Perceived helpfulness of caregiver support resources: Results from a state-wide poll.

Objective: Our goal was to identify specific types of services desired by caregivers and determine subgroups most interested in each service type. Methods: Caregiving questions were added to a state-wide poll conducted in a majority-rural state. Those who identified as caregivers (n = 428) were asked to report on the helpfulness of 6 domains of services. Descriptive analysis and logistic regressions were conducted. Results: Top resources caregivers identified as potentially helpful included hands-on services (33.9%), help coordinating care from multiple providers (21.5%), help with finances (18.9%), and help managing emotional stress (17.8%). Only 15% indicated no caregiver resources would be helpful. Younger caregivers endorsed several service domains as more helpful than older caregivers; caregivers reporting higher stress were more likely to endorse most domains as helpful. Conclusion: Data reinforces the overwhelming need to offer caregiver services. Navigation and integrated and tailored service models may be beneficial to help caregivers identify and access appropriate services within healthcare systems. Innovation: This study uses an innovative approach to identifying needs of caregivers, who are often invisible within the healthcare system. Our findings suggest a paradigm shift is needed to broaden the scope and depth of services offered to caregivers.

Long-term Mammography Screening Trends and Predictors of Return to Screening after the COVID-19 Pandemic: Results from a Statewide Registry.

Purpose To evaluate long-term trends in mammography screening rates and identify sociodemographic and breast cancer risk characteristics associated with return to screening after the COVID-19 pandemic. Materials and Methods In this retrospective study, statewide screening mammography data of 222 384 female individuals aged 40 years or older (mean age, 58.8 years ± 11.7 [SD]) from the Vermont Breast Cancer Surveillance System were evaluated to generate descriptive statistics and Joinpoint models to characterize screening patterns during 2000-2022. Log-binomial regression models estimated associations of sociodemographic and risk characteristics with post-COVID-19 pandemic return to screening. Results The proportion of female individuals in Vermont aged 50-74 years with a screening mammogram obtained in the previous 2 years declined from a prepandemic level of 61.3% (95% CI: 61.1%, 61.6%) in 2019 to 56.0% (95% CI: 55.7%, 56.3%) in 2021 before rebounding to 60.7% (95% CI: 60.4%, 61.0%) in 2022. Screening adherence in 2022 remained substantially lower than that observed during the 2007-2010 apex of screening adherence (66.1%-67.0%). Joinpoint models estimated an annual percent change of -1.1% (95% CI: -1.5%, -0.8%) during 2010-2022. Among the cohort of 95 644 individuals screened during January 2018-March 2020, the probability of returning to screening during 2020-2022 varied by age (eg, risk ratio [RR] = 0.94 [95% CI: 0.93, 0.95] for age 40-44 vs age 60-64 years), race and ethnicity (RR = 0.84 [95% CI: 0.78, 0.90] for Black vs White individuals), education (RR = 0.84 [95% CI: 0.81, 0.86] for less than high school degree vs college degree), and by 5-year breast cancer risk (RR = 1.06 [95% CI: 1.04, 1.08] for very high vs average risk). Conclusion Despite a rebound to near prepandemic levels, Vermont mammography screening rates have steadily declined since 2010, with certain sociodemographic groups less likely to return to screening after the pandemic. Keywords: Mammography, Breast, Health Policy and Practice, Neoplasms-Primary, Epidemiology, Screening Supplemental material is available for this article. © RSNA, 2024.

Home and wild food procurement were associated with improved food security during the COVID-19 pandemic in two rural US states.

Both food insecurity and home and wild food procurement (HWFP), including gardening, increased in many countries during the COVID-19 pandemic; yet little evidence has demonstrated what impact HWFP had on food security. Using data from a representative sample of nearly 1000 residents in the two most rural US states (Vermont and Maine) conducted via an online survey in Spring/Summer 2021, as well as matching techniques, we compare food security outcomes among households who did and did not participate in HWFP in the first year of the pandemic. Nearly 60% of respondents engaged in HWFP in some way during the first year of the pandemic, with food insecure households more likely to do HWFP. Furthermore, HWFP early in the COVID-19 pandemic is associated with improved food security in the 9-12 months later, though these improvements were primarily associated with newly, not chronically, food insecure households. Newly and chronically food insecure households were more likely to want to continue these activities in the future, but also exhibited greater barriers to land access and costs associated with these activities. These results suggest that HWFP may provide food security improvements for certain households that utilize them, especially during crisis situations. Future research about HWFP should continue to explore multiple HWFP strategies, their barriers, and their potentially myriad relationships to food security, diet, and health outcomes, especially with longitudinal data.

