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1.
J Safety Res ; 82: 159-165, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36031243

RESUMO

INTRODUCTION: Roundabouts are a proven safety countermeasure for intersection safety. This study examined the safety effects of roundabout conversions in Carmel, Indiana, also known as the "Roundabout City." Doing so is of particular interest because Carmel has a high density of roundabouts and its drivers understand their effectiveness and are familiar with navigating them. This study also adds to the current state of knowledge about innovative double-teardrop roundabouts (i.e., linked roundabouts with teardrop-shaped central islands). METHOD: Negative binomial models accounting for correlation within site pairs were applied to evaluate the safety effects of converting conventional intersections to roundabouts on total crashes, injury crashes, and property-damage-only (PDO) crashes between study sites and control sites for different roundabout types (single-lane, multi-lane, and double-teardrop). We compared crash data from a 2-year period before the installation of the roundabouts with the 2-year period after the conversions. RESULTS: Injury crashes were 47% lower than what would have been expected without the roundabout conversions. The effects were strongest at the double-teardrop roundabouts, where injury crashes were significantly reduced by 84% and total crashes by 63%. Single-lane roundabouts experienced significant decreases of 51% in total crashes and 50% in PDO crashes (and a nonsignificant decrease of 50% in injury crashes). Multi-lane roundabouts were associated with increases in total and PDO crashes but a 15% decrease in injury crashes, though all were nonsignificant. CONCLUSIONS: Overall, the City of Carmel's roundabout program is associated with reductions in injury crashes, which indicates improvements to safety. Single-lane and double-teardrop roundabouts are associated with improvements in the occurrence and severity of crashes. PRACTICAL APPLICATIONS: Double-teardrop roundabouts should be considered for installation at interchange terminals to improve highway safety.


Assuntos
Acidentes de Trânsito , Planejamento Ambiental , Humanos , Indiana , Modelos Estatísticos , Segurança
3.
PLoS One ; 17(8): e0269258, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35914005

RESUMO

Understanding habitat selection of top predators is critical to predict their impacts on ecological communities and interactions with humans, particularly in recovering populations. We analyzed habitat selection in a recovering population of bobcats (Lynx rufus) in south-central Indiana using a Random Forest model. We predicted that bobcats would select forest habitat and forest edges but avoid agriculture to maximize encounters with prey species. We also predicted that bobcats would avoid developed areas and roads to minimize potential antagonistic interactions with humans. Results partially supported our predictions and were consistent with bobcats in the early stages of population expansion. Bobcats exhibited elevated use near forest edges, thresholds of avoidance near agriculture, and thresholds of selection for low and intermediate habitat heterogeneity. Bobcats exhibited peak probability of use 1-3 km from major roads, >800 m from minor roads, and <1km from developed areas, suggesting tradeoffs in reward for high-quality hunting areas and mortality risk. Our Random Forest model highlighted complex non-linear patterns and revealed that most shifts in habitat use occurred within 1 km of the edge of each habitat type. These results largely supported previous studies in the Midwest and across North America but also produced refinements of bobcat habitat use in our system, particularly at habitat boundaries. Refined models of habitat selection by carnivores enable improved prediction of the most suitable habitat for recovering populations and provides useful information for conservation.


Assuntos
Lynx , Animais , Ecossistema , Humanos , Indiana , América do Norte
4.
PLoS One ; 17(8): e0263949, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36001634

