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1.
Prev Chronic Dis ; 21: E41, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38843117

RESUMO

Michigan's CHRONICLE, the Chronic Disease Registry Linking Electronic Health Record Data, is a near-real-time disease monitoring system designed to harness electronic health record (EHR) data and existing health information exchange (HIE) infrastructure for transformative public health surveillance. Strong evidence indicates that using EHR data in chronic disease monitoring will provide rapid insight over time on health care use, outcomes, and public health interventions. We examined the potential of EHR data for chronic disease surveillance through close collaboration with our statewide HIE network and 2 participating health systems. We describe the development of CHRONICLE, the promising findings from its implementation, the identified challenges, and how those challenges will inform the next steps in testing, refining, and expanding the system. By detailing our approach to developing CHRONICLE and the considerations and early steps required to build an innovative, EHR-based chronic disease registry, we aim to inform public health leaders and professionals on the value of EHR data for chronic disease surveillance. With systematic testing, evaluation, and enhancement, our goal for CHRONICLE, as a fully realized and comprehensive surveillance system, is to model how collaborative health information exchange can support evidence-based strategies, resource allocation, and precision in disease monitoring.


Assuntos
Registros Eletrônicos de Saúde , Troca de Informação em Saúde , Sistema de Registros , Humanos , Doença Crônica/epidemiologia , Michigan/epidemiologia , Vigilância da População/métodos
2.
Ethn Dis ; 34(1): 1-7, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38854790

RESUMO

Introduction: Coronavirus disease (COVID) dashboards rarely provide insights about the racialized contexts in which vaccination inequities occur. Objective: The purpose of this study was to use the emerging Project REFOCUS dashboard to contextualize COVID vaccination patterns among 6 diverse communities. Methods: We queried the dashboard to generate descriptive statistics on vaccination trends and racism-related contextual factors among the 6 Project REFOCUS pilot sites (Albany, Georgia, Bronx, New York, Detroit, Michigan, Helena-West Helena, Arkansas, San Antonio, Texas, and Wake County, North Carolina). Results: Vaccination rates, demographic indicators, and contextual factors differed across sites. As of October 17, 2022, the proportion of people who had received at least 1 COVID vaccine dose ranged from 58.4% (Wayne County, Michigan) to 95.0% (Wake County, North Carolina). The pilot sites with the greatest percentage of Black residents (Dougherty County, Georgia, Wayne County, Michigan, and Phillips County, Arkansas) had lower proportions of fully vaccinated people. Wayne County, Michigan, had the highest level of residential segregation between Black and White residents (78.5%) and non-White and White residents (68.8%), whereas Phillips County, Arkansas, had the highest overall mortgage denial rates (38.9%). Both counties represent settings where over 75.0% of residents report Black race and over 30.0% of the population live in poverty. Discussion: The dashboard integrates racism-related factors with COVID vaccination visualizations and provides a fuller picture of the context in which COVID trends are occurring. Conclusions: Community organizers, researchers, policymakers, and practitioners can track racism-related factors and other social determinants of health as part of the contexts in which COVID-related inequities occur.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Racismo , Determinantes Sociais da Saúde , Humanos , COVID-19/prevenção & controle , COVID-19/etnologia , Projetos Piloto , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/uso terapêutico , Negro ou Afro-Americano/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Estados Unidos , Feminino , Masculino , Disparidades em Assistência à Saúde/etnologia , Michigan , Adulto , População Branca/estatística & dados numéricos , Pessoa de Meia-Idade
3.
JAMA Netw Open ; 7(6): e2415295, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38848066

RESUMO

Importance: Alcohol use disorder (AUD) is present in nearly half of individuals with bipolar disorder (BD) and is associated with markedly worsening outcomes. Yet, the concurrent treatment of BD and AUD remains neglected in both research and clinical care; characterizing their dynamic interplay is crucial in improving outcomes. Objective: To characterize the longitudinal alcohol use patterns in BD and examine the temporal associations among alcohol use, mood, anxiety, and functioning over time. Design, Setting, and Participants: This cohort study selected participants and analyzed data from the Prechter Longitudinal Study of Bipolar Disorder (PLS-BD), an ongoing cohort study that recruits through psychiatric clinics, mental health centers, and community outreach events across Michigan and collects repeated phenotypic data. Participants selected for the present study were those with a diagnosis of BD type I (BDI) or type II (BDII) who had been in the study for at least 5 years. Data used were extracted from February 2006 to April 2022, and follow-up ranged from 5 to 16 years. Main Outcomes and Measures: Alcohol use was measured using the Alcohol Use Disorders Identification Test. Depression, mania or hypomania, anxiety, and functioning were measured using the 9-Item Patient Health Questionnaire, the Altman Self-Rating Mania Scale, the 7-item Generalized Anxiety Disorder assessment scale, and the Life Functioning Questionnaire, respectively. Results: A total of 584 individuals (386 females (66.1%); mean [SD] age, 40 [13.6] years) were included. These participants had a BDI (445 [76.2%]) or BDII (139 [23.8%]) diagnosis, with or without a lifetime diagnosis of AUD, and a median (IQR) follow-up of 9 (0-16) years. More problematic alcohol use was associated with worse depressive (ß = 0.04; 95% credibility interval [CrI], 0.01-0.07) and manic or hypomanic symptoms (ß = 0.04; 95% CrI, 0.01-0.07) as well as lower workplace functioning (ß = 0.03; 95% CrI, 0.00-0.06) over the next 6 months, but increased depressive and manic or hypomanic symptoms were not associated with greater subsequent alcohol use. These latter 2 associations were more pronounced in BDII than BDI (mania or hypomania: ß = 0.16 [95% CrI, 0.02-0.30]; workplace functioning: ß = 0.26 [95% CrI, 0.06-0.45]). Alcohol use was not associated with anxiety over time. Conclusions and Relevance: This study found that alcohol use, regardless of diagnostic status, was associated with mood instability and poorer work functioning in BD, but increased mood symptoms were not associated with subsequent alcohol use. Given its prevalence and repercussions, dimensional and longitudinal assessment and management of alcohol use are necessary and should be integrated into research and standard treatment of BD.


