Telehealth Coverage for a Pediatric Gastroenterology Consult Service at a Regional Hospital: An Accepted, Useful, and Sustainable Model of Care.

OBJECTIVE: To evaluate a novel telehealth inpatient pediatric gastroenterology (GI) consult service at a regional children's hospital in regard to acceptance, utility, quality, sustainability, and provider resiliency. STUDY DESIGN: Patients requiring GI care at a regional children's hospital between July 2020 and June 2021 were treated by an in-person or telehealth physician with physician assistant support, randomly assigned based on a weekly preset staffing schedule. A retrospective, multidomain program evaluation was performed based on the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) and STEM (SPROUT Telehealth Evaluation and Management) frameworks, using statistical analysis to compare the patient cohorts and anonymous surveys to assess provider perceptions. RESULTS: In total, 1051 patient-days of GI care were provided for 348 patients, 17% by telehealth and 83% in-person. There were no significant differences in diagnosis, transfer, or readmission rates between the cohorts. No transfers occurred for reasons other than need to access specialized services not available at the regional hospital. Daily consult workload was slightly greater for telehealth physicians. Primary and consult team providers accepted the practice. The model continued beyond the first year. In total, 75% of local GI physicians reported greater Brief Resilience Scores in the context of shifting 20% of their inpatient call weeks to another campus's physicians. CONCLUSION: Episodic pediatric GI consult service coverage via telehealth at a regional hospital was well accepted, useful, and sustainable, with improved physician resilience and no adverse outcomes seen. Telehealth holds promise for leveraging pediatric subspecialty physicians across hospitals, allowing complex patients to be admitted closer to home while reducing inpatient coverage requirements for smaller physician groups.

Health care in pregnancy during the COVID-19 pandemic and pregnancy outcomes in six low- and-middle-income countries: Evidence from a prospective, observational registry of the Global Network for Women's and Children's Health.

OBJECTIVE: To assess, on a population basis, the medical care for pregnant women in specific geographic regions of six countries before and during the first year of the coronavirus disease 2019 (COVID-19) pandemic in relationship to pregnancy outcomes. DESIGN: Prospective, population-based study. SETTING: Communities in Kenya, Zambia, the Democratic Republic of the Congo, Pakistan, India and Guatemala. POPULATION: Pregnant women enrolled in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry. METHODS: Pregnancy/delivery care services and pregnancy outcomes in the pre-COVID-19 time-period (March 2019-February 2020) were compared with the COVID-19 time-period (March 2020-February 2021). MAIN OUTCOME MEASURES: Stillbirth, neonatal mortality, preterm birth, low birthweight and maternal mortality. RESULTS: Across all sites, a small but statistically significant increase in home births occurred between the pre-COVID-19 and COVID-19 periods (18.9% versus 20.3%, adjusted relative risk [aRR] 1.12, 95% CI 1.05-1.19). A small but significant decrease in the mean number of antenatal care visits (from 4.1 to 4.0, p = <0.0001) was seen during the COVID-19 period. Of outcomes evaluated, overall, a small but significant decrease in low-birthweight infants in the COVID-19 period occurred (15.7% versus 14.6%, aRR 0.94, 95% CI 0.89-0.99), but we did not observe any significant differences in other outcomes. There was no change observed in maternal mortality or antenatal haemorrhage overall or at any of the sites. CONCLUSIONS: Small but significant increases in home births and decreases in the antenatal care services were observed during the initial COVID-19 period; however, there was not an increase in the stillbirth, neonatal mortality, maternal mortality, low birthweight, or preterm birth rates during the COVID-19 period compared with the previous year. Further research should help to elucidate the relationship between access to and use of pregnancy-related medical services and birth outcomes over an extended period.

Long-term effects of a community-based positive youth development program for Black youth: health, education, and financial well-being in adulthood.