RESUMO

Escherichia coli (E. coli) is the most common Gram-negative pathogen isolated in human infections. Antimicrobial resistant (AMR) E. coli originating from dogs may directly or indirectly cause disease in humans. The objective of this study was to calculate the proportion of antimicrobial susceptible E. coli isolated from canine specimens submitted to the Indiana Animal Disease Diagnostic Laboratory and to identify temporal patterns of susceptibility among these isolates. Susceptibility data of 2,738 E. coli isolates from dogs from 2010 through 2019 were used in this study. Proportions of isolates susceptible to the various antimicrobials were calculated using SAS statistical software and the Cochran-Armitage trend test was used to investigate the temporal trends in susceptibility. A multivariable binary logistic regression model was built to investigate the association between host factors and AMR. Overall, 553/2,738 (20.2%) of the isolates were susceptible to 17 of the 27 antimicrobials examined. Of the 2,638 isolates examined for amikacin susceptibility, 2,706 (97.5%) were susceptible, 2,657/2,673 (99.4%) isolates were susceptible to imipenem, and 2,099/2,670 (78.6%) were susceptible to marbofloxacin. A significant decreasing trend in susceptibility was observed for amoxicillin-clavulanic acid (P<0.0001), ampicillin (P<0.0001), Cefazolin (P<0.0001), ceftazidime (P = 0.0067), chloramphenicol (P<0.0001), and orbifloxacin (P = 0.008). The overall percentage of AMR isolates (isolates not susceptible to at least one antimicrobial) was 61.7% (1,690/2,738) and 29.3% (801/2,738) of isolates were multidrug resistant. Multivariable regression analyses showed significant associations between AMR and age (P = 0.0091), breed (P = 0.0008), and sample isolation site/source (P<0.0001). The decreasing trend in the proportion of isolates susceptible to several beta-lactam antimicrobials suggests that resistance of Escherichia coli in dogs to these antimicrobials could be increasing in Indiana. The decreasing trend in susceptibility to these drugs could be due to selection pressure from antimicrobial use.


Assuntos
Infecções por Escherichia coli , Escherichia coli , Animais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Cães , Farmacorresistência Bacteriana , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/veterinária , Humanos , Indiana/epidemiologia , Testes de Sensibilidade Microbiana , Fatores de Risco
5.
J Am Pharm Assoc (2003) ; 62(5): 1615-1622, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35718713

RESUMO

BACKGROUND: Community pharmacists are one of the most accessible health professionals and provide many different services. However, lack of access to complete patient information is a barrier to making meaningful patient interventions. OBJECTIVES: To determine (1) current and desired health information access among community pharmacists in the Community Pharmacy Enhanced Services Network (CPESN) of Indiana and (2) design considerations for a health information exchange tool for use by community pharmacists. METHODS: This voluntary study was conducted over an 8-day survey period in which 40 pharmacies within the CPESN Indiana network were contacted during regular business hours and asked to take part in a 15-minute telephone survey. Questions asked were informed by the following Consolidated Framework for Implementation Research intervention characteristics domain constructs: relative advantage, evidence strength and quality, adaptability, trialability, complexity, costs, and design quality and packaging. RESULTS: Of the 40 contacted pharmacies, 32 (80%) completed the survey. Most pharmacies reported access to immunization registry data; no other routine access was reported by any pharmacy. In questions assessing the relative advantage of Health Information Exchange (HIE) access compared with their current information access, at least 84.4% said that they agreed or strongly agreed with all statements. When choosing the data element most desirable to have access to via HIE in a community pharmacy, the most frequently selected choices were updated medication orders (n = 18, 56.3%), progress notes (n = 5, 15.6%), and laboratory tests (n = 4, 12.5%). Suggestions to improve ease of implementation included integration within dispensing software and clinical decision-making support features, such as alerts for pertinent lab values. CONCLUSION: Integrating HIE data into community pharmacies would provide community pharmacists with access to important patient data, and pharmacists believed that this would improve their practice. Future research should explore whether implementation of this type of tool leads to better patient outcomes and improved pharmacist job satisfaction.


Assuntos
Serviços Comunitários de Farmácia , Troca de Informação em Saúde , Farmácias , Humanos , Indiana , Farmacêuticos
6.
Proc Natl Acad Sci U S A ; 119(25): e2118329119, 2022 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-35696566