Assuntos
Consumo de Bebidas Alcoólicas , Transtorno Bipolar , Humanos , Transtorno Bipolar/psicologia , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/complicações , Feminino , Masculino , Adulto , Estudos Longitudinais , Pessoa de Meia-Idade , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Alcoolismo/complicações , Afeto , Michigan/epidemiologia , Ansiedade/epidemiologia , Ansiedade/psicologia
4.
Sci Rep ; 14(1): 13624, 2024 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-38871762

RESUMO

Among Arab-American women in Michigan, rates of cervical cancer screening are lower than those in non-Hispanic White and Black women in the state. A deep understanding of the Arab community's perspective on cervical cancer screening is needed to address the disparity in rates across populations in Michigan. Arab and Chaldean women across Michigan were invited to participate in Zoom-based focus groups to understand the attitudes, acceptability, and barriers of cervical cancer screening among this population. Four focus groups with a total of 19 women aged 30 to 61 were conducted. The focus groups were conducted in English, Arabic, or both languages. The guided discussion was focused on knowledge of cervical cancer and Human papillomavirus (HPV) and its transmission, attitudes towards HPV vaccination, and attitudes towards cervical cancer screening. HPV self-sampling as an alternative to traditional provider-based screening was specifically discussed as this has been proposed as a way to increase screening in hard-to-reach populations. The conversations revealed insights related to barriers at the individual and community levels for screening and vaccination, attitudes towards preventive health care including screening, a need for accessible women's health literature, and health education. The women also discussed vaccine hesitancy related to HPV and COVID-19, suggesting a need for targeted community interventions.


Assuntos
Árabes , Detecção Precoce de Câncer , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Aceitação pelo Paciente de Cuidados de Saúde , Neoplasias do Colo do Útero , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Árabes/psicologia , COVID-19/prevenção & controle , COVID-19/psicologia , COVID-19/epidemiologia , Detecção Precoce de Câncer/psicologia , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Michigan , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pesquisa Qualitativa , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia , Neoplasias do Colo do Útero/diagnóstico , Vacinação/psicologia , Vacinação/estatística & dados numéricos
5.
J Water Health ; 22(5): 811-824, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38822461

RESUMO

Wastewater surveillance has been a tool for public health officials throughout the COVID-19 pandemic. Universities established pandemic response committees to facilitate safe learning for students, faculty, and staff. These committees met to analyze both wastewater and clinical data to propose mitigation strategies to limit the spread of COVID-19. This paper reviews the initial efforts of utilizing campus data inclusive of wastewater surveillance for SARS-CoV-2 RNA concentrations, clinical case data from university response teams, and mitigation strategies from Grand Valley State University in West Michigan (population 21,648 students) and Oakland University in East Michigan (population 18,552 students) from November 2020 to April 2022. Wastewater positivity rates for both universities ranged from 32.8 to 46.8%. Peak viral signals for both universities directly corresponded to variant points of entry within the campus populations from 2021 to 2022. It was found that the organization of clinical case data and variability of wastewater testing data were large barriers for both universities to effectively understand disease dynamics within the university population. We review the initial efforts of onboarding wastewater surveillance and provide direction for structuring ongoing surveillance workflows and future epidemic response strategies based on those that led to reduced viral signals in campus wastewater.


Assuntos
COVID-19 , SARS-CoV-2 , Águas Residuárias , Universidades , Águas Residuárias/virologia , Águas Residuárias/análise , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Michigan/epidemiologia , Saúde Pública
6.
PLoS One ; 19(6): e0305394, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38885247

RESUMO

Rising atmospheric carbon dioxide levels are impacting global temperatures, ecological systems, and human societies. Natural carbon sequestration through the conservation of soil and native ecosystems may slow or reduce the amount of CO2 in the atmosphere, and thus slow or mitigate the rate of global warming. Most of the research investigating carbon sequestration in natural systems occurs in forested ecosystems, however rare ecosystems such as coastal plain marshes and wet-mesic sand prairie collectively may serve as significant carbon sinks. Our objectives were to measure and assess the importance of carbon sequestration in three rare ecosystems (oak-pine barrens, coastal plain marsh, and wet-mesic sand prairie) in western Lower Michigan. We measured carbon in standing vegetation, dead organic matter, and soils within each ecosystem and adjacent encroaching forested areas. Driven by tree carbon, total carbon stocks in encroaching areas were greater than in intact rare ecosystems. Soil organic carbon was greater in all intact ecosystems, though only significantly so in coastal plain marsh. Principal components analysis explained 72% of the variation and revealed differences between intact ecosystems and their encroaching areas. Linear models using the ratio of red to green light reflectance successfully predicted SOC in intact coastal plain marsh and wet-mesic sand prairie. Our results infer the importance of these rare ecosystems in sequestering carbon in soils and support the need to establish federal or state management practices for the conservation of these systems.


