in reducing health care worker stress has not yet been explored in a definitive trial. OBJECTIVE: This study aimed to investigate the effectiveness of an unguided digital MBSH app (Headspace) in reducing health care worker stress. METHODS: This was a definitive superiority randomized controlled trial with 2182 National Health Service staff in England recruited on the web and allocated in a 1:1 ratio to fully automated Headspace (n=1095, 50.18%) or active control (Moodzone; n=1087, 49.82%) for 4.5 months. Outcomes were subscales of the Depression, Anxiety, and Stress (primary outcome) Scale short form; Short Warwick Edinburgh Mental Well-being Scale; Maslach Burnout Inventory; 15-item Five-Facet Mindfulness Questionnaire minus Observe items; Self-Compassion Scale-Short Form; Compassionate Love Scale; Penn State Worry Questionnaire; Brooding subscale of the Ruminative Response Scale; and sickness absence. RESULTS: Intention-to-treat analyses found that Headspace led to greater reductions in stress over time than Moodzone (b=-0.31, 95% CI -0.47 to -0.14; P<.001), with small effects. Small effects of Headspace versus Moodzone were found for depression (b=-0.24, 95% CI -0.40 to -0.08; P=.003), anxiety (b=-0.19, 95% CI -0.32 to -0.06; P=.004), well-being (b=0.14, 95% CI 0.05-0.23; P=.002), mindfulness (b=0.22, 95% CI 0.09-0.34; P=.001), self-compassion (b=0.48, 95% CI 0.33-0.64; P<.001), compassion for others (b=0.02, 95% CI 0.00-0.04; P=.04), and worry (b=-0.30, 95% CI -0.51 to -0.09; P=.005) but not for burnout (b=-0.19, -0.04, and 0.13, all 95% CIs >0; P=.65, .67, and .35), ruminative brooding (b=-0.06, 95% CI -0.12 to 0.00; P=.06), or sickness absence (γ=0.09, 95% CI -0.18 to 0.34). Per-protocol effects of Headspace (454/1095, 41.46%) versus Moodzone (283/1087, 26.03%) over time were found for stress, self-compassion, and compassion for others but not for the other outcomes. Engagement (practice days per week) and improvements in self-compassion during the initial 1.5-month intervention period mediated pre- to postintervention improvements in stress. Improvements in mindfulness, rumination, and worry did not mediate pre- to postintervention improvements in stress. No serious adverse events were reported. CONCLUSIONS: An unguided digital MBSH intervention (Headspace) can reduce health care workers' stress. Effect sizes were small but could have population-level benefits. Unguided digital MBSH interventions can be part of the solution to reducing health care worker stress alongside potentially costlier but potentially more effective in-person mindfulness-based interventions, nonmindfulness courses, and organizational-level interventions. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number ISRCTN15424185; https://tinyurl.com/rv9en5kc.
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Esgotamento Profissional , Atenção Plena , Aplicativos Móveis , Esgotamento Profissional/terapia , Pessoal de Saúde , Humanos , Atenção Plena/métodos , Medicina EstatalRESUMO
DESIGN: Cross-sectional survey. OBJECTIVE: To evaluate the perceived helpfulness of pharmacological and non-pharmacological interventions and their combinations for neuropathic pain (NeuP) and subcategories of NeuP after spinal cord injury (SCI). SETTING: Six Spinal Cord Injury Model System Centers. METHODS: Three hundred ninety one individuals at least one year post traumatic SCI were enrolled. A telephone survey was conducted to determine the pharmacologic and non-pharmacologic treatments used in the last 12 months for each participant's three worst pains, whether these treatments were "helpful", and if currently used, each treatments' effectiveness. RESULTS: Two hundred twenty participants (56%) reported 354 distinct NeuPs. Pharmacological treatments rated helpful for NeuP were non-tramadol opioids (opioids were helpful for 86% of opioid treated NeuPs), cannabinoids (83%), and anti-epileptics (79%). Non-pharmacological treatments rated helpful for NeuP were massage (76%), body position adjustment (74%), and relaxation therapy (70%). Those who used both opioids and exercise reported greater NeuP treatment helpfulness compared to participants using opioids without exercise (P = 0.03). CONCLUSIONS: Opioids, cannabinoids, and massage were reported more commonly as helpful than treatments recommended as first-line therapies by current clinical practice guidelines (CPGs) for NeuP after SCI (antiepileptics and antidepressants). Individuals with SCI likely value the modulating effects of pharmacological and non-pharmacological treatments on the affective components of pain in addition to the sensory components of pain when appraising treatment helpfulness.