RESUMO

Under harsh Pleistocene climates, migration and other forms of seasonally patterned landscape use were likely critical for reproductive success of mastodons (Mammut americanum) and other megafauna. However, little is known about how their geographic ranges and mobility fluctuated seasonally or changed with sexual maturity. We used a spatially explicit movement model that coupled strontium and oxygen isotopes from two serially sampled intervals (5+ adolescent years and 3+ adult years) in a male mastodon tusk to test for changes in landscape use associated with maturation and reproductive phenology. The mastodon's early adolescent home range was geographically restricted, with no evidence of seasonal preferences. Following inferred separation from the matriarchal herd (starting age 12 y), the adolescent male's mobility increased as landscape use expanded away from his natal home range (likely central Indiana). As an adult, the mastodon's monthly movements increased further. Landscape use also became seasonally structured, with some areas, including northeast Indiana, used only during the inferred mastodon mating season (spring/summer). The mastodon died in this area (>150 km from his core, nonsummer range) after sustaining a craniofacial injury consistent with a fatal blow from a competing male's tusk during a battle over access to mates. Northeast Indiana was likely a preferred mating area for this individual and may have been regionally significant for late Pleistocene mastodons. Similarities between mammutids and elephantids in herd structure, tusk dimorphism, tusk function, and the geographic component of male maturation indicate that these traits were likely inherited from a common ancestor.


Assuntos
Extinção Biológica , Mastodontes , Comportamento Sexual Animal , Migração Animal , Animais , Dente Canino , Fósseis , Indiana , Masculino , Mastodontes/crescimento & desenvolvimento , Reprodução , Estações do Ano
7.
Front Public Health ; 10: 810042, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35602152

RESUMO

Pre-exposure prophylaxis, or PrEP, is a once-daily preventative prescription pill against HIV for adults or adolescents who have sex or inject drugs. PrEP may be especially useful among Black and Hispanic Americans, who are particularly at risk for HIV in the United States. In spite of this vulnerability, rates of PrEP use in Black and Hispanic communities are low. Here, we examined familiarity with, prior usage of, and future interest in PrEP among 364 Black and Hispanic Indiana residents. Indiana is an important context for this work, due to severe HIV outbreaks in the area over the last 8 years. Around half of all participants had never heard of PrEP, with Hispanic participants being less familiar than Black participants. Prior PrEP use was low, at around 10%, and was lower for Hispanic than Black participants. Around 21% of all participants reported interest in PrEP after learning of it in our study. Further, participants identified strategies that would make discussions about PrEP with a medical provider more comfortable. Black and Hispanic participants reported feeling the most comfortable with addressing PrEP usage with providers if: (a) the provider was the one who brought up the subject of PrEP, (b) there was written information available to the patient (i.e., brochures), and (c) the patient already knew they qualified for the prescription in terms of personal eligibility and insurance coverage. Additional provider and patient education, as well as openness on the part of the provider, can help to lessen the disparities associated with PrEP need and actual PrEP usage.


Assuntos
Infecções por HIV , Profilaxia Pré-Exposição , Adolescente , Adulto , Afro-Americanos , Infecções por HIV/epidemiologia , Hispânico ou Latino , Homossexualidade Masculina , Humanos , Indiana , Masculino
8.
Respir Care ; 67(8): 976-984, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35610026

RESUMO

BACKGROUND: Heated humidified high-flow nasal cannula (HFNC) is a respiratory support device historically used in pediatrics for infants with bronchiolitis. No large-scale analysis has determined the current frequency or demographic distribution of HFNC use in children. The objective of this study was to determine the frequency and correlates of HFNC use in children presenting to the hospital for asthma, bronchiolitis, or pneumonia. METHODS: This longitudinal observational study was based on electronic health record data from a large regional health information exchange, the Indiana Network for Patient Care (INPC). Subjects were age 0-18 y with recorded hospital encounters at an INPC hospital between 2010-2019 with International Classification of Diseases codes for bronchiolitis, asthma, or pneumonia. Annual proportions of HFNC use among all hospital encounters were assessed using generalized additive models. Log-binomial regression models were used to identify correlates of incident HFNC use and determine risk ratios of specific subjects receiving HFNC. RESULTS: The study sample included 242,381 unique subjects with 412,712 hospital encounters between 2010-2019. The 10-y period prevalence of HFNC use was 2.54% (6,155/242,381) involving 7,974 encounters. Hospital encounters utilizing HFNC increased by 400%, from 326 in 2010 to 1,310 in 2019. This increase was evenly distributed across all 3 diagnostic categories (bronchiolitis, asthma, and pneumonia). Sex, race, age, and ethnicity all significantly influenced the risk of HFNC use. Over the 10-y period, the percentage of all hospital encounters using HFNC increased from 1.11% in 2010 to 3.15% in 2018. Subjects with multiple diagnoses had significantly higher risk of receiving HFNC. CONCLUSIONS: The use of HFNC in children presenting to the hospital with common respiratory diseases has increased substantially over the past decade and is no longer confined to treating infants with bronchiolitis. Demographic and diagnostic factors significantly influenced the frequency of HFNC use.