Assuntos
Sequestro de Carbono , Carbono , Ecossistema , Florestas , Solo , Michigan , Solo/química , Carbono/análise , Áreas Alagadas , Conservação dos Recursos Naturais/métodos , Árvores , Dióxido de Carbono/análise
7.
Am J Mens Health ; 18(3): 15579883241258318, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38879823

RESUMO

Black men are disproportionately affected by type 2 diabetes (T2D) and experience higher diabetes-related complications than non-Hispanic White men. To address the complex barriers in diabetes self-management for Black men, we implemented a 3-month peer-led and empowerment-based Diabetes Self-Management Education (DSME) and Support (DSMS) intervention in Metro Detroit. Twenty-five Black men ≥55 years of age with self-reported T2D were randomized to the intervention group (n=12)-10 hr of DSME and 9 hr of DSMS-or enhanced usual care (EUC) group (n=13)-10 hr of DSME. Peer leaders (n = 3) were trained by certified diabetes care and education specialists (CDCESs) to cofacilitate the support sessions. Outcomes (hemoglobin A1c [HbA1c], diabetes self-care activities, and diabetes distress) were assessed preintervention and postintervention. In the intervention and EUC groups, mean HbA1c decreased by 0.20% (p = .52, SD = 0.99) and 0.13% (p = .68), respectively. General diet (p = .03, M change: 1.32, SD = 1.71) and blood glucose monitoring (p < .05, M change: 0.50, SD = 0.74) scores improved among those in the intervention group. General diet scores also improved in the EUC group: mean change: 1.77, p = .08, although changes were not statistically significant. Changes in diabetes distress scores differed based on the number of sessions attended, with a significant decrease in those attending 7 to 12 sessions (n = 7), >50%, (p = .003, M change: -5.71, SD = 3.20). Implementing a peer-led DSMS program for Black men was feasible, adopted, and led to positive changes in outcomes. Scaling up the intervention and assessing sustainability is warranted.


Assuntos
Negro ou Afro-Americano , Diabetes Mellitus Tipo 2 , Estudos de Viabilidade , Grupo Associado , Autogestão , Humanos , Masculino , Diabetes Mellitus Tipo 2/terapia , Pessoa de Meia-Idade , Michigan , Projetos Piloto , Idoso , Autocuidado , Hemoglobinas Glicadas/análise
8.
J Extra Corpor Technol ; 56(2): 55-64, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38888548

RESUMO

BACKGROUND: The Perfusion Measures and Outcomes (PERForm) registry was established in 2010 to advance cardiopulmonary bypass (CPB) practices and outcomes. The registry is maintained through the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative and is the official registry of the American Society of Extracorporeal Technology. METHODS: This first annual PERForm registry report summarizes patient characteristics as well as CPB-related practice patterns in adult (≥18 years of age) patients between 2019 and 2022 from 42 participating hospitals. Data from PERForm are probabilistically matched to institutional surgical registry data. Trends in myocardial protection, glucose, anticoagulation, temperature, anemia (hematocrit), and fluid management are summarized. Additionally, trends in equipment (hardware/disposables) utilization and employed patient safety practices are reported. RESULTS: A total of 40,777 adult patients undergoing CPB were matched to institutional surgical registry data from 42 hospitals. Among these patients, 54.9% underwent a CABG procedure, 71.6% were male, and the median (IQR) age was 66.0 [58.0, 73.0] years. Overall, 33.1% of the CPB procedures utilized a roller pump for the arterial pump device, and a perfusion checklist was employed 99.6% of the time. The use of conventional ultrafiltration decreased over the study period (2019 vs. 2022; 27.1% vs. 24.9%) while the median (IQR) last hematocrit on CPB has remained stable [27.0 (24.0, 30.0) vs. 27.0 (24.0, 30.0)]. Pump sucker termination before protamine administration increased over the study period: (54.8% vs. 75.9%). CONCLUSION: Few robust clinical registries exist to collect data regarding the practice of CPB. Although data submitted to the PERForm registry demonstrate overall compliance with published perfusion evidence-based guidelines, noted opportunities to advance patient safety and outcomes remain.


Assuntos
Ponte Cardiopulmonar , Sistema de Registros , Humanos , Sistema de Registros/estatística & dados numéricos , Masculino , Idoso , Ponte Cardiopulmonar/estatística & dados numéricos , Ponte Cardiopulmonar/instrumentação , Pessoa de Meia-Idade , Feminino , Michigan , Adulto
9.
JMIR Mhealth Uhealth ; 12: e54946, 2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38889070

