[Implementation of the COVID-19 vaccination campaign: experiences and perspectives from the point of view of the Association of Statutory Health Insurance Physicians Westfalen-Lippe (KVWL)]. / Umsetzung der COVID-19-Impfkampagne: Erfahrungen und Perspektiven aus Sicht der Kassenärztlichen Vereinigung Westfalen-Lippe (KVWL).

The main task of the Association of Statutory Health Insurance Physicians Westfalen-Lippe (KVWL) is to provide comprehensive outpatient medical and psychotherapeutic care in the region of Westfalen-Lippe (WL). It represents approximately 15,000 physicians and psychotherapists. Since the beginning of the COVID-19 pandemic, the range of tasks has expanded to include dealing with the pandemic and its containment.This article describes the implementation of the COVID-19 vaccination campaign in WL, the northeastern part of North Rhine-Westphalia (NRW) with a population of 8.3 million, as well as the experience gained in setting up vaccination centers and conducting mass vaccinations. A key problem throughout the time of mass vaccination was the unsteady availability of vaccines. This negatively impacted the operation of the vaccination centers, particularly their utilization and performance. Another burden in the implementation of the vaccination targets was the frequent lack of transparency and comprehensible communication in the dedicated guidelines for the vaccination order (prioritization). Nevertheless, the policy targets were entirely implemented.

Investigating Racial Differences among Men in COVID-19 Diagnosis, and Related Psychosocial and Behavioral Factors: Data from the Michigan Men's Health Event.

Extant research is growing in its ability to explain sex differences in novel coronavirus 2019 (COVID-19) diagnosis and mortality. Moving beyond comparisons based on biological sex is now warranted to capture a more nuanced picture of disparities in COVID-19 diagnosis and mortality specifically among men who are more likely to die of the illness. The objective of this study was to investigate racial disparities in COVID-19-related psychosocial, behavior and health variables among men. The present study utilizes a sample of 824 men who participated in a free health event held in a Midwestern state. Chi-square analysis showed that African American men were more likely to report an adverse impact of COVID-19 based on several factors including experiencing more COVID-19-related medical issues (χ2 = 4.60 p = 0.03); higher COVID-19 diagnosis (χ2 = 4.60 p = 0.02); trouble paying for food (χ2 = 8.47, p = 0.00), rent (χ2 = 12.26, p = 0.00), medication (χ2 = 7.10 p = 0.01) and utility bills (χ2 = 19.68, p = 0.00); higher fear of contracting COVID-19 (χ2 = 31.19, p = 0.00); and higher rates of death of close friends and family due to COVID (χ2 = 48.85, p = 0.00). Non-Hispanic white men reported more increased stress levels due to COVID-19 compared to African American men (χ2 = 10.21, p = 0.01). Regression analysis showed that race was a significant predictor of self-reported COVID-19 diagnosis (OR = 2.56, p < 0.05) after controlling for demographic characteristics. The results showed that compared to non-Hispanic White men, African American men were more likely to report an adverse impact of COVID-19 based on several factors including experiencing more COVID-19-related medical issues; higher COVID-19 diagnosis; trouble paying for food, rent, medication and utility bills; higher fear of contracting COVID-19; and higher rates of death of close friends and family due to COVID. Interestingly, non-Hispanic white men reported more increased stress levels due to COVID-19 compared to African American men.

Michigan Men's diabetes project (MenD): protocol for a peer leader diabetes self-management education and support intervention.

BACKGROUND: Black men are more likely to be diagnosed with type 2 diabetes (T2D) compared to non-Hispanic White men, and this disparity increases among men over the age of 55. A growing body of literature demonstrates the critical role of gender in the management of health behaviors such as T2D and shows that male gender norms can conflict with healthy behaviors. These studies suggest that tailoring diabetes self-management interventions to address the needs of Black men may be critical to helping them to achieve optimal health outcomes. Further, our own research on Blacks with T2D found gender disparities in participation in diabetes interventions, with males participating at significantly lower rates than females. Peer leaders are trained lay individuals who are used to provide ongoing diabetes self-management support to people with diabetes, particularly in minority communities. However, despite studies showing that diabetes management interventions using peer leaders have been successful, the majority of peer leaders as well as the participants in those studies are women. The limited studies to date suggest that Black men with T2D prefer peer-led, male-to-male T2D programs, however, this research consists primarily of nonrandomized, small sample feasibility studies calling for additional studies to establish the efficacy of these approaches. The proposed study will develop and preliminarily validate the effectiveness of an adapted peer leader diabetes self-management support (PLDSMS) intervention designed to improve diabetes-related lifestyle and self-management behaviors in Black men (over 55) with T2D. METHOD: We propose to tailor an existing intervention by 1) our using male peers and 2) modifying the peer leader training content to focus on material appropriate for men. The proposed study includes a developmental phase (development of the intervention with expert feedback, followed by feasibility testing with Black men) and a validation phase [randomized clinical trial (RCT)]. DISCUSSION: If successful, this study will lead to the development and dissemination of an intervention that will address the unique needs of Black men with T2D, helping them to achieve optimal diabetes self-management and health outcomes. TRIAL REGISTRATION: Registered at ClinicalTrials.gov with an ID NCT04760444 on February 17, 2021.