Assuntos
Asma , Bronquiolite , Pneumonia , Adolescente , Asma/epidemiologia , Asma/terapia , Bronquiolite/terapia , Cânula , Criança , Pré-Escolar , Humanos , Indiana , Lactente , Recém-Nascido , Oxigenoterapia , Pneumonia/epidemiologia , Pneumonia/terapia
9.
BMC Health Serv Res ; 22(1): 622, 2022 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-35534824

RESUMO

BACKGROUND: The COVID-19 pandemic thrust people living with HIV (PLWH) and HIV/AIDS service organizations into an environment ripe with uncertainty. This study examined Indiana HIV/AIDS service provider perceptions of how COVID-19 affected the overall health and access to care of their clients, and how the organizations prepared for, adapted, and responded to the needs of PLWH during the pandemic. METHODS: Guided by the socioecological model, fifteen semi-structured interviews were conducted with ten different HIV/AIDS service organizations across the state of Indiana. RESULTS: Despite the profound disruptions experienced by HIV programs, HIV/AIDS service organizations responded quickly to the challenges posed by the COVID-19 pandemic through myriad innovative strategies, largely informed by prior experiences with the HIV epidemic. CONCLUSIONS: The lessons provided by HIV/AIDS service organizations are invaluable to informing future pandemic response for PLWH. Service delivery innovations in response to the COVID-19 crisis may provide insights to improve HIV care continuity strategies for vulnerable populations far beyond the pandemic.


Assuntos
Síndrome de Imunodeficiência Adquirida , COVID-19 , Infecções por HIV , Síndrome de Imunodeficiência Adquirida/epidemiologia , COVID-19/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Humanos , Indiana/epidemiologia , Pandemias , SARS-CoV-2
10.
J Adolesc Health ; 71(2): 217-225, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35562301

RESUMO

PURPOSE: To determine key elements of a contraception navigator program that provides a personalized approach to overcoming patient-specific barriers by a trained navigator in central Indiana. METHODS: A human-centered design approach was used to engage adolescents and community stakeholders in co-design sessions. Sessions incorporated techniques, such as divergent brainwriting and journey maps, which led to the exploration of various themes that were ultimately used to inform key elements of the contraception navigator program. RESULTS: Adolescents aged 15-17 years (N = 35) and community stakeholders (N = 11) participated in co-design sessions. Analysis verified that the process of obtaining contraception for pregnancy prevention could be intimidating for young people. The importance of language, the presence of stigma, and the knowledge of side effects were all discussed. Essential elements of a contraceptive navigator program included building trust to ultimately co-create a plan that can overcome patient-specific barriers. Having a variety of communication methods available, as well as contraceptive side-effect support, will be essential. DISCUSSION: Using human-centered design techniques to engage adolescent and community stakeholders can help inform the development of a contraceptive navigator program. A trusted navigator that can address patient-specific barriers to contraception access both before and after contraception is obtained is a key element identified by stakeholders.