RESUMO

Background: Hypertension, a key modifiable risk factor for cardiovascular disease, is more prevalent among Black and low-income individuals. To address this health disparity, leveraging safety-net emergency departments for scalable mobile health (mHealth) interventions, specifically using text messaging for self-measured blood pressure (SMBP) monitoring, presents a promising strategy. This study investigates patterns of engagement, associated factors, and the impact of engagement on lowering blood pressure (BP) in an underserved population. Objective: We aimed to identify patterns of engagement with prompted SMBP monitoring with feedback, factors associated with engagement, and the association of engagement with lowered BP. Methods: This is a secondary analysis of data from Reach Out, an mHealth, factorial trial among 488 hypertensive patients recruited from a safety-net emergency department in Flint, Michigan. Reach Out participants were randomized to weekly or daily text message prompts to measure their BP and text in their responses. Engagement was defined as a BP response to the prompt. The k-means clustering algorithm and visualization were used to determine the pattern of SMBP engagement by SMBP prompt frequency-weekly or daily. BP was remotely measured at 12 months. For each prompt frequency group, logistic regression models were used to assess the univariate association of demographics, access to care, and comorbidities with high engagement. We then used linear mixed-effects models to explore the association between engagement and systolic BP at 12 months, estimated using average marginal effects. Results: For both SMBP prompt groups, the optimal number of engagement clusters was 2, which we defined as high and low engagement. Of the 241 weekly participants, 189 (78.4%) were low (response rate: mean 20%, SD 23.4) engagers, and 52 (21.6%) were high (response rate: mean 86%, SD 14.7) engagers. Of the 247 daily participants, 221 (89.5%) were low engagers (response rate: mean 9%, SD 12.2), and 26 (10.5%) were high (response rate: mean 67%, SD 8.7) engagers. Among weekly participants, those who were older (>65 years of age), attended some college (vs no college), married or lived with someone, had Medicare (vs Medicaid), were under the care of a primary care doctor, and took antihypertensive medication in the last 6 months had higher odds of high engagement. Participants who lacked transportation to appointments had lower odds of high engagement. In both prompt frequency groups, participants who were high engagers had a greater decline in BP compared to low engagers. Conclusions: Participants randomized to weekly SMBP monitoring prompts responded more frequently overall and were more likely to be classed as high engagers compared to participants who received daily prompts. High engagement was associated with a larger decrease in BP. New strategies to encourage engagement are needed for participants with lower access to care.


Assuntos
Serviço Hospitalar de Emergência , Provedores de Redes de Segurança , Telemedicina , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Telemedicina/estatística & dados numéricos , Telemedicina/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Provedores de Redes de Segurança/estatística & dados numéricos , Adulto , Hipertensão/terapia , Hipertensão/psicologia , Hipertensão/epidemiologia , Idoso , Michigan/epidemiologia , Envio de Mensagens de Texto/instrumentação , Envio de Mensagens de Texto/estatística & dados numéricos , Envio de Mensagens de Texto/normas , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/estatística & dados numéricos , Determinação da Pressão Arterial/instrumentação
10.
Plast Reconstr Surg ; 153(6): 1379-1386, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38810163

RESUMO

BACKGROUND: Patients are commonly monitored for hyponatremia after intracranial procedures, yet the prevalence of hyponatremia after cranial vault reconstruction (CVR) remains unclear. The purpose of this study is to define the prevalence, risk factors, and complications of hyponatremia after CVR to optimize postoperative sodium surveillance protocols. METHODS: Patients with nonsyndromic, single-suture craniosynostosis who underwent primary CVR between 2009 and 2020 at Michigan Medicine were included (n = 231). Demographic, intraoperative, and postoperative characteristics were compared by postoperative hyponatremia status at P < 0.05 significance. Hyponatremia was defined as mild (<135 mEq/L), moderate (<130 mEq/L), or severe (<125 mEq/L) based on the lowest postoperative laboratory draw. RESULTS: Twenty-three patients (10.0%) developed mild postoperative hyponatremia. No patient developed moderate or severe postoperative hyponatremia. On multivariable regression, decreased preoperative sodium level (P = 0.03) and decreased preoperative weight (P = 0.02) were significantly associated with mild postoperative hyponatremia. No patient developed complications or required hospital readmission because of hyponatremia. CONCLUSIONS: This large retrospective cohort study of patients with nonsyndromic single-suture craniosynostosis demonstrated a 10% prevalence of mild, clinically inconsequential hyponatremia and 0% prevalence of moderate or severe, clinically significant hyponatremia after primary CVR. Patients with low preoperative sodium level or weight were at increased risk for developing mild postoperative hyponatremia. The results suggest that patients with preoperative sodium greater than 140 mEq/L or preoperative weight greater than 10 kg may be candidates for limited postoperative sodium surveillance; however, future prospective studies are warranted before implementation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Craniossinostoses , Hiponatremia , Procedimentos de Cirurgia Plástica , Complicações Pós-Operatórias , Humanos , Hiponatremia/epidemiologia , Hiponatremia/etiologia , Craniossinostoses/cirurgia , Feminino , Masculino , Estudos Retrospectivos , Prevalência , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Lactente , Fatores de Risco , Michigan/epidemiologia , Crânio/cirurgia
11.
PLoS One ; 19(5): e0300005, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38753617