BACKGROUND: Childhood poverty is known to be associated with poor health. For youth living in extreme poverty, community-based programs focused on youth development are one strategy to improve health and well-being outcomes. However, very few evaluations of the long-term effectiveness of youth development programs have been conducted. The aim of this study was to assess the long-term effectiveness of a positive youth development program (PYD), serving a segregated housing project with a history of community violence, to improve the health, education, and financial well-being of its alumni. METHODS: A quasi-experimental causal comparative study design was used to study the effectiveness of the Cabrini-Green Youth Program (CGYP). CGYP alumni (mean: 16.8 +/- 7.4 years after program participation) were surveyed. For comparison, participants from the same housing project who were eligible to participate in the CGYP but did not, were identified. RESULTS: In total, 246/417 (59%) eligible alumni were located. 221 alumni were available to be interviewed; 191/221 (86%) completed the interview survey along with 143 in the comparison group. Both groups self-identified as being Black, African American, and of Other race. Alumni were younger (34.6 vs. 38.1 years, p < .001), less likely to be female (62% vs. 74%, p =.03), and more likely to have been abused as a child (26% vs. 11%, p = .001). The majority in both groups reported to be in good to excellent health (83% of alumni vs. 74% of comparison group). After adjusting for comparison group differences, alumni were more likely to have completed college, 24% vs. 12% (adjusted odds ratio (aOR) 2.47, 95% CI, 1.25-4.86), and to end up with some money at the end of the month, 35% vs. 19% (aOR 2.16, 95% CI, 1.17, 3.97). CONCLUSIONS: Participation in a PYD program starting at a young age may be associated with reduced poverty in adulthood, possibly aided by higher educational attainment and resultant increased income. PYD may be an effective strategy to supplement evidenced-based poverty reducing policies. This study of a voluntary, community-based PYD program is unique in its up to 33-year follow-up and an outcome assessment that measures more than knowledge change.

Eviction and Pediatric Health Outcomes in Chicago.

According to Eviction Lab there were 6877 evictions in Chicago in 2016. The rate was "1.1%" and came out to 18.79 evictions per day in Chicago in 2016. The presence of children in a household (HH) poses a greater risk for eviction than race or gender. Census tract-level data from the Chicago Department of Public Health, the Eviction Lab and American Community Survey was used to assess the relationship between eviction and pediatric health outcomes for 653 census tracts in Chicago. Correlation matrices and linear regression models were used to evaluate the relationship between eviction and health outcomes. Regression models were adjusted for the following: (1) female-led family HH with less than a high school degree and below poverty and (2) race/ethnicity. Compared to White Non-Hispanic HH, predominantly Black and Hispanic HH had higher rates of very low birth weight (VLBW), infant mortality (IM), eviction filings, and evictions. All covariates were found to be significantly correlated (p < 0.01). Eviction filing rates and eviction rates were significant predictors for both VLBW and IM in both unadjusted and adjusted models (p < 0.05). Though we cannot conclude causality, these results suggest that census tracts which experience high rates of eviction also experience high rates of VLBW and IM and this relationship should be further investigated.

Promoting Safe Firearm Storage in an Urban Neighborhood: The Views of Parents Concerning the Role of Health Care Providers.

Pediatric clinics are uniquely positioned to assess and advocate for the health and safety of Chicago's children in relation to accidental firearm-related injury and death. The best means of counseling families should be tailored to the individual community and patient population. We aimed to determine rates of firearm ownership and attitudes towards counseling about firearms in a community on the west side of Chicago with high rates of gun violence. An anonymous survey about gun ownership was administered at a federally qualified health center. The survey was completed by 206 adults with children less than 18 living in the home. A minority of participants (8.3%; n = 17) indicated that a gun was kept in or around the home. The majority of firearm owners reported using safe storage practices. However, just over half of the gun owners and non-gun owners had a favorable opinion of counseling about firearm safety in healthcare settings. Other strategies in addition to physician counseling will be required to promote safe firearm storage in this neighborhood with high rates of community violence.

Assessing Strengths, Challenges, and Equity Via Pragmatic Evaluation of a Social Care Program.

OBJECTIVE: Models of pragmatic social care program evaluations are needed as many are clinical services programs and are not focused on research, limiting the ability to address key evidence gaps. We describe the use of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to conduct a pragmatic evaluation of a pediatric ambulatory social care program. METHODS: Our evaluation was based on automated electronic health record data on clinics, community partners, social care program processes, and social needs screen data linked to patient sociodemographic characteristics from February 2020 to September 2021. Two Reach outcomes were assessed: 1) the proportion of eligible patients that completed social needs screening and 2) the proportion of positive screens that receive social care program follow-up. The Effectiveness outcome was meeting families' resource need(s). RESULTS: Reach among eligible patients who completed screening was 79.2%. Reach for positive screens receiving social care program referrals demonstrated a higher proportion of referrals among patients with a preferred healthcare language (PHL) of Spanish (45.1%) compared to English (31.2%, P < .001). Effectiveness analyses demonstrated that overall, 75.1% of social care program referrals had all social resource needs met, 17.5% had some needs met, and 7.4% had no needs met. The percent of patients with all resource needs met was higher for patients with PHL of Spanish or Non-English, Non-Spanish (79% for each respectively) compared to English (73%, P = .023). CONCLUSIONS: Maximizing automated data collection is likely the most feasible way for social care programs to complete evaluation activities outside of the research context.