Assuntos
Comportamento Contraceptivo , Anticoncepção , Adolescente , Anticoncepção/métodos , Anticoncepcionais , Feminino , Acesso aos Serviços de Saúde , Humanos , Indiana , Gravidez
11.
Contraception ; 113: 113-118, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35577148

RESUMO

OBJECTIVE(S): College-age people have the highest numbers of unintended pregnancies and pharmacies within college campuses are in a unique position to meet student needs. Our objective was to implement a pharmacist contraceptive prescribing service in a campus pharmacy and examine the service utilization. STUDY DESIGN: The Purdue University Pharmacy (Indiana, United States) implemented a pharmacist hormonal contraception prescribing service via a collaborative drug therapy management agreement with the campus student health center. The collaborative drug therapy management agreement enables pharmacists to independently prescribe pills, patches, rings, injections, and emergency contraception to students meeting eligibility criteria. After completing a patient health screening and blood pressure check, the pharmacist discusses the eligible method(s) and prescribes up to a 12-month supply. A referral to another provider for long-acting reversible contraception or further evaluation may also be provided. We collected basic information about each encounter (e.g., age, blood pressure, method of contraception prescribed, and time). RESULTS: During the 2020-2021 academic year, 125 prescribing consultations took place with an average appointment length of 20 minutes (range, 12-65 minutes). The median patient age was 21 years (range, 18-30 years). Eligible patients (n = 123, 98%) received a prescription and 119 (95%) prescriptions were written: combined oral pill (n = 91, 77%), injection (n = 12, 10%), patch (n = 6, 5%), vaginal ring (n = 5, 4%), and progestin only pill (n = 5, 4%). CONCLUSION(S): The pharmacist contraception prescribing service developed by the Purdue University Pharmacy and Student Health Center is a unique approach to meeting the needs of students. Few external resources are required for implementation, and most patients were medically eligible to receive hormonal contraception. IMPLICATIONS: Collaboration between on-campus student health centers and pharmacies can be explored as 1 approach to increase access to hormonal contraception for students.


Assuntos
Farmácias , Farmacêuticos , Adolescente , Adulto , Anticoncepcionais Orais Hormonais , Prescrições de Medicamentos , Feminino , Acesso aos Serviços de Saúde , Humanos , Indiana , Gravidez , Estados Unidos , Adulto Jovem
12.
Pediatr Blood Cancer ; 69(8): e29619, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35441446

RESUMO

BACKGROUND: Sickle cell disease (SCD) leads to end-organ damage and shortened life expectancy. The second highest incidence of SCD in Indiana is in Lake County, but until 2017, there was no SCD expert within 65 miles. The Indiana Hemophilia and Thrombosis Center (IHTC) developed the Sickle Care coordination OutReach and Education (SCORE) program in 2017 to bring high-quality, guideline-based care to children with SCD. PROCEDURE: The St. Vincent IRB deemed this retrospective analysis of SCORE clinic care from 2017 to 2020 exempt. Data on the number of transcranial Dopplers (TCD) performed, HU dosing escalation, and vaccine rates were collected along with the number of school and home visits completed. RESULTS: Fifty-three children, adolescents, and young adults completed 288 SCORE clinic visits during the study period; over 75% completed at least three clinic visits. Mean HU dose increased significantly with SCORE clinic care. TCD screening rates increased every year starting in 2018 through 2020 when we added local care coordination. One hundred seventy-three vaccines were administered in SCORE outreach clinics. The PPSV23 vaccines had a 100% acceptance rate, and seasonal influenza had a 75.8% acceptance rate. CONCLUSION: Access to care coordination services and local hematology specialty care alleviates barriers to care and enables comprehensive SCD care delivery to children in need. Prior to the establishment of the SCORE clinic, 75% of children in Lake County were not receiving recommended stroke screening. The SCORE clinic model demonstrates feasibility and impact when delivering on the promise of high-quality care for children with SCD.


Assuntos
Anemia Falciforme , Acidente Vascular Cerebral , Adolescente , Anemia Falciforme/complicações , Anemia Falciforme/epidemiologia , Anemia Falciforme/terapia , Criança , Humanos , Indiana/epidemiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/prevenção & controle , Ultrassonografia Doppler Transcraniana
13.
PLoS One ; 17(4): e0267167, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35439280