RESUMO

Strategies to prevent or delay Alzheimer's disease and related dementias (AD/ADRD) are urgently needed, and blood pressure (BP) management is a promising strategy. Yet the effects of different BP control strategies across the life course on AD/ADRD are unknown. Randomized trials may be infeasible due to prolonged follow-up and large sample sizes. Simulation analysis is a practical approach to estimating these effects using the best available existing data. However, existing simulation frameworks cannot estimate the effects of BP control on both dementia and cardiovascular disease. This manuscript describes the design principles, implementation details, and population-level validation of a novel population-health microsimulation framework, the MIchigan ChROnic Disease SIMulation (MICROSIM), for The Effect of Lower Blood Pressure over the Life Course on Late-life Cognition in Blacks, Hispanics, and Whites (BP-COG) study of the effect of BP levels over the life course on dementia and cardiovascular disease. MICROSIM is an agent-based Monte Carlo simulation designed using computer programming best practices. MICROSIM estimates annual vascular risk factor levels and transition probabilities in all-cause dementia, stroke, myocardial infarction, and mortality in a nationally representative sample of US adults 18+ using the National Health and Nutrition Examination Survey (NHANES). MICROSIM models changes in risk factors over time, cognition and dementia using changes from a pooled dataset of individual participant data from 6 US prospective cardiovascular cohort studies. Cardiovascular risks were estimated using a widely used risk model and BP treatment effects were derived from meta-analyses of randomized trials. MICROSIM is an extensible, open-source framework designed to estimate the population-level impact of different BP management strategies and reproduces US population-level estimates of BP and other vascular risk factors levels, their change over time, and incident all-cause dementia, stroke, myocardial infarction, and mortality.


Assuntos
Simulação por Computador , Humanos , Michigan/epidemiologia , Doença Crônica , Masculino , Demência/epidemiologia , Idoso , Feminino , Fatores de Risco , Método de Monte Carlo , Pressão Sanguínea , Pessoa de Meia-Idade , Doenças Cardiovasculares/epidemiologia , Adulto , Doença de Alzheimer , Idoso de 80 Anos ou mais
12.
AANA J ; 92(3): 173-180, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38758711

RESUMO

The second victim experience is defined as a healthcare professional who is traumatized by adverse events that have occurred to the patient, the first victim. This traumatization can cause a range of symptoms such as guilt, anxiety, disturbed sleep, and decreased job satisfaction. The purposes of this study were to understand certified registered nurse anesthetists' (CRNAs') second victim distress, perceived support, and the impact of the second victim experience on absenteeism and turnover intention. A survey was administered to CRNAs from the Michigan Association of Nurse Anesthetists, with a total of 172 responses suitable for analysis. Psychological distress was experienced by 20.3% (n = 35) of CRNAs. Additionally, 16.3% (n = 28) and 15.1% (n = 26) of CRNAs experienced physical distress and professional self-efficacy issues respectively where CRNAs doubted whether they were a good healthcare provider and questioned their professional abilities. Turnover intentions and absenteeism were also evaluated with 11.6% of CRNAs wanting to take a job outside of patient care and/or quit their job, and 13% identified that they needed a mental health day and/or time away from work after their experience. Organizations must consider offering peer support and supportive counseling for practitioners who have suffered from traumatic events and identify desired forms of support among staff.


Assuntos
Enfermeiros Anestesistas , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Inquéritos e Questionários , Michigan , Reorganização de Recursos Humanos , Satisfação no Emprego , Absenteísmo
13.
J Matern Fetal Neonatal Med ; 37(1): 2345852, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38797682

RESUMO

Objective: To investigate the relationship between preeclampsia and SARS-CoV-2 infection during pregnancy. Methods: This was a retrospective cohort study of pregnant women between March and October 2020. Pregnant patients admitted to 14 obstetrical centers in Michigan, USA formed the study population. Of the N = 1458 participants, 369 had SARS-CoV-2 infection (cases). Controls were uninfected pregnancies that were delivered in the same obstetric unit within 30 days of the index case. Robust Poisson regression was used to estimate relative risk (RR) of preterm and term preeclampsia and preeclampsia involving placental lesions. The analysis included adjustment for relevant clinical and demographic risk factors.Results: SARS-CoV-2 infection during pregnancy increased the risk of preeclampsia [adjusted aRR = 1.69 (1.26-2.26)], preeclampsia involving placental lesions [aRR = 1.97(1.14-3.4)] and preterm preeclampsia 2.48(1.48-4.17). Although the highest rate of preeclampsia was observed in patients infected with SARS-CoV-2 who were symptomatic (18.4%), there was increased risk even in asymptomatic SARS-CoV-2 infected patients (14.2%) relative to non-infected controls (8.7%) (p < 0.05). This association with symptomatology was also noted with preterm preeclampsia for which the rate doubled from 2.7% in controls to 5.2% in asymptomatic cases and reached 11.8% among symptomatic cases (p < 0.05). The rate of preterm preeclampsia among cases of pregnant people self-identified as Black reached 10.1% and was almost double the rate of the reminder of the group of infected pregnancies (5.3%), although the rate among uninfected was almost the same (2.7%) for both Black and non-Black groups (interaction p = 0.05).Conclusions: Infection with SARS-CoV-2 increases the risk of preeclampsia even in the absence of symptoms, although symptomatic persons are at even higher risk. Racial disparities in the development of preterm preeclampsia after SARS-CoV-2 infection may explain discrepancies in prematurity between different populations.


