Implementation of a Pediatric Population Health Asthma Program in Academic Medical Center-Affiliated Urban and Suburban Practices.

A tiered pediatric Asthma Population Health Management Program (APHMP), based on evidence-based practices, that differentially targets populations for intervention based on rising risk for high utilization and disease complications was implemented at 6 urban and suburban practices affiliated with an academic medical center. In addition to standard pediatric asthma care, APHMP adds regular administration of the asthma control test (ACT), provider education on performance variation, and monitoring through the electronic health record-based asthma registry. As patients' use of acute health care services and complications increases, APHMP integrates multidisciplinary interventions, including an asthma coach who conducts environmental assessments in addition to addressing social needs, into their primary care. A retrospective cohort study method was used to assess population-level effects on asthma event rates and practice- and provider-level variation from 2017 to 2019. Consistent with well-documented health disparities in pediatric asthma, the analysis demonstrated that patients who were male (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.02-1.43), 4-8 years old (OR = 4.91, 95% CI = 3.27-7.37), Spanish speaking (OR = 1.67, 95% CI = 1.54-1.81), from low-income neighborhoods (OR = 1.56, 95% CI = 1.53-2.46), and with ACT <20 (OR = 2.88, 95% CI = 1.97-4.21) had higher odds of having asthma events. Six percent of patients studied were found to be at risk for high health care utilization and disease complications. Study limitations include the absence of a control group, the mixed model data collection approach, and the effects of seasonal variation on asthma events. Future directions include analyzing disease management program outcomes of incorporating an asthma coach into a patient's primary care team and addressing provider-level variation in asthma event rates.

Programs and interventions promoting health equity in LGBTQ2+ populations in Canada through action on social determinants of health. / Programmes et interventions favorisant l'équité en santé dans les populations LGBTQ2+ au Canada par des mesures sur les déterminants sociaux de la santé.

Sexual and gender minorities (SGM) experience a number of health inequities. That social determinants of health drive these inequities is well-documented, but there is little evidence on the number and types of interventions across Canada that address these determinants for these populations. We conducted an environmental scan of programs in Canada that target SGM, and classified the programs based on their level of intervention (individual/interpersonal, institutional and structural). We found that few programs target women, mid-life adults, Indigenous people or ethnoracial minorities, recent immigrants and refugees, and minority language speakers, and few interventions operate at a structural level.

A number of gaps exist in programs promoting health equity and interventions by addressing social determinants of health for sexual and gender minorities in Canada. Efforts to develop new programming should consider LGBTQ2+ communities who are underserved by existing services (e.g. Indigenous people, ethnoracial minorities, women, recent immigrants or refugees). Very few programs addressed employment, disability, education or housing, which are important upstream determinants of health. Most programming focussed on the individual and interpersonal levels of intervention. Systemic interventions were scarce; efforts should focus on examining existing structural-level interventions to consider scalability.

Il existe un certain nombre de lacunes dans les programmes favorisant l'équité en santé et les interventions visant les déterminants sociaux de la santé pour les minorités sexuelles et de genre au Canada. Les efforts visant à élaborer de nouveaux programmes devraient prendre en compte les communautés LGBTQ2+, qui sont mal desservies par les services existants (en particulier les Autochtones, les minorités ethnoraciales, les femmes, les immigrants récents ou réfugiés). Très peu de programmes traitent de l'emploi, de l'invalidité, de l'éducation ou du logement, qui sont d'importants déterminants en amont de la santé. La plupart des programmes sont axés sur les niveaux d'intervention individuels et interpersonnels. Les interventions systémiques étant rares, les efforts devraient être axés sur l'étude des interventions structurelles déjà en place enfin d'en envisager l'extension.

Effective control of SARS-CoV-2 transmission between healthcare workers during a period of diminished community prevalence of COVID-19.

Previously, we showed that 3% (31/1032)of asymptomatic healthcare workers (HCWs) from a large teaching hospital in Cambridge, UK, tested positive for SARS-CoV-2 in April 2020. About 15% (26/169) HCWs with symptoms of coronavirus disease 2019 (COVID-19) also tested positive for SARS-CoV-2 (Rivett et al., 2020). Here, we show that the proportion of both asymptomatic and symptomatic HCWs testing positive for SARS-CoV-2 rapidly declined to near-zero between 25th April and 24th May 2020, corresponding to a decline in patient admissions with COVID-19 during the ongoing UK 'lockdown'. These data demonstrate how infection prevention and control measures including staff testing may help prevent hospitals from becoming independent 'hubs' of SARS-CoV-2 transmission, and illustrate how, with appropriate precautions, organizations in other sectors may be able to resume on-site work safely.

Establishing a community-based participatory research partnership among people who use drugs in Ottawa: the PROUD cohort study.

BACKGROUND: Grounded in a community-based participatory research (CBPR) framework, the PROUD (Participatory Research in Ottawa: Understanding Drugs) Study aims to better understand HIV risk and prevalence among people who use drugs in Ottawa, Ontario. The purpose of this paper is to describe the establishment of the PROUD research partnership. METHODS: PROUD relies on peers' expertise stemming from their lived experience with drug use to guide all aspects of this CBPR project. A Community Advisory Committee (CAC), comprised of eight people with lived experience, three allies and three ex-officio members, has been meeting since May 2012 to oversee all aspects of the project. Eleven medical students from the University of Ottawa were recruited to work alongside the committee. Training was provided on CBPR; HIV and harm reduction; and administering HIV point-of-care (POC) tests so that the CAC can play a key role in research design, data collection, analysis, and knowledge translation activities. RESULTS: From March-December 2013, the study enrolled 858 participants who use drugs (defined as anyone who has injected or smoked drugs other than marijuana in the last 12 months) into a prospective cohort study. Participants completed a one-time questionnaire administered by a trained peer or medical student, who then administered an HIV POC test. Recruitment, interviews and testing occurred in both the fixed research site and various community settings across Ottawa. With consent, prospective follow-up will occur through linkages to health care records available through the Institute for Clinical and Evaluation Sciences. CONCLUSION: The PROUD Study meaningfully engaged the communities of people who use drugs in Ottawa through the formation of the CAC, the training of peers as community-based researchers, and integrated KTE throughout the research project. This project successfully supported skill development across the team and empowered people with drug use experience to take on leadership roles, ensuring that this research process will promote change at the local level. The CBPR methods developed in this study provide important insights for future research projects with people who use drugs in other settings.