RESUMO

BACKGROUND: Human Papillomavirus associated oropharyngeal cancers have been on the rise in the past three decades. Dentists are uniquely positioned to discuss vaccination programs with their patients. The goal of this project was to assess the readiness of dentists in the state of Indiana in being able to administer vaccines. METHODS: An 18-question online survey was sent to licensed dentists in the state of Indiana. Mantel-Haenszel chi-square tests, followed by multivariable analyses using ordinal logistic regression were conducted to assess providers' comfort levels and willingness to administer vaccines in both children and adults, by provider characteristics (practice type, location, and years in practice). RESULTS: A total of 569 completed surveys were included for data analyses. Most dentists (58%) responded positively when asked if they would consider offering vaccinations in their office, if allowed by state legislation. In general, dentists working in academic settings and federally qualified health centers were more agreeable to offering vaccination in their practice. The level of agreement with "Dentists should be allowed to administer HPV, Influenza, Hep A and COVID 19 vaccines" for both children and adults decreased with increased years of practice. More than half of the respondents (55%) agreed that dental providers were competent to administer vaccines and needed no further training. CONCLUSION: The study results suggest the willingness of dentists in the state of Indiana to offer vaccinations in their practices, if allowed by legislation. PRACTICAL IMPLICATIONS: Dental providers can be a unique resource to add to workforce for improving vaccination efforts.


Assuntos
COVID-19 , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Adulto , Vacinas contra COVID-19 , Criança , Odontólogos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Indiana , Papillomaviridae , Infecções por Papillomavirus/prevenção & controle , Vacinação
14.
Brain Inj ; 36(4): 528-535, 2022 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-35285357

RESUMO

OBJECTIVE: Research has shown that as many as 60% of adults in the criminal justice system have a history of traumatic brain injury (TBI), but the examination of effective interventions to reduce recidivism has only just begun. The present study explored the extent to which resource facilitation (RF) may decrease recidivism among those individuals with TBI. METHODS: Over a 2-year period, a prospective, non-randomized controlled study was conducted that included 1,504 justice-involved individuals exiting the Indiana Department of Corrections (IDOC). Participants were screened for a history of TBI as they entered parole or community corrections, with 211 (14%) offenders screening positive for moderate-to-severe TBI. Thirty-one of the 211 offenders offered RF chose to participate in the intervention, while 180 declined and served as the comparison group. RESULTS: Participants in RF were found to recidivate significantly less often at 6 and 12 months post-release when looking at rearrests or return to incarceration combined between the two groups. CONCLUSION: Our findings suggest that the increased risk for reincarceration in those individuals with TBI could be mitigated by the use of RF.


Assuntos
Lesões Encefálicas Traumáticas , Criminosos , Reincidência , Adulto , Humanos , Indiana , Estudos Prospectivos , Reincidência/prevenção & controle
15.
J Am Dent Assoc ; 153(7): 659-667, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35287943

RESUMO

BACKGROUND: Although Medicaid expansion aims to eliminate financial barriers to health care for low-income people in the United States, health care accessibility cannot be guaranteed without clinicians who provide health care to Medicaid recipients. This study examined the characteristics of Indiana dentists that are associated with the likelihood of participating in Medicaid after expansion in 2015. METHODS: This study included Indiana-licensed dentists who renewed their licenses in 2018 and provided supplemental data elements related to demographics, education and training, and professional characteristics. Dentists' Medicaid engagement behavior was categorized on the basis of when claims were submitted from 2014 through 2017. Statistical analyses included the χ2 test and generalized multinomial logit model. RESULTS: Overall, 2,037 Indiana-licensed dentists were included in the study. Of these, 802 (39.4%) were continually active in Medicaid during the study period, and 116 (5.7%) became active after expansion. Dentists had a greater likelihood of engaging in Medicaid after expansion if they were female, specialized in oral and maxillofacial surgery, practiced in a group practice, and were located in a rural county. CONCLUSIONS: This study shows that dentists with certain demographic and practice characteristics had a greater likelihood of participation in Indiana Medicaid after expansion in 2015. Several findings from this study are consistent with previous research regarding the emerging trends in workforce diversity and show the impact of expansion policies on the dental safety net. PRACTICAL IMPLICATIONS: This study presents an effective framework for the use of administrative and regulatory data sources for state-level analysis of the Medicaid safety net.