Understanding barriers and facilitators of appropriate antibiotic use: a qualitative analysis of an online parenting forum.

PURPOSE: Antibiotic use and misuse are common in pregnant women and young children. Few studies have assessed real-world discussions of antibiotics in these populations. Using social media posts of pregnant women and parents, our goal was to identify key themes about facilitators and barriers to appropriate antibiotic usage. METHODS: A purposive sample of public posts and comments relevant to antibiotic use was collected from the BabyCenter United States social media site. Using a directed content analysis, themes related to facilitators and barriers to appropriate antibiotic use were identified. RESULTS: Seven hundred and twenty-six posts and 5227 comments were analysed. Themes centred around individual factors, interpersonal factors, and structural factors. Individual factors included knowledge and beliefs. Though misinformation was present, most parents were aware of appropriate antibiotic usage and perceived antibiotics as safe and effective. Some hesitance around using antibiotics led to recommendations for home remedies or over-the-counter treatments. Interpersonal factors focused on a lack of available offline peer support, the expertise of providers, as well as a potential lack of attention from those providers. Structural factors, including access to care, also impacted parents' antibiotic use and misuse. CONCLUSION: Though most parents demonstrated appropriate knowledge about antibiotics and a willingness to follow guidelines, negative experiences with their providers, a lack of support from peers, and structural factors presented as potential barriers to appropriate antibiotic use. Implementing avenues for peer support for parents, allowing more time for providers to address parents' concerns, and improving access to providers could improve appropriate antibiotic use in parents.

Statewide Trends in Buprenorphine Prescribing in Rural and Nonrural Vermont: Analysis of Population-based Patient Pharmacy Claims.

IMPORTANCE: Opioid-related mortality rates have risen dramatically over the past decade, and office-based opioid treatment using buprenorphine offers hope for combatting this trend. Vermont's policymakers, health care systems, and treatment providers have worked to expand access to treatment throughout the rural state. OBJECTIVE: The objective of the current study was to characterize the trends in the number of buprenorphine prescribers and the number of patients per prescriber in Vermont over the past decade (2010-2020). METHODS: We used Vermont's all-payer claims database to identify patients with buprenorphine claims between 2010 and 2020 and their prescribers. We conducted analyses of trends in the number of prescribers treating different numbers of patients, the number of patients treated by prescribers in those categories, and the number of rural (vs nonrural) patients filling buprenorphine prescriptions. We used Z tests to determine if there were statistical differences between trends. RESULTS: The number of buprenorphine prescribers treating 10+ patients grew more rapidly than other prescriber groups ( P < 0.001). Nearly half of Vermont patients in 2020 were treated by 33 high-volume prescribers who treated 100 or more patients with buprenorphine. The number of patients filling buprenorphine prescriptions in Vermont increased by 98% between 2010 and 2020, with greater increases seen among rural than nonrural residents (107% vs 72%; P = 0.008). CONCLUSIONS AND RELEVANCE: Since 2010, Vermont has increased utilization of its office-based opioid treatment capacity, particularly in rural counties.

Spillover After Mammography Guideline Change: Evidence From State-Level Trends.

INTRODUCTION: Changes to which age groups are recommended for mammography may have affected screening rates for all women. This spillover effect has not previously been shown empirically in a national sample. METHODS: Using data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System from 2002 to 2018, authors tested whether screening trends at a national level changed after the 2009 U.S. Preventive Services Task Force guideline change. The authors also tested whether state-level screening trends for women aged 40-49 years and 75+ years were associated with screening trends for women aged 50-74 years. Analyses were conducted in March-December 2022. RESULTS: In a model predicting state-level trends in screening for women aged 50-74 years, authors find positive, statistically significant associations with screening trends for women aged 40-49 years (p=0.033) and for women aged 75+ years (p<0.001). CONCLUSIONS: Deimplementation is difficult and important for controlling healthcare spending and delivering high value care. However, states most successful at reducing mammography screening rates among those aged 40-49 years and 75+ years also had greater reductions in recommended screening among women aged 50-74 years. More work is needed to understand and mitigate the unintended consequences of deimplementation.