Evaluating the effect of maternal non-communicable disease on adverse pregnancy outcomes and birthweight in Pakistan, a facility based retrospective cohort study.

Non-communicable diseases (NCDs) claim 74% of global lives, disproportionately affecting lower and middle-income countries like Pakistan. NCDs may increase the risk of preterm birth (PTB), caesarean section (CS), and low birthweight. This study aims to determine whether the high prevalence of NCDs in Pakistan play a role in the high rates of preterm births, and CS. This retrospective cohort study from Aga Khan University Hospital, Pakistan, investigated effects of pre-existing NCDs on pregnancy outcomes of 817 pregnant women. Medical records were used to generate odds ratios for the risk of PTB, labour outcome and birthweight in women with type 1 and type 2 diabetes, hypertension, asthma and thyroid disorders. Multinomial logistic regression and general linear models were used to adjust for confounding variables using IBM SPSS Statistics (v27). Type 2 diabetes significantly increased the risk of PTB and elective CS (both P < 0.05). Elective CS was significantly increased by hypertension and asthma (both, P < 0.05). Surprisingly, asthma halved the risk of PTB (P < 0.05), while type 1 diabetes significantly increased birthweight from 2832 to 3253g (P < 0.001). In conclusion, pre-existing NCDs increase the risk of negative pregnancy outcomes, including PTB, elective CS and birthweight. Asthma, however reduced PTB and justifies further investigation.

Childhood Protective Factors and Future Adult Health Outcomes in an Urban Environment.

Purpose: To evaluate protective factors that help individuals overcome adverse health outcomes associated with childhood trauma in an urban environment. Methods: This retrospective cohort study included adults born between 1970 and 1995 who grew up in the former Cabrini-Green Homes, a low-income, Chicago public housing development. Participants completed surveys asking about general health, smoking, and mental health status. Surveys included questions related to neighborhood and family support, community safety, and childhood youth program participation. Simple regression models were performed to compare childhood exposure of adverse and protective factors to adult health outcomes. Multivariable logistic regression models were constructed to adjust for age, sex, and educational attainment. Results: 334 former residents completed the survey, and only those that reported an adversity score ≥ 2 were included in the analysis (n = 248). For those individuals who reported that their families cared for them as children, they described feeling hopeful about the future (OR 2.77, 95% CI, 1.28-6.00, aOR 2.63, 95% CI, 1.21-5.75) and reported decreased smoking rates as adults (OR 0.30, 95% CI, 0.14-0.66, aOR 0.35, 95% CI, 0.16-0.78). Better self-reported adult health status was associated with residents who believed the neighborhood looked out for one another (OR 2.31, 95% CI, 1.21-4.42, aOR 2.01, 95% CI, 1.02-3.95). Conclusion: These findings suggest that a caring family and neighborhood connectedness are protective in mitigating childhood adversity. Devoting resources to strengthen families and communities is a promising strategy to promote healthier adult behaviors.

Unhealthy behaviours in urban Illinois communities affected by eviction: A descriptive analysis.

Eviction of renter-occupied homes is an emerging public health crisis adversely impacting populations already at risk. Although housing quality and home-owner foreclosures have been linked to health outcomes, the relationship between eviction of renter-occupied homes and health has not been well established. The demographics and socioeconomic status of renters differs from homeowners, as such any relationship with health outcomes should be distinguished between the two. The aim of this study is to provide a descriptive analysis of the relationship between renter-specific eviction and unhealthy behaviours at the census tract level. Using data from the Centers for Disease Control and Prevention 500 Cities Project, the Eviction Lab and the U.S. Census Bureau, this study assesses the relationship between eviction rates and health indicators for 1,267 urban census tracts in Illinois in 2016. Binge drinking, current smoking, no leisure-time physical activity, obesity and sleeping <7 hr were used as indicators of unhealthy behaviour as categorised by the Centers for Disease Control and Prevention500 Cities Project. Unadjusted and adjusted linear regression models were used to assess and describe the relationship between each of the dependent variables and each of the independent variables. All five of the unhealthy behaviour indicators were found to be significantly associated with eviction rates and eviction filing rates after adjustment for confounding variables. This study contributes to the understudied area of research focused on how eviction rates contribute to the social determinants of health for already at-risk populations.

Educational Attainment of Male Homicide Victims Aged 18 to 24 Years in Chicago: 2006 to 2015.