Assuntos
COVID-19 , Pré-Eclâmpsia , Complicações Infecciosas na Gravidez , SARS-CoV-2 , Humanos , Feminino , Gravidez , Pré-Eclâmpsia/epidemiologia , COVID-19/epidemiologia , COVID-19/complicações , Estudos Retrospectivos , Adulto , Complicações Infecciosas na Gravidez/epidemiologia , Michigan/epidemiologia , Fatores de Risco , Adulto Jovem , Estudos de Casos e Controles
14.
JMIR Res Protoc ; 13: e54043, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38748461

RESUMO

BACKGROUND: People with low income are disproportionately affected by type 2 diabetes (T2D), and 17.6% of US adults with T2D experience food insecurity and low diet quality. Low-carbohydrate eating plans can improve glycemic control, promote weight loss, and are associated with improved cardiometabolic health and all-cause mortality. Little is known about supporting low-carbohydrate eating for people with T2D, although food-as-medicine interventions paired with nutrition education offer a promising solution. OBJECTIVE: This program aims to support the initiation of dietary changes by using grocery delivery and low-carbohydrate education to increase the quality of low-carbohydrate nutrition among people with T2D and food insecurity. METHODS: This program was a nonrandomized pilot conducted at 21 primary care practices in Michigan. Adults with T2D and food insecurity or low income were eligible to enroll. Patients were referred by primary care clinic staff. All participants received the 3-month program, which included monthly US $80 credits for healthy foods, free grocery delivery from Shipt, and low-carbohydrate nutrition education. Food credits were restricted to the purchase of healthy foods. Education materials, developed in collaboration with providers and patients, included print, digital, interactive web, and video formats. At enrollment, participants completed a survey including demographics, diabetes health, diet and physical activity, and diabetes management and knowledge. After the 3-month program, participants completed a survey with repeat assessments of diabetes health, diet and physical activity, and diabetes management and knowledge. Perspectives on participant experience and perceived program impact, food purchasing behaviors, and use of educational materials were also collected. Diabetes health information was supplemented with data from participant medical records. We plan to perform mixed methods analysis to assess program feasibility, acceptability, and impact. Primary quality improvement (QI) measures are the number of patients referred and enrolled, use of US $80 food credits, analysis of food purchasing behavior, participant experience with the program, and program costs. Secondary QI measures include changes in hemoglobin A1c, weight, medications, self-efficacy, diabetes and carbohydrate knowledge, and activity between baseline and follow-up. RESULTS: This program started in October 2022. Data collection is expected to be concluded in June 2024. A total of 151 patients were referred to the program, and 83 (55%) were enrolled. The average age was 57 (SD 13; range 18-86) years, 72% (57/79) were female, 90% (70/78) were White, and 96% (74/77) were of non-Hispanic ethnicity. All participants successfully ordered grocery delivery during the program. CONCLUSIONS: This pilot QI program aimed to improve diet quality among people with T2D and food insecurity by using grocery delivery and low-carbohydrate nutrition education. Our findings may help inform the implementation of future QI programs and research studies on food-as-medicine interventions that include grocery delivery and education for people with T2D. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54043.


Assuntos
Diabetes Mellitus Tipo 2 , Melhoria de Qualidade , Humanos , Diabetes Mellitus Tipo 2/terapia , Projetos Piloto , Feminino , Masculino , Michigan , Adulto , Pessoa de Meia-Idade , Insegurança Alimentar , Pobreza , Educação de Pacientes como Assunto/métodos
15.
Subst Use Misuse ; 59(9): 1416-1423, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38733118

RESUMO

Background: Chronic non-cancer pain affects 20% of Americans. This is significantly impacted by the ongoing opioid crisis and reduced opioid dispensing. Public perceptions additionally shape pain management strategies. Purpose: This study explores public attitudes toward prescription opioids for chronic non-cancer pain. We aim to understand how public attitudes are influenced by the evolving opioid crisis and shifting opioid use patterns. Methods: In Michigan, 823 adults participated in a Qualtrics survey on attitudes toward nonmedical and medical prescription opioid use. Multivariable logistic regression was performed to identify factors associated with beliefs that doctors prescribe opioids for too long (Model 1) and chronic pain patients should transition to alternative treatments (Model 2). Results: About half (49.4%) of respondents believed doctors keep patients on prescription opioids for too long, while two-thirds (65.7%) agreed chronic pain patients should be tapered off medications. Knowing someone who misused opioids and perceptions of substance use (e.g. perceived risk of prescription opioid misuse, stigma toward chronic pain patients, perceived prevalence of prescription opioid misuse, and awareness of fentanyl) were associated with greater odds of believing doctors keep patients on opioids too long. Demographics (age and education), substance use histories and perceptions (e.g. perceived risk and stigma) were associated with greater odds of believing patients should be tapered off their medication. Conclusions: These findings inform strategies to correct public misperceptions, emphasizing the importance of personal experience, perceived risks, and stigmatization of chronic pain patients. This insight can guide effective pain management for those with chronic non-cancer pain.


Assuntos
Analgésicos Opioides , Dor Crônica , Humanos , Dor Crônica/tratamento farmacológico , Dor Crônica/psicologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Analgésicos Opioides/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Transtornos Relacionados ao Uso de Opioides/psicologia , Idoso , Adulto Jovem , Opinião Pública , Michigan , Uso Indevido de Medicamentos sob Prescrição/psicologia , Adolescente , Inquéritos e Questionários
16.
Pediatr Blood Cancer ; 71(7): e31048, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38693643

RESUMO

BACKGROUND AND OBJECTIVE: National guidelines recommend that children with sickle cell anemia (SCA) be seen regularly by primary care providers (PCPs) as well as hematologists to receive comprehensive, multidisciplinary care. The objective is to characterize the patterns of primary and hematology care for children with SCA in Michigan. METHODS: Using validated claims definitions, children ages 1-17 years with SCA were identified using Michigan Medicaid administrative claims from 2010 to 2018. We calculated the number of outpatient PCP and hematologist visits per person-year, as well as the proportion of children with at least one visit to a PCP, hematologist, or both a PCP and hematologist annually. Negative binomial regression was used to calculate annual rates of visits for each provider type. RESULTS: A total of 875 children contributed 2889 person-years. Of the total 22,570 outpatient visits, 52% were with a PCP and 34% with a hematologist. Annually, 87%-93% of children had a visit with a PCP, and 63%-85% had a visit with a hematologist. Approximately 66% of total person-years had both visit types within a year. The annual rate ranged from 2.3 to 2.5 for hematologist visits and from 3.7 to 4.1 for PCP visits. CONCLUSIONS: Substantial gaps exist in the receipt of annual hematology care. Given that the majority of children with SCA see a PCP annually, strategies to leverage primary care visits experienced by this population may be needed to increase receipt of SCA-specific services.