A multifaceted assessment of emotional tolerance and intensity in hoarding.

Hoarding is characterized by emotionally reinforced saving behaviors, which often combine with excessive acquisition to give rise to clutter, distress, and impairment. Despite the central role emotional processes are thought to play in hoarding, very little research has directly examined this topic. There is suggestive evidence linking hoarding with several facets of emotional intolerance and avoidance, though one key limitation of this past research has been the exclusive reliance on self-report questionnaires. The aim of the current study was to conduct a multimethod investigation of the relationship between hoarding and perceptions of, and cognitions about, negative emotional states. A large unselected sample of nonclinical young adults (N=213) completed questionnaires, behavioral tasks, and a series of negative mood inductions to assess distress tolerance (DT), appraisals of negative emotions, and emotional intensity and tolerance. Hoarding symptoms were associated with lowered tolerance of negative emotions, as well as perceiving negative emotions as more threatening. Individuals high in hoarding symptoms also experienced more intense emotions during the mood inductions than individuals low in hoarding symptoms, though there was no association with poorer performance on a behavioral index of DT. Across measures, hoarding was consistently associated with experiencing negative emotions more intensely and reporting lower tolerance of them. This relationship was particularly pronounced for the difficulty discarding and acquiring facets of hoarding. Our results offer initial support for the important role of emotional processes in the cognitive-behavioral model of hoarding. A better understanding of emotional dysfunction may play a crucial role in developing more effective treatments for hoarding.

Monitoring unmet needs: using 2-1-1 during natural disasters.

BACKGROUND: Hurricanes Katrina and Rita struck the Gulf Coast forcing unprecedented mass evacuation and devastation. Texas 2-1-1 is a disaster communication hub between callers with unmet needs and community services at disaster sites and evacuation destinations. PURPOSE: To describe the location and timing of unmet disaster needs collected in real-time through Katrina-Rita disaster phases. METHODS: In 2008-2010, a total of 25 data sets of Texas 2-1-1 calls from August-December 2005 were recoded and merged. In 2011-2012, analysis was performed of unmet need types, with comparisons over time and location; mapping was adjusted by population size. RESULTS: Of 635,983 total 2-1-1 calls during the study period, 65% included primary disaster unmet needs: housing/shelter (28%); health/safety (18%); food/water (15%); transportation/fuel (4%). Caller demand spiked on Mondays, decreasing to a precipitous drop on weekends and holidays. Unmet needs surged during evacuation and immediate disaster response, remaining at higher threshold through recovery. Unmet need volume was concentrated in metropolitan areas. After adjusting for population size, "hot-spots" showed in smaller evacuation destinations and along evacuation routes. CONCLUSIONS: New disaster management strategies and policies are needed for evacuation destinations to support extended evacuation and temporary or permanent relocation. Planning and monitoring disaster resources for unmet needs over time and location could be targeted effectively using real-time 2-1-1 call patterns. Smaller evacuation communities were more vulnerable, exhausting their limited resources more quickly. Emergency managers should devise systems to more quickly authorize vouchers and reimbursements. As 2-1-1s expand and coordinate disaster roles nationwide, opportunities exist for analysis of unmet disaster needs to improve disaster management and enhance community resiliency.

Microbubble ultrasound contrast in the assessment of hepatic artery patency following liver transplantation: role in reducing frequency of hepatic artery arteriography.

We prospectively evaluated the role of microbubble ultrasound contrast for detection of hepatic artery thrombosis following liver transplantation. The hepatic artery of adult liver transplant recipients with suspected thrombosis on surveillance Doppler ultrasound (US) were re-examined by a second observer. In patients with no hepatic spectral Doppler signal the microbubble contrast agent Levovist was used. The presence or absence of flow following microbubble contrast was evaluated against arteriography or repeated Doppler US findings. A total of 794 surveillance Doppler US examinations were performed in 231 patients. Hepatic artery flow was demonstrated in 759 of 794 (95.6%) examinations. Microbubble ultrasound contrast was administered in 31 patients (35 studies) with suspected hepatic artery thrombosis. Following microbubble US contrast the hepatic artery could not be demonstrated in 13 of 35 (37.1%) studies (12 patients). Eight patients had arteriography: there was hepatic artery thrombosis in 7 patients and 1 patient had a patent, highly attenuated artery. Detection of a patent hepatic artery increased from 759 of 794 (95.6%) to 781 of 794 (98.4%) with the addition of microbubble contrast. Upon independent reading of the data, the degree of operator confidence in the assessment of the hepatic artery patency prior to microbubble contrast was 4.7 (CI 1.92-7.5) but rose to 8.45 (CI 7.06-9.84) following microbubble contrast ( p<0.0001). In 22 of 35 (62.9%) of studies arteriography could potentially have been avoided. Ultrasound microbubble contrast media may reduce the need for invasive arteriography in the assessment of suspected hepatic artery thrombosis.