Scientific advances in health care have been disproportionately distributed across social strata. Disease burden is also disproportionately distributed, with marginalized groups having the highest ...risk of poor health outcomes. Social determinants are thought to influence health care delivery and the management of chronic diseases among marginalized groups, but the current conceptualization of social determinants lacks a critical focus on the experiences of people within their environment. The purpose of this article was to integrate the literature on marginalization and situate the concept in the framework of social determinants of health. We demonstrate that social position links marginalization and social determinants of health. This perspective provides a critical lens to assess the societal power dynamics that influence the construction of the socio‐environmental factors affecting health. Linking marginalization with social determinants of health can improve our understanding of the inequities in health care delivery and the disparities in chronic disease burden among vulnerable groups.
We conducted a scoping review to assess barriers to and facilitators of integrating HIV preexposure prophylaxis (PrEP) and family planning (FP) at the patient, provider, and implementation levels, ...and to identify gaps in knowledge.
We conducted a search of five bibliographic databases from database inception to March 2022: PubMed, CINAHL, Embase, Web of Science and Scopus. Two reviewers screened abstracts and full texts to determine eligibility based on a priori inclusion and exclusion criteria. We categorized studies by their relevance to patient, provider, and implementation barriers, and extracted data based on prespecified elements.
Our initial search strategy yielded 1151 results, and 34 publications were included. Barriers to PrEP implementation in family planning settings included low PrEP knowledge among patients, hesitance to take PrEP due to perceived stigma, decreased willingness of providers unfamiliar with PrEP to prescribe PrEP, and limited financial and staffing resources that make prescribing and monitoring PrEP difficult. Facilitators included robust training for providers, stigma reduction efforts, leadership engagement, and increased resources specifically in settings with processes in place that ease the process of prescribing and monitoring PrEP.
Advances in implementation strategy development, stigma reduction, and drug development will be essential to reinforcing PrEP care in family planning settings and thereby reducing the incidence of HIV in women through highly effective pharmacologic HIV prevention methods.
Developed countries, such as the USA, have achieved significant decreases in cervical cancer burden since the introduction of Pap smear-based programs in the 1960s. Due to implementation barriers and ...limited resources, many countries in sub-Saharan Africa (SSA) have been unable to attain such reductions. The purpose of this review is to evaluate implementation strategies used to improve the uptake and sustainability of cervical cancer prevention programs in SSA.
A reviewer (LJ) independently searched PubMed, Ovid/MEDLINE, Scopus, and Web of Science databases for relevant articles with the following search limits: English language, peer reviewed, and published between 1996 and 2017. The 4575 search results were screened for eligibility (CJ, LJ) to identify original research that empirically evaluated or tested implementation strategies to improve cervical cancer prevention in SSA. Fifty-three articles met criteria for inclusion in the final review. AA, CJ, and LJ abstracted the included articles for implementation-related content and evaluated them for risk of bias according to study design with the National Heart, Lung, and Blood Institute's (NHLBI) Quality Assessment Tools. Results were reported according to PRISMA guidelines.
The 53 included studies are well represented among all sub-Saharan regions: South (n = 16, 30.2%), West (n = 16, 30.2%), East (n = 14, 26.4%), and Middle (n = 7, 13.2%). There are 34 cross-sectional studies (64.2%), 10 pre-posttests (18.9%), 8 randomized control trials (15.1%), and one nonrandomized control trial (1.9%). Most studies are "fair" quality (n = 22, 41.5%). Visual inspection with acetic acid (VIA) (n = 19, 35.8%) was used as the main prevention method more frequently than HPV DNA/mRNA testing (n = 15, 28.3%), Pap smear (n = 13, 24.5%), and HPV vaccine (n = 9, 17.0%). Effectiveness of strategies to improve program implementation was measured using implementation outcomes of penetration (n = 33, 62.3%), acceptability (n = 15, 28.3%), fidelity (n = 14, 26.4%), feasibility (n = 8, 15.1%), adoption (n = 6, 11.3%), sustainability (n = 2, 3.8%), and cost (n = 1, 1.9%). Education strategies (n = 38, 71.7%) were used most often but have shown limited effectiveness.
This systematic review highlights the need to diversify strategies that are used to improve implementation for cervical cancer prevention programs. While education is important, implementation science literature reveals that education is not as effective in generating change. There is a need for additional organizational support to further incentivize and sustain improvements in implementation.