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OBJECTIVES: This systematic review aims to gain a comprehensive understanding of the feasibility, acceptability, and efficacy of mindfulness-based interventions (MBIs) on depression, anxiety, fatigue, and health-related quality of life among individuals with upper motor neuron disorders (UMNDs). DATA SOURCES: PubMed, PsycINFO, Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature were searched for relevant studies published between January 2001 and June 2021. STUDY SELECTION: Clinical trials published in English evaluating MBIs in adults with the 4 most common UMNDs (multiple sclerosis, brain injury including stroke, spinal cord injury, amyotrophic lateral sclerosis) were included. DATA EXTRACTION: Two reviewers independently performed the risk of bias assessment using standardized tools and extracted desired data electronically. DATA SYNTHESIS: A total of 44 studies were included: 26 randomized controlled trials, 10 nonrandomized controlled trials, and 8 pre-post intervention studies. The average ± SD duration of MBIs was 8±2 weeks. On average, 85%±14% of participants completed the MBI, and the retention rate at follow-up was 80%±16%. Only 14% of the studies delivered MBIs virtually, and feasibility metrics were similar to in-person studies. Among studies reporting acceptability data, most participants reported satisfaction with the MBI. Randomized controlled trials that evaluated the effects of MBI on depression, anxiety, fatigue, and quality of life revealed greater relative improvement in these outcomes among MBI participants compared with controls, with differences greater when compared with passive control than active control participants. None of the studies included in this review studied dose response. CONCLUSIONS: Based on current data, MBIs are feasible and offer a promising approach to address the biopsychosocial needs of individuals with UMNDs. MBIs are associated with a high acceptance rate among participants, with notable improvements in depression, anxiety, fatigue, and quality of life post intervention. Future studies are needed to evaluate alternate models of delivery of MBIs and the dose-response relationship.
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Atenção Plena , Adulto , Humanos , Qualidade de Vida/psicologia , Estudos de Viabilidade , Fadiga , Neurônios MotoresRESUMO
Historically, the prevalence of child growth failure (CGF) has been tracked dichotomously as the proportion of children more than 2 SDs below the median of the World Health Organization growth standards. However, this conventional "thresholding" approach fails to recognize child growth as a spectrum and obscures trends in populations with the highest rates of CGF. Our analysis presents the first ever estimates of entire distributions of HAZ, WHZ, and WAZ for each of 204 countries and territories from 1990 to 2020 for children less than 5 years old by age group and sex. This approach reflects the continuous nature of CGF, allows us to more comprehensively assess shrinking or widening disparities over time, and reveals otherwise hidden trends that disproportionately affect the most vulnerable populations.
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OBJECTIVE: To determine whether preventive dental visits are associated with fewer subsequent nonpreventive dental visits and lower dental expenditures. DATA SOURCES: Indiana Medicaid enrollment and claims data (2015-2018) and the Area Health Resource File. STUDY DESIGN: A repeated measures design with individual and year fixed effects examining the relationship between preventive dental visits (PDVs) and nonpreventive dental visits (NPVs) and dental expenditures. DATA COLLECTION/EXTRACTION METHODS: Not applicable. PRINCIPAL FINDINGS: Of 28,152 adults (108,349 observation-years) meeting inclusion criteria, 36.0% had a dental visit, 27.8% a PDV, and 22.1% a NPV. Compared to no PDV in the prior year, at least one was associated with fewer NPVs (ß = -0.13; 95% CI -0.12, -0.11), lower NPV expenditures (ß = -$29.12.53; 95% CI -28.07, -21.05), and lower total dental expenditures (-$70.12; 95% -74.92, -65.31), as well as fewer PDVs (ß = -0.24; 95% CI -0.26, -0.23). CONCLUSIONS: Our findings suggest that prior year PDVs are associated with fewer subsequent NPVs and lower dental expenditures among Medicaid-enrolled adults. Thus, from a public insurance program standpoint, supporting preventive dental care use may translate into improved population oral health outcomes and lower dental costs among certain low-income adult populations, but barriers to consistent utilization of PDV prohibit definitive findings.
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Gastos em Saúde , Medicaid , Adulto , Estados Unidos , Humanos , Pobreza , Assistência OdontológicaRESUMO
OBJECTIVE: To evaluate college students' awareness of an educational initiative to increase campus influenza vaccination rates and strategies to improve it. PARTICIPANTS: Students attending a large public comprehensive university. METHODS: An investigator-developed, online survey evaluated awareness of the initiative, the students' perception of incentives, and other motivations to receive seasonal influenza vaccine. RESULTS: The vaccination rate was 43%, despite low awareness of the initiative (28%). Awareness was significantly higher among vaccinated students (p = 0.0013). Having knowledge that appointments to receive vaccine were not needed increased the motivation of vaccinated students more than unvaccinated students (p = 0.0001). Personal influencers increased motivation of vaccinated students only when they were aware of the initiative (p = 0.04). Tangible incentives did not motivate students. CONCLUSIONS: Campus vaccination rates increased despite low initiative awareness. Improvements to the initiative should include strategies to increase emphasis on vaccination program conveniences like accessibility and perhaps engage personal influencers more.