Optimal non-pharmaceutical pandemic response strategies depend critically on time horizons and costs.

The COVID-19 pandemic has called for swift action from local governments, which have instated non-pharmaceutical interventions (NPIs) to curb the spread of the disease. The swift implementation of social distancing policies has raised questions about the costs and benefits of strategies that either aim to keep cases as low as possible (suppression) or aim to reach herd immunity quickly (mitigation) to tackle the COVID-19 pandemic. While curbing COVID-19 required blunt instruments, it is unclear whether a less-transmissible and less-deadly emerging pathogen would justify the same response. This paper illuminates this question using a parsimonious transmission model by formulating the social distancing lives vs. livelihoods dilemma as a boundary value problem using calculus of variations. In this setup, society balances the costs and benefits of social distancing contingent on the costs of reducing transmission relative to the burden imposed by the disease. We consider both single-objective and multi-objective formulations of the problem. To the best of our knowledge, our approach is distinct in the sense that strategies emerge from the problem structure rather than being imposed a priori. We find that the relative time-horizon of the pandemic (i.e., the time it takes to develop effective vaccines and treatments) and the relative cost of social distancing influence the choice of the optimal policy. Unsurprisingly, we find that the appropriate policy response depends on these two factors. We discuss the conditions under which each policy archetype (suppression vs. mitigation) appears to be the most appropriate.

Belief correlations with parental vaccine hesitancy: Results from a national survey.

We conducted a nationally representative survey of parents' beliefs and self-reported behaviors regarding childhood vaccinations. Using Bayesian selection among multivariate models, we found that beliefs, even those without any vaccine or health content, predicted vaccine-hesitant behaviors better than demographics, social network effects, or scientific reasoning. The multivariate structure of beliefs combined many types of ideation that included concerns about both conspiracies and side effects. Although they are not strongly related to vaccine-hesitant behavior, demographics were key predictors of beliefs. Our results support some of the previously proposed pro-vaccination messaging strategies and suggest some new strategies not previously considered.

Realizamos una encuesta nacionalmente representativa sobre las creencias y comportamientos autodeclarados por los padres con relación a la vacunación infantil. Usando selección bayesiana entre modelos multivariados, encontramos que las creencias, aun aquellas sin ningún contenido sobre vacunas o salud, predijeron comportamientos indecisos sobre la vacuna mejor que las características demográficas, los efectos de las redes sociales o el razonamiento científico. La estructura multivariada de las creencias combinó muchos tipos de ideación que incluyó preocupaciones tanto sobre conspiraciones como efectos secundarios. Aunque no están relacionados fuertemente con los comportamientos de indecisión, las características demográficas fueron predictores centrales de las creencias. Nuestros resultados apoyan algunas de las estrategias de mensajes pro­vacunación propuestas previamente y sugieren algunas nuevas estrategias no consideradas anteriormente. [vacunación, encuesta, cultura acumulativa, bayesiana].

Reciprocal relationships among influenza experiences, perceptions, and behavior: Results from a national, longitudinal survey of United States adults.

OBJECTIVE: Our objective was to model the reciprocal relationships of perceived risk of contracting influenza with and without influenza vaccination, vaccination behavior, and reported influenza illness. METHODS: We fit structural equation models to data from a longitudinal survey of adults in the United States collected through the RAND American Life Panel. Data come from fall and spring surveys fielded before and after each of 3 influenza seasons, 2016/2017, 2017/2018, and 2018/2019, for a total of 6 waves. RESULTS: As expected, reported influenza experience was associated with increased perceived influenza risk in subsequent survey waves. Furthermore, perceived risk was associated with subsequent vaccination behavior, such that vaccination was more common for those with higher perceived unvaccinated influenza risk and lower perceived vaccinated influenza risk. Perhaps surprisingly, both elements of perceived risk were also associated with a greater likelihood of subsequent reported influenza illness. This malleability in illness reports may reflect uncertainty, as more respondents reported being sick but being unsure about whether they had influenza than reported certainty that they had influenza. CONCLUSIONS: Interventions that influence perceptions about past experience with influenza, including increased testing and informational campaigns about influenza symptoms, could have unanticipated impacts on perceptions of influenza vaccination and vaccination behavior.