Assuntos
Anemia Falciforme , Atenção Primária à Saúde , Humanos , Anemia Falciforme/terapia , Criança , Masculino , Pré-Escolar , Feminino , Adolescente , Lactente , Atenção Primária à Saúde/estatística & dados numéricos , Estados Unidos , Michigan , Hematologia , Seguimentos , Medicaid/estatística & dados numéricos , Prognóstico
17.
Neurology ; 102(11): e209390, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38718313

RESUMO

BACKGROUND AND OBJECTIVES: Distal symmetric polyneuropathy (DSP) is a disabling, often painful condition associated with falls and reduced quality of life. Non-Hispanic Black people and people with low income are underrepresented in existing DSP studies; therefore, it is unknown whether data accurately reflect the prevalence, risk factors, and burden of disease in these populations. METHODS: Patients older than 40 years presenting to an outpatient internal medicine clinic predominantly serving Medicaid patients in Flint, Michigan, were enrolled in a cross-sectional study. Demographics, clinical characteristics, including medication use, anthropomorphic measurements, fasting lipids, and hemoglobin A1c were collected. DSP was defined using the modified Toronto Clinical Neuropathy Score (mTCNS). Multivariable logistic regression was performed to model DSP and undiagnosed DSP as a function of potential risk factors age, metabolic syndrome, and race. DSP burden was measured using Peripheral Neuropathy Quality of Life Instrument-97. RESULTS: Two hundred participants were enrolled, and 169 (85%) completed all data collection. The population was 55% female of mean age (SD) 58.2 years (10.4) and 69% non-Hispanic Black. Among the population, 50% had diabetes, 67% had metabolic syndrome, and 47% had a household income <$20,000. DSP was present in 73% of the population, of which 75% were previously undiagnosed. Neuropathic pain was documented in 57% of participants with DSP. DSP based on mTCNS criteria was associated with older age (odds ratio [OR] 1.1 [95% confidence interval (CI) 1.03-1.2]) and metabolic syndrome (OR 4.4 [1.1-18.1]). Non-Hispanic Black participants had lower odds of DSP (OR 0.1 [0.01-0.4]) than non-Hispanic White and Hispanic participants. DSP burden was high, including increased pain, health-related worry, and poorer quality of life (all p < 0.001). DISCUSSION: DSP is extremely common and often underrecognized in this predominantly non-Hispanic Black, low-income population and leads to substantial disease burden. Metabolic syndrome is a highly prevalent, modifiable risk factor in this population that should be managed to lower DSP prevalence.


Assuntos
Negro ou Afro-Americano , Pobreza , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estudos Transversais , Idoso , Qualidade de Vida , Polineuropatias/epidemiologia , Polineuropatias/etnologia , Michigan/epidemiologia , Adulto
18.
J Am Med Inform Assoc ; 31(7): 1479-1492, 2024 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-38742457

RESUMO

OBJECTIVES: To develop recommendations regarding the use of weights to reduce selection bias for commonly performed analyses using electronic health record (EHR)-linked biobank data. MATERIALS AND METHODS: We mapped diagnosis (ICD code) data to standardized phecodes from 3 EHR-linked biobanks with varying recruitment strategies: All of Us (AOU; n = 244 071), Michigan Genomics Initiative (MGI; n = 81 243), and UK Biobank (UKB; n = 401 167). Using 2019 National Health Interview Survey data, we constructed selection weights for AOU and MGI to represent the US adult population more. We used weights previously developed for UKB to represent the UKB-eligible population. We conducted 4 common analyses comparing unweighted and weighted results. RESULTS: For AOU and MGI, estimated phecode prevalences decreased after weighting (weighted-unweighted median phecode prevalence ratio [MPR]: 0.82 and 0.61), while UKB estimates increased (MPR: 1.06). Weighting minimally impacted latent phenome dimensionality estimation. Comparing weighted versus unweighted phenome-wide association study for colorectal cancer, the strongest associations remained unaltered, with considerable overlap in significant hits. Weighting affected the estimated log-odds ratio for sex and colorectal cancer to align more closely with national registry-based estimates. DISCUSSION: Weighting had a limited impact on dimensionality estimation and large-scale hypothesis testing but impacted prevalence and association estimation. When interested in estimating effect size, specific signals from untargeted association analyses should be followed up by weighted analysis. CONCLUSION: EHR-linked biobanks should report recruitment and selection mechanisms and provide selection weights with defined target populations. Researchers should consider their intended estimands, specify source and target populations, and weight EHR-linked biobank analyses accordingly.


