Comparison of Community-Level and Patient-Level Social Risk Data in a Network of Community Health Centers

“no clear standard has emerged on how to implement social risk screening, nor how clinicians can or should use social risk information to adjust patient care or make referrals to community resources. Moreover, some have questioned the benefit of integrating social risk screening into primary care, raising concerns about the additional burden of adding more required data collection to already busy primary care practices and the limited resources available to address identified social risk factors. [..] relying solely on community-level data to understand the social context of an individual patient and/or to guide patient-level interventions poses a risk of ecological … Read More

Where Health Improvement Lags in Recent Decades—Pain and Mental Health

“The health of the US population has improved enormously in many areas but been stagnant in others. The biggest success may have been improvements for people with cardiovascular disease. Major cardiovascular events are declining in incidence, and cardiovascular disease risk factors are better controlled than they used to be. There are many elements behind this good news, the 2 most important being pharmaceuticals to treat cardiovascular disease and public health efforts to reduce smoking. Other areas of health in which there have been major improvements include lung cancer (associated with reduced smoking), breast cancer (stemming from improved treatment), and colorectal … Read More

No-Fault Compensation for Vaccine Injury — The Other Side of Equitable Access to Covid-19 Vaccines

“Wealthy governments that have invested in vaccine candidates have made bilateral agreements with developers that could result in vaccine doses being reserved for the highest-income countries — a phenomenon known as “vaccine nationalism” — potentially leaving people in poor countries vulnerable to Covid-19. The response to vaccine nationalism has been the creation of the COVAX Facility, an international partnership that aims to financially support leading vaccine candidates and ensure access to vaccines for lower-income countries. Seventy-nine higher-income countries are COVAX members. Their governments will help support 92 countries that couldn’t otherwise afford Covid-19 vaccines. [..] Equally important is offering companies … Read More

Constructing the Modern American Midwife: White Supremacy and White Feminism Collide

“US exceptionalism in maternity care is marked by the lack of midwives as primary providers. Out of 100 births, only 10 to 12 will be attended by a midwife – and 9 out of 10 of these midwives are white. Yet globally, most childbearing women are attended to by midwives, only turning to an obstetrician if serious complications arise. According to WHO and The Lancet, midwives could help avert roughly two-thirds of all maternal and newborn deaths, while providing 87% of all essential sexual, reproductive, and maternal health services. Midwifery is one of the most ancient of traditions and professions … Read More

Effective interventions for potentially modifiable risk factors for late-onset dementia: a costs and cost-effectiveness modelling study

“[Abstract methods] we searched PubMed and Web of Science from inception to March 12, 2020, and included interventions that: successfully targeted any of nine prespecified potentially modifiable risk factors (hypertension, diabetes, hearing loss, obesity, physical inactivity, social isolation, depression, cigarette smoking, and less childhood education); had robust evidence that the intervention improved risk or risk behaviour; and are feasible to enact in an adult population. We established when in the life course each intervention would be delivered. We calculated dementia incidence reduction from annual incidence of dementia in people with each risk factor, and population attributable fraction for each risk, … Read More

Evaluation of Risk-Adjusted Home Time After Hospitalization for Heart Failure as a Potential Hospital Performance Metric

“Although the implementation of HRRP [Hospital Readmission Reduction Program] has been associated with significant reductions in readmission rates for HF [heart failure], it remains unclear whether current health policies have contributed to improvement in patients’ overall experience or quality of life. Although there has been an increasing emphasis on use of patient-oriented outcomes in evaluation of therapeutic benefits of newer HF therapies in clinical trials, the role of patient-oriented outcomes in defining hospital-level care quality for patients with HF is limited. [..] we assessed home time after hospitalization for HF through Medicare administrative claims data and its association with currently … Read More

Reducing Common Mental Disorder Prevalence in Populations

“The burden of common mental disorders (CMDs), including major depressive and anxiety disorders, is substantial. CMDs contribute to lowered work productivity, family dysfunction, substance misuse, suicide, and reduced life expectancy. The point prevalence of CMDs has been stable since the 1980s, although expenditures on mental health care and drug therapy have increased dramatically. Given failure of increased treatment to lower CMD prevalence, some have called for reconceptualizing the diagnosis of CMDs and investing in new research to improve treatment. [..] We need to consider organizational reforms in treatment delivery for the subset of patients at highest risk of relapse and … Read More

Coronary Artery Calcium for Personalized Risk Management—A Second Chance for Aspirin in Primary Prevention?

“Over the last 2 years, use of low-dose aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) has become one of the most debated topics in cardiology. Initial trials conducted between the 1980s and early 2000s suggested a significant benefit in a primary prevention population at high risk. However, with expanded use of statins and declining ASCVD rates in Western countries in the last 2 decades, the benefit of prophylactic aspirin became progressively less certain among individuals without established ASCVD. Three trials published in 2018 found no benefit or modest benefit with aspirin and raised concerns about the potential … Read More

Age and environment-related differences in gait in healthy adults using wearables

“[Abstract] Many traditional assessments of physical function utilized in clinical trials are limited because they are episodic, therefore, cannot capture the day-to-day temporal fluctuations and longitudinal changes in activity that individuals experience. In order to understand the sensitivity of gait speed as a potential endpoint for clinical trials, we investigated the use of digital devices during traditional clinical assessments and in real-world environments in a group of healthy younger (n = 33, 18–40 years) and older (n = 32, 65–85 years) adults. We observed good agreement between gait speed estimated using a lumbar-mounted accelerometer and gold standard system during the performance of traditional gait … Read More

Active monitoring, radical prostatectomy and radical radiotherapy in PSA-detected clinically localised prostate cancer: the ProtecT three-arm RCT

“[Abstract] Objectives: To evaluate the effectiveness of conventional treatments for localised prostate cancer (active monitoring, radical prostatectomy and radical radiotherapy) in men aged 50–69 years. Design: A prospective, multicentre prostate-specific antigen testing programme followed by a randomised trial of treatment, with a comprehensive cohort follow-up. Setting: Prostate-specific antigen testing in primary care and treatment in nine urology departments in the UK. Participants: Between 2001 and 2009, 228,966 men aged 50–69 years received an invitation to attend an appointment for information about the Prostate testing for cancer and Treatment (ProtecT) study and a prostate-specific antigen test; 82,429 men were tested, 2664 … Read More