Association among trust in health care providers, friends, and family, and vaccine hesitancy.

A health care provider's vaccination recommendation is one of the most important factors influencing parents' decisions about whether to vaccinate their children. Unfortunately, vaccine hesitancy is associated with mistrust of health care providers and the medical system. We conducted a survey of 2440 adults through the RAND American Life Panel in 2019. Respondents were asked to rate their trust in pediatricians, OB/GYNs, doulas, midwives, lactation consultants, friends and family for information about childhood vaccines. Respondents were also asked about willingness to vaccinate a hypothetical child as a measure of vaccine hesitancy. We used principal component analysis to characterize variance in responses on trust items and logistic regression to model the relationship between trust and vaccine hesitancy. Vaccine hesitancy was associated with: (1) lower overall trust; (2) reduced trust in OB/GYNs and pediatricians and greater trust in doulas, midwives, and lactation consultants; and (3) greater trust in friends and family.

Using an Agent-based Model to Examine Deimplementation of Breast Cancer Screening.

OBJECTIVE: The objective of this study was to examine the potential impact of provider social networks and experiences with patients on deimplementation of breast cancer screening. RESEARCH DESIGN: We constructed the Breast Cancer-Social network Agent-based Model (BC-SAM), which depicts breast cancer screening decisions, incidence, and progression among 10,000 women ages 40 and over and the screening recommendations of their providers over a 30-year period. The model has patient and provider modules that each incorporate social network influences. Patients and providers were connected in a network, which represented patient-patient peer connections, provider-provider peer connections, connections between providers and patients they treat, and friend/family relationships between patients and providers. We calibrated provider decisions in the model using data from the CanSNET national survey of primary care physicians in the United States, which we fielded in 2016. RESULTS: First, assuming that providers' screening recommendations for women ages 50-74 remain unchanged but their recommendations for screening among younger (below 50 y old) and older (75+ y old) women decrease, we observed a decline in predicted screening rates for women ages 50-74 due to spillover effects. Second, screening rates for younger and older women were slow to respond to changes in provider recommendations; a 78% decline in provider recommendations to older women over 30 years resulted in an estimated 23% decline in patient screening in that group. Third, providers' experiences with unscreened patients, friends, and family members modestly increased screening recommendations over time (7 percentage points). Finally, we found that provider peer effects can have a substantial impact on population screening rates and can entrench existing practices. CONCLUSION: Modeling cancer screening as a complex social system demonstrates a range of potential effects and may help target future interventions designed to reduce overscreening.

Modeling the impact of school reopening on SARS-CoV-2 transmission using contact structure data from Shanghai.

BACKGROUND: Mathematical modeling studies have suggested that pre-emptive school closures alone have little overall impact on SARS-CoV-2 transmission, but reopening schools in the background of community contact reduction presents a unique scenario that has not been fully assessed. METHODS: We adapted a previously published model using contact information from Shanghai to model school reopening under various conditions. We investigated different strategies by combining the contact patterns observed between different age groups during both baseline and "lockdown" periods. We also tested the robustness of our strategy to the assumption of lower susceptibility to infection in children under age 15 years. RESULTS: We find that reopening schools for all children would maintain a post-intervention R0 < 1 up to a baseline R0 of approximately 3.3 provided that daily contacts among children 10-19 years are reduced to 33% of baseline. This finding was robust to various estimates of susceptibility to infection in children relative to adults (up to 50%) and to estimates of various levels of concomitant reopening in the rest of the community (up to 40%). However, full school reopening without any degree of contact reduction in the school setting returned R0 virtually back to baseline, highlighting the importance of mitigation measures. CONCLUSIONS: These results, based on contact structure data from Shanghai, suggest that schools can reopen with proper precautions during conditions of extreme contact reduction and during conditions of reasonable levels of reopening in the rest of the community.

Comparing covariation among vaccine hesitancy and broader beliefs within Twitter and survey data.