Assuntos
Bancos de Espécimes Biológicos , Registros Eletrônicos de Saúde , Humanos , Viés de Seleção , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Registro Médico Coordenado , Estados Unidos , Idoso , Reino Unido , Michigan
19.
Circ Cardiovasc Qual Outcomes ; 17(6): e010662, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38775053

RESUMO

BACKGROUND: Patients with heart failure (HF) overestimate survival compared with model-predicted estimates, but the reasons for this discrepancy are poorly understood. We characterized how patients with end-stage HF and their care partners understand prognosis and elicited their preferences around prognosis communication. METHODS: We conducted in-depth, semistructured interviews with patients with end-stage HF and their care partners between 2021 and 2022 at a tertiary care center in Michigan. Participants were asked to describe barriers they faced to understanding prognosis. All interviews were coded and analyzed using an iterative content analysis approach. RESULTS: Fifteen patients with end-stage HF and 15 care partners participated, including 7 dyads. The median patient age was 66.5 years (range, 31-80) and included 9 of 15 (60%) White participants and 9 of 15 (60%) were males. Care partners included 10 of 15 (67%) White participants and 6 of 15 (40%) were males. Care partners were partners (n=7, 47%), siblings (n=4, 27%), parents (n=2, 13%), and children (n=2, 13%). Most patients demonstrated a poor understanding of their prognosis. In contrast, care partners commonly identified the patient's rapidly declining trajectory. Patients and care partners described ineffective prognosis communication with clinicians, common barriers to understanding prognosis, and similar suggestions on improving prognosis communication. Barriers to understanding prognosis included (1) conversation avoidance by physicians, (2) information inconsistency across different physicians, (3) distractions during prognosis communication due to emphasis on other conditions, and (4) confusion related to the use of medical jargon. Most patients and care partners wanted discussions around prognosis to begin early in the course of the disease, repeated routinely using layperson's terms, incorporating both quality of life and survival assessments, and involving care partners. Both patients and care partners did not expect precise survival estimates. CONCLUSIONS: Patients with end-stage HF demonstrate a poor understanding of their prognosis compared with their care partners. Patients and care partners are open to discussing prognosis early, using direct and patient-centered language.


Assuntos
Cuidadores , Conhecimentos, Atitudes e Prática em Saúde , Insuficiência Cardíaca , Entrevistas como Assunto , Preferência do Paciente , Humanos , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/psicologia , Insuficiência Cardíaca/fisiopatologia , Masculino , Feminino , Idoso , Prognóstico , Pessoa de Meia-Idade , Adulto , Idoso de 80 Anos ou mais , Michigan , Cuidadores/psicologia , Comunicação , Compreensão , Pesquisa Qualitativa , Letramento em Saúde , Relações Médico-Paciente
20.
Circ Cardiovasc Qual Outcomes ; 17(6): e010288, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38813695

RESUMO

BACKGROUND: The large and increasing number of adults living with dementia is a pressing societal priority, which may be partially mitigated through improved population-level blood pressure (BP) control. We explored how tighter population-level BP control affects the incidence of atherosclerotic cardiovascular disease (ASCVD) events and dementia. METHODS: Using an open-source ASCVD and dementia simulation analysis platform, the Michigan Chronic Disease Simulation Model, we evaluated how optimal implementation of 2 BP treatments based on the Eighth Joint National Committee recommendations and SPRINT (Systolic Blood Pressure Intervention Trial) protocol would influence population-level ASCVD events, global cognitive performance, and all-cause dementia. We simulated 3 populations (usual care, Eighth Joint National Committee based, SPRINT based) using nationally representative data to annually update risk factors and assign ASCVD events, global cognitive performance scores, and dementia, applying different BP treatments in each population. We tabulated total ASCVD events, global cognitive performance, all-cause dementia, optimal brain health, and years lived in each state per population. RESULTS: Optimal implementation of SPRINT-based BP treatment strategy, compared with usual care, reduced ASCVD events in the United States by ≈77 000 per year and produced 0.4 more years of stroke- or myocardial infarction-free survival when averaged across all Americans. Population-level gains in years lived free of ASCVD events were greater for SPRINT-based than Eighth Joint National Committee-based treatment. Survival and years spent with optimal brain health improved with optimal SPRINT-based BP treatment implementation versus usual care: the average patient with hypertension lived 0.19 additional years and 0.3 additional years in optimal brain health. SPRINT-based BP treatment increased the number of years lived without dementia (by an average of 0.13 years/person with hypertension), but increased the total number of individuals with dementia, mainly through more adults surviving to advanced ages. CONCLUSIONS: Tighter BP control likely benefits most individuals but is unlikely to reduce dementia prevalence and might even increase the number of older adults living with dementia.


Assuntos
Anti-Hipertensivos , Pressão Sanguínea , Cognição , Demência , Hipertensão , Humanos , Cognição/efeitos dos fármacos , Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Hipertensão/mortalidade , Pressão Sanguínea/efeitos dos fármacos , Idoso , Masculino , Demência/epidemiologia , Demência/diagnóstico , Demência/mortalidade , Feminino , Resultado do Tratamento , Pessoa de Meia-Idade , Fatores de Risco , Medição de Risco , Incidência , Fatores de Tempo , Idoso de 80 Anos ou mais , Michigan/epidemiologia , Simulação por Computador , Aterosclerose/epidemiologia , Aterosclerose/diagnóstico , Aterosclerose/tratamento farmacológico , Estados Unidos/epidemiologia
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