Assuntos
Odontólogos , Medicaid , Feminino , Acesso aos Serviços de Saúde , Humanos , Indiana , Masculino , Pobreza , Estados Unidos
16.
J Hosp Palliat Nurs ; 24(3): E94-E100, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35285462

RESUMO

The need for palliative care (PC) has gained increased attention during the COVID-19 pandemic. Palliative care adds an extra layer of support and care for patients with advanced chronic illnesses and their families. Because of pandemic restrictions, access and provision of PC services were challenging and resulted in huge suffering and caregiving burden among patients with advanced chronic illnesses and their families, especially those living in smaller towns and rural communities. The study aimed to describe the impact of COVID-19 on PC services and examine various ethical, moral, and practice issues and challenges experienced by rural providers. Using a community-based participatory research approach, a purposive sample of health care providers (n = 15) was obtained from smaller towns and rural communities in Indiana, United States. Online individual interviews were used for data collection. Thematic analysis showed several concerns including restricted visitation, communication challenges, "hard to say goodbye over iPad", moral distress among providers, and preference for home hospice services. Findings call for strategies to implement best PC practices and programs to support providers and families in smaller towns and rural communities.


Assuntos
COVID-19 , Cuidados Paliativos , COVID-19/epidemiologia , Humanos , Indiana/epidemiologia , Cuidados Paliativos/métodos , Pandemias , População Rural , Estados Unidos
17.
Prev Med ; 158: 107023, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35307370

RESUMO

Given low rates of uptake of the COVID-19 vaccine for children 12-17 and 5-11 years old, research is needed to understand parental behaviors and behavioral intentions related to COVID-19 vaccination for their children. In the state of Indiana, we conducted a non-random, online survey of parents or caregivers (N = 10,266) about their COVID-19 vaccine intentions or behaviors, demographic characteristics, and potential motivating reasons for getting the vaccine. In terms of behaviors/intentions, 44.8% of participants indicated they were vaccine acceptors (i.e., had already had their children vaccinated or would as soon as it was possible), 13.0% indicated they were vaccine hesitators (i.e., wanted to wait and see), and 42.2% indicated they were vaccine rejecters (i.e., would not vaccinate or only would if mandated). Compared to vaccine rejecters, vaccine hesitators were more likely to be motivated by perceptions of vaccine safety and efficacy, normative influences such as close friends/family who had been vaccinated and a recommendation from a provider, as well as if they were vaccinated themselves. These findings have implications for the development of targeted vaccine promotion strategies, such as social norms messaging and a focus on vaccine safety, in order to increase COVID-19 vaccination for eligible children.


Assuntos
COVID-19 , Vacinas , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Criança , Humanos , Indiana , Intenção , Pais , SARS-CoV-2 , Vacinação
18.
BMJ Open ; 12(3): e059315, 2022 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-35321899

RESUMO

OBJECTIVE: To examine victimisation rates, geographic patterns and neighbourhood characteristics associated with non-fatal firearm injury rates before and during the COVID-19 pandemic. DESIGN: A retrospective cohort study. SETTING: City of Indianapolis, Indiana, USA, 1 January 2017-30 June 2021. PARTICIPANTS: Intentional non-fatal firearm injury victims from Indianapolis Metropolitan Police Department records. The study included information on 2578 non-fatal firearm injury victims between ages 0 and 77 years. Of these victims, 82.5% were male and 77.4% were black. PRIMARY AND SECONDARY OUTCOME MEASURES: Rates of non-fatal firearm injuries per 100 000 population by victim age, race, sex and incident motive. Prepandemic and peripandemic non-fatal firearm injury rates. RESULTS: Non-fatal shooting rates increased 8.60%, from 57.0 per 100 000 person-years in prepandemic years to 65.6 per 100 000 person-years during the pandemic (p<0.001). Rates of female victims (15.2 vs 23.8 per 100,000; p<0.001) and older victims (91.3 vs 120.4 per 100,000; p<0.001) increased significantly during the pandemic compared with the prepandemic period. Neighbourhoods with higher levels of structural disadvantage (IRR: 1.157, 95% CI 1.012 to 1.324) and prepandemic firearm injury rates (IRR: 1.001, 95% CI 1.001 to 1.002) was positively associated with higher rates of non-fatal firearm injuries during the pandemic, adjusting for neighbourhood characteristics. CONCLUSIONS: Non-fatal firearm injuries increased significantly during the COVID-19 pandemic, particularly among female and older victims. Efforts are needed to expand and rethink current firearm prevention efforts that both address the diversification of victimisation and the larger societal trauma of firearm violence.