Over the past decade, the percentage of adults in the United States who use some form of social media has roughly doubled, increasing from 36 percent in early 2009 to 72 percent in 2019. There has been a corresponding increase in research aimed at understanding opinions and beliefs that are expressed online. However, the generalizability of findings from social media research is a subject of ongoing debate. Social media platforms are conduits of both information and misinformation about vaccines and vaccine hesitancy. Our research objective was to examine whether we can draw similar conclusions from Twitter and national survey data about the relationship between vaccine hesitancy and a broader set of beliefs. In 2018 we conducted a nationally representative survey of parents in the United States informed by a literature review to ask their views on a range of topics, including vaccine side effects, conspiracy theories, and understanding of science. We developed a set of keyword-based queries corresponding to each of the belief items from the survey and pulled matching tweets from 2017. We performed the data pull of the most recent full year of data in 2018. Our primary measures of belief covariation were the loadings and scores of the first principal components obtained using principal component analysis (PCA) from the two sources. We found that, after using manually coded weblinks in tweets to infer stance, there was good qualitative agreement between the first principal component loadings and scores using survey and Twitter data. This held true after we took the additional processing step of resampling the Twitter data based on the number of topics that an individual tweeted about, as a means of correcting for differential representation for elicited (survey) vs. volunteered (Twitter) beliefs. Overall, the results show that analyses using Twitter data may be generalizable in certain contexts, such as assessing belief covariation.

Cell-Free Synthesis of Natural Compounds from Genomic DNA of Biosynthetic Gene Clusters.

A variety of chemicals can be produced in a living host cell via optimized and engineered biosynthetic pathways. Despite the successes, pathway engineering remains demanding because of the lack of specific functions or substrates in the host cell, the cell's sensitivity in vital physiological processes to the heterologous components, or constrained mass transfer across the membrane. In this study, we show that complex multidomain proteins involved in natural compound biosynthesis can be produced from encoding DNA in vitro in a minimal complex PURE system to directly run multistep reactions. Specifically, we synthesize indigoidine and rhabdopeptides with the in vitro produced multidomain nonribosomal peptide synthetases BpsA and KJ12ABC from the organisms Streptomyces lavendulae and Xenorhabdus KJ12.1, respectively. These in vitro produced proteins are analyzed in yield, post-translational modification and in their ability to synthesize the natural compounds, and compared to recombinantly produced proteins. Our study highlights cell-free PURE system as suitable setting for the characterization of biosynthetic gene clusters that can potentially be harnessed for the rapid engineering of biosynthetic pathways.

The Stability of Influenza Vaccination Behavior Over Time: A Longitudinal Analysis of Individuals Across 8 Years.

BACKGROUND: Seasonal influenza vaccination is an important behavior with significant individual and public health consequences, yet fewer than half of individuals in the USA are vaccinated annually. To promote vaccination adherence, it is important to understand the factors that affect vaccination behavior. PURPOSE: In this research, we focused on one such factor, an individual's vaccination history. We gathered longitudinal data to track and understand the relationship between an individual's vaccination history and their current behaviors. METHODS: U.S. adults completed multiple surveys over an 8 year period, which asked about whether they had received the influenza vaccination during the previous flu season. We analyzed the data to determine the strength of the relationship between vaccination decisions across single-year and multiyear intervals. Additionally, we fitted two mathematical models to the data to determine whether individuals were better characterized as having a stable propensity to vaccinate or a stable propensity to repeat their previous decisions. RESULTS: Individuals exhibited highly consistent behavior across adjacent years, yet, across the complete extent of the longitudinal study, they were far more likely to repeat the earlier decision to vaccinate. Surprisingly, the results of the mathematical model suggest that individuals are better characterized as having a stable propensity to repeat their previous decisions rather than a stable propensity to vaccinate per se. Although most individuals had an extremely strong tendency to repeat the previous decision, some had a far weaker propensity to do so. CONCLUSIONS: This suggests that interventions intended to increase vaccination uptake might be most impactful for those individuals with only a weak tendency to vaccinate or not to vaccinate.

Beliefs around childhood vaccines in the United States: A systematic review.