The Impact of Nonpharmacological Interventions on Patient Experience, Opioid Use, and Health Care Utilization in Adult Cardiac Surgery Patients: Protocol for a Mixed Methods Study.

BACKGROUND: Despite pharmacological treatments, patients undergoing cardiac surgery experience severe anxiety and pain, which adversely affect outcomes. Previous work examining pediatric and nonsurgical adult patients has documented the effectiveness of inexpensive, nonpharmacological techniques to reduce anxiety and pain as well as health care costs and length of hospitalization. However, the impact of nonpharmacological interventions administered by a dedicated comfort coach has not been evaluated in an adult surgical setting. OBJECTIVE: This trial aims to assess whether nonpharmacological interventions administered by a trained comfort coach affect patient experience, opioid use, and health care utilization compared with usual care in adult cardiac surgery patients. This study has 3 specific aims: assess the effect of a comfort coach on patient experience, measure differences in inpatient and outpatient opioid use and postoperative health care utilization, and qualitatively evaluate the comfort coach intervention. METHODS: To address these aims, we will perform a prospective, randomized controlled trial of 154 adult cardiac surgery patients at Michigan Medicine. Opioid-naive patients undergoing first-time, elective cardiac surgery via sternotomy will be randomized to undergo targeted interventions from a comfort coach (intervention) versus usual care (control). The individualized comfort coach interventions will be administered at 6 points: preoperative outpatient clinic, preoperative care unit on the day of surgery, extubation, chest tube removal, hospital discharge, and 30-day clinic follow-up. To address aim 1, we will examine the effect of a comfort coach on perioperative anxiety, self-reported pain, functional status, and patient satisfaction through validated surveys administered at preoperative outpatient clinic, discharge, 30-day follow-up, and 90-day follow-up. For aim 2, we will record inpatient opioid use and collect postdischarge opioid use and pain-related outcomes through an 11-item questionnaire administered at the 30-day follow-up. Hospital length of stay, readmission, number of days in an extended care facility, emergency room, urgent care, and an unplanned doctor's office visit will be recorded as the primary composite endpoint defined as total days spent at home within the first 30 days after surgery. For aim 3, we will perform semistructured interviews with patients in the intervention arm to understand the comfort coach intervention through a thematic analysis. RESULTS: This trial, funded by Blue Cross Blue Shield of Michigan Foundation in 2019, is presently enrolling patients with anticipated manuscript submissions from our primary aims targeted for the end of 2020. CONCLUSIONS: Data generated from this mixed methods study will highlight effective nonpharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. This study's findings may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery. TRIAL REGISTRATION: ClinicalTrials.gov NCT04051021; https://clinicaltrials.gov/ct2/show/NCT04051021. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/21350.

Mental health care use in men with comorbid diabetes and depression: The role of age and race.

OBJECTIVES: Older adults with diabetes have double the normal average risk for depression. While women also report higher rates of depression, men are less likely than women to recognize symptoms and seek assistance for mental health treatment. Racial disparities in mental health care use among men have also been identified. While age and gender differences in mental health care use have been accounted for in adults with comorbid diabetes and depression little is known about within group differences among men. The purpose of this study was to examine the influence of age and race on mental health service use in a sample of men with comorbid diabetes and depression. METHODS: This study utilized secondary data from a large health care delivery system serving in a Midwestern urban city and included 335 Black, and non-Latino White men with comorbid type 2 diabetes and depression. RESULTS AND DISCUSSION: Findings indicate that men under the age of 55 were less likely to experience a 6-month or more delay in receiving a psychiatric medication prescription after their initial depression diagnosis. Black men over 55 years of age were significantly more likely to experience a delay of over six months to receiving psychiatric medication. More research is needed to explore preferred depression treatment methods for older Black men with type 2 diabetes, in addition to any issues with access to pharmacological medications to treat depression.