Homicide is a preventable public health issue that has detrimental effects on both victims and witnesses and increases health care costs. From 2006 to 2015, homicide has been the second leading cause of death for youth aged 15 to 24 years in the United States. Educational attainment has been widely regarded as a protective factor against justice system involvement and violent injury. We conducted a time-trend analysis examining educational attainment levels for male victims of homicide aged 18 to 24 years in the City of Chicago, 2006 to 2015, to describe the educational attainment of youth homicide victims in Chicago. We used data from the Illinois Violent Death Reporting System and the United States Census Bureau from 2006 to 2015. Cases included male victims of homicide, 18 to 24 years of age, the injury leading to death occurred in the City of Chicago, injury leading to death occurred between 2006 and 2015, and whether or not a high school degree or equivalent had been obtained. Data were described over time using percentages and rates per 100,000 with 95% confidence intervals. Chicago male homicide victims aged 18 to 24 years were less likely to have at least a high school degree than the general population of males aged 18 to 24 years in Chicago. The homicide rate for males aged 18 to 24 years without a high school degree was significantly higher than those with a high school degree or equivalent for every time point, except 2007, and also in four of the seven Chicago Planning Regions when compared with the other three. We found there is a concentrated risk pool for undereducated male youth in Chicago.

Factors associated with intimate partner homicide in Illinois, 2005-2010: Findings from the Illinois Violent Death Reporting System.

BACKGROUND: Critical elements in intimate partner homicides (IPH) often go undocumented. Previous studies have highlighted precipitating causes, but few have examined the place of injury that led to the victim's death. We sought to describe IPH cases in Illinois and in particular to examine factors surrounding the location of injury that led to the victim's death. METHODS: We analyzed data collected in the Illinois Violent Death Reporting System to assess victim demographics, perpetrator characteristics, the victim/perpetrator relationship, and circumstances surrounding the location of injury that led to the victim's death. RESULTS: From 2005 to 2010, 275 cases were identified as IPH. Women comprised 60.4% of victims and men 39.6%. Among perpetrators, 78.5% were identified as male and 21.5% as female. Of the 31 corollary victims, 54.8% were less than 18 years and 58.1% were injured in front of a family member. Females were 1.6 times more likely to have the injury that led to their death occur at their residence, as compared to males (OR 1.6, 95% CI 1.1-2.9). Cases in which the perpetrator had documented history of abuse were 2.4 times more likely to have the fatal injury occur at the victim's residence compared to those that did not have previous history (OR 2.4, 95% CI 1.2-4.8). IPH cases in which the perpetrator was the current partner of the victim were twice as likely to have the injury leading to the victim's death occur at the victim's residence compared to those perpetrators who were not a current partner (OR 2.1, 95% CI 1.2-3.5). CONCLUSIONS: Considering the increased risk of IPH occurring at the place of residence for women at the hands of current intimate partners and by perpetrators with a previous history of abuse, prevention efforts may wish to prioritize in-home and relocation intervention strategies. LEVEL OF EVIDENCE: Epidemiologic, level IV.

Prevalence of chronic complication among type 2 diabetics attending primary health care centers of Al Ahsa district of Saudi Arabia: a cross sectional survey.

BACKGROUND: The morbidity and mortality related to diabetes is a great global concern. The knowledge of chronic complications of diabetes and associated co morbidity factors is very important for formulating the necessary policies and action plan. AIMS: To determine the prevalence of chronic complications and comorbidity among the type 2 diabetics attending the primary health care centers of Al Ahsa district of Saudi Arabia. MATERIAL & METHODS: This cross sectional retrospective survey was carried out on 506 type 2 diabetic patients attending the different primary health care centers of ministry of health, Al Ahsa. Data regarding the co morbidity factors and chronic complications were recorded from the health records of the selected diabetic patients. Data analysis was done by SPSS version 16. A p < 0.05 was considered significant for all statistical calculations. RESULTS: Overall 72.72% (95% CI 69.78-74.45) of the study subjects were suffering from one or more complications of diabetic mellitus. Among them 33.39% (165) were suffering from single, 25.29% (128) with two and 15% (75) from more than two complications. The overall prevalence of complication among the female subjects was significantly higher than the male (78.16%, 95% CI 76.76-84.40 Vs 65.76%, 95% CI 61.63-69.89, p=.038). The chronic complication was higher among the urban population than the rural population (77.3% 95% CI 72.88-80.26 Vs 69.78% 95% CI 66.1%-76.92%, p=.035). CONCLUSION: The result showed a high percentage of chronic complications among the diabetic patients of this region. The high percentage of obesity, hypertension and dyslipidaemia among them are important co morbidity factors which if not controlled can cause further increase in the number of chronic complications.