BACKGROUND: While childhood vaccines are safe and effective, some parents remain hesitant to vaccinate their children, which has led to outbreaks of vaccine preventable diseases. The goal of this systematic review was to identify and summarize the range of beliefs around childhood vaccines elicited using open-ended questions, which are better suited for discovering beliefs compared to closed-ended questions. METHODS: PubMed, Embase, and PsycINFO were searched using keywords for childhood vaccines, decision makers, beliefs, and attitudes to identify studies that collected primary data using a variety of open-ended questions regarding routine childhood vaccine beliefs in the United States. Study designs, population characteristics, vaccine types, and vaccine beliefs were abstracted. We conducted a qualitative analysis to conceptualize beliefs into themes and generated descriptive statistics. RESULTS: Of 1727 studies identified, 71 were included, focusing largely on parents (including in general, and those who were vaccine hesitant or at risk of hesitancy). Seven themes emerged: Adverse effects was most prominent, followed by mistrust, perceived lack of necessity, pro-vaccine opinions, skepticism about effectiveness, desire for autonomy, and morality concerns. The most commonly described beliefs included that vaccines can cause illnesses; a child's immune system can be overwhelmed if receiving too many vaccines at once; vaccines contain harmful ingredients; younger children are more susceptible to vaccine adverse events; the purpose of vaccines is profit-making; and naturally developed immunity is better than that acquired from vaccines. Nearly a third of the studies exclusively assessed minority populations, and more than half of the studies examined beliefs only regarding HPV vaccine. CONCLUSIONS: Few studies used open-ended questions to elicit beliefs about vaccines. Many of the studies that did so, focused on HPV vaccine. Concerns about vaccine safety were the most commonly stated beliefs about childhood vaccines, likely because studies were designed to capture barriers and challenges to vaccination.

Modification and de novo design of non-ribosomal peptide synthetases using specific assembly points within condensation domains.

Non-ribosomal peptide synthetases (NRPSs) are giant enzyme machines that activate amino acids in an assembly line fashion. As NRPSs are not restricted to the incorporation of the 20 proteinogenic amino acids, their efficient manipulation would enable microbial production of a diverse range of peptides; however, the structural requirements for reprogramming NRPSs to facilitate the production of new peptides are not clear. Here we describe a new fusion point inside the condensation domains of NRPSs that results in the development of the exchange unit condensation domain (XUC) concept, which enables the efficient production of peptides, even containing non-natural amino acids, in yields up to 280 mg l-1. This allows the generation of more specific NRPSs, reducing the number of unwanted peptide derivatives, but also the generation of peptide libraries. The XUC might therefore be suitable for the future optimization of peptide production and the identification of bioactive peptide derivatives for pharmaceutical and other applications.

Linking physician attitudes to their breast cancer screening practices: A survey of US primary care providers and gynecologists.

Despite changes to breast cancer screening guidelines intended to decrease screening in younger and older women, mammography rates remain high. We investigated physician attitudes towards screening younger and older women. Surveys were mailed to US primary care providers and gynecologists between May and September 2016 (871/1665, 52.3% adjusted response rate). We assessed physician (1) attitudes towards screening younger (45-49years) and older (75+ years) women and (2) recommendations for routine mammography. We used exploratory factor analysis to identify underlying themes among physician attitudes and created measures standardized to a 5-point scale. Using multivariable logistic regression models, we examined associations between physician attitudes and screening recommendations. Attitudes identified with factor analysis included: potential regret, expectations, and discordant guidelines (referred to as potential regret), patient-related hazards due to screening, physician limitations and uncertainty, and concerns about rationing care. Gynecologists had higher levels of potential regret compared to internists. In adjusted analyses, physicians with increasing potential regret (1-point increment on 5-point scale) had higher odds of recommending mammography to younger (OR 8.68; 95% CI 5.25-14.36) and older women (OR 4.62; 95% CI 3.50-6.11). Increasing concern for patient-related hazards was associated with decreased odds of recommending screening to older women (OR 0.68; 95% CI 0.56-0.83). Physicians were more motivated by potential regret in recommending screening for younger and older women than by concerns for patient-related hazards in screening. Addressing physicians' most salient concerns, such as fear of missing cancer diagnoses and malpractice, may present an important opportunity to improving delivery of guideline-concordant cancer screening.