Assuntos
COVID-19 , Armas de Fogo , Ferimentos por Arma de Fogo , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Indiana/epidemiologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Ferimentos por Arma de Fogo/epidemiologia , Adulto Jovem
19.
J Forensic Nurs ; 18(3): 146-155, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35271529

RESUMO

BACKGROUND: Indiana ranks among the highest in the nation for child abuse and neglect reports. Already facing a persistent shortage of sexual assault nurse examiners (SANEs) to serve patients across the life span, residents with medical forensic needs were often being referred to other hospitals across the state for care or simply were not receiving medical forensic examinations because of lack of access to trained examiners. The Indiana SANE Training Project was established to evaluate the forensic nursing workforce throughout Indiana and work to expand access to qualified SANEs through training and collaboration with stakeholders, with a focus on rural and underserved areas of the state. METHODS: The Project gathered information from nurses who participated in activities during the first Project year. This information was evaluated for service gaps and ongoing training needs. The project coordinator then convened a workgroup of stakeholders and subject matter experts to evaluate and respond to the most immediate need-limited access to pediatric medical forensic providers. RESULTS: From September 2018 to December 2019, nurses were trained by the Project ( n = 160). Of those, 86% indicated that their hospital did not provide medical forensic examinations to pediatric patients. The Pediatric SANE Intensive was launched in October 2020 and trained pediatric SANEs ( n = 28). Upon completion, participants reported 47% increase in confidence and 56% increase in competence related to caring for pediatric patients. DISCUSSION: Statewide collaboration is a critical component of establishing a consistent approach to care, strengthening multidisciplinary partnerships, increasing access to medical forensic services across the life span and in rural and underserved areas, and promoting the Indiana Guidelines for Medical Forensic Examination of Pediatric Sexual Abuse Patients.


Assuntos
Enfermagem Forense , Delitos Sexuais , Criança , Medicina Legal/educação , Humanos , Indiana , Recursos Humanos
20.
BMC Palliat Care ; 21(1): 25, 2022 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-35183136

RESUMO

With the growing aging population and high prevalence of chronic illnesses, there is an increasing demand for palliative care. In the US state of Indiana, an estimated 6.3 million people are living with one or more chronic illnesses, a large proportion of them reside in rural areas where there is limited access to palliative care leading to major healthcare inequities and disparities. This study aims to identify common barriers and facilitators to access palliative care services in rural areas of Indiana from the perspectives of healthcare providers including clinicians, educators, and community stakeholders. Using a community-based participatory approach, a purposive sample of palliative care  providers (n = 15) in rural areas of Indiana was obtained. Penchansky and Thomas (1981) theoretical framework of access was used to guide the study. A semi-structured individual in-depth interview guide was used to collect the data. All the interviews were conducted online, audio-recorded, and transcribed. Barriers to palliative care  include: misconceptions about palliative care as an underrecognized specialty; lack of trained palliative care providers; late involvement of inpatient palliative care and community hospice services; inadequate palliative care education and training; financial barriers, attitudes and beliefs around PC; and geographical barriers. Facilitators to palliative care include financial gains supporting palliative care growth, enhanced nurses' role in identifying patients with palliative care needs and creating awareness and informing the community about palliative care. Robust education and awareness, enhancing advanced practice nurses' roles, increasing funding and resources are essential to improve the access of palliative care services in the rural communities of Indiana.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Idoso , Humanos , Indiana , Cuidados Paliativos , Pesquisa Qualitativa , População Rural
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