Intimate partner violence (IPV), the physical, sexual, psychological abuse or control by a former or current intimate partner, affects almost one-third of women in the United States. IPV exposure can ...result in many negative outcomes including physical injury, increased stress, and depression. Currently, there is a small, but, growing body of literature examining the link between IPV victimization and increased cardiovascular disease (CVD) risk among young adult women. To better prevent this negative outcome, it is imperative to understand what factors associated with IPV victimization may be increasing this risk. A secondary analysis of Wave IV of the Add Health study was conducted to examine possible factors mediating past year IPV exposure and 30-year CVD risk score including perceived stress, depressive symptoms, and alcohol dependence among a representative sample of young adult women in the United States. Multiple mediation analyses were run to examine the possible mediating factors in the relationship between IPV and CVD risk. In a multiple mediation model, the indirect effect of perceived stress became insignificant when depressive symptoms were introduced. The findings of this study reveal that 30-year CVD risk in the context of IPV victimization should continue to be examined among this population. The mediation models suggested the importance of stress and depression in the context of IPV and heart health. Screening for depression among women exposed to IPV should be considered as an important intervention point, not only to mitigate mental health issues, but to also help prevent the development of cardiovascular disease.
•Stress and depression may mediate the relationship between intimate partner violence and 30-year CVD risk.•Depression may have a more direct effect on 30-year CVD risk than stress in a multiple mediation model.•Screening for depression among those who experience IPV may be an important intervention point in CVD prevention.
Intimate partner violence (IPV), the physical, sexual, psychological abuse or control by a former or current intimate partner, affects almost one third of women in the United States. IPV exposure can ...result in many negative outcomes including physical injury, increased stress, and depression. Currently, there is a growing body of literature examining the link between IPV victimization and poor heart health. However, there is little known on how IPV affects cardiovascular disease (CVD) risk among young adult women and what outcomes associated with IPV victimization may be increasing this risk. A secondary analysis of the National Longitudinal Study of Adolescent to Adult Health (Add Health) was conducted to examine the association between past-year IPV exposure and 30-year CVD risk score among a representative sample of young adult women in the United States. Regression analyses were run to examine the relationship between IPV and 30-year CVD risk score. The results of the bivariate analyses suggested that past-year IPV exposure may have a small but significant impact on 30-year CVD risk score; however, this finding becomes insignificant when important covariates are introduced into the model highlighting the complexity of IPV and its co-occurring phenomenon. The findings of this study reveal that 30-year CVD risk in the context of IPV victimization should continue to be examined in this population as CVD risk may continue to grow as one experiences IPV. Future research should examine possible mediating factors in this relationship as well as biological markers that may help better understand this relationship.
Student Run Clinics (SRCs) are a common aspect of medical education, present at more than half of US medical schools, and noted for providing care to communities that might otherwise lack access, ...including the uninsured and underinsured. To date, few studies have rigorously quantified the health and economic benefits of SRCs, and the present study remedies that.
We used Monte Carlo simulations to estimate the health impact of common preventive health interventions applied to individuals in quality-adjusted life-years (QALYs). We then used those measurements to estimate the health and economic impact of United Community Clinic (UCC), a student-run clinic in Philadelphia, PA. We found that with an annual operating budget of $50,000, UCC saves 6.5 QALYs, corresponding to over $850,000 saved.
Using Monte Carlo simulation methods, the health and economic impact of SRCs can be reasonably estimated to demonstrate the utility of SRCs and justify their growing importance in the healthcare delivery landscape of the US.
Chronic illnesses cause significant mortality in adults. Caregivers (spouses, adult children, friends) support adults with chronic illness in multiple ways, for instance through support of their ...autonomous decisions about how and why to engage in self‐care.
Aim
To examine interventions designed to improve the health and well‐being of adults with chronic illness by enhancing the autonomy supportive behaviours of caregivers.
Design
Systematic review of randomized controlled trials with narrative synthesis.
Data sources
All available dates of publication through August 2020 conducted in PubMed, Medline, Ageline, PsychInfo, and CINAHL.
Methods
Randomized controlled interventions of adults with chronic illness and their caregivers with content to enhance caregiver autonomy support were included. Interventions involving healthcare personnel, adults without self‐care capacity, or not published in English were excluded. Quality was appraised using Joanna Briggs Institute recommendations. Common themes in autonomy support and associated outcomes (e.g., self‐care, social support) were synthesized.
Results
Search identified 1,426 studies with 16 included in review (N = 2,486 dyads). Methodological quality was moderate. Successful interventions were skills‐based, targeted various communication styles, contained in‐person elements, and involved nurses. Half of the interventions assessed autonomy support outcomes; 63% (5 of 8) of these improved autonomy support. Results were generally positive for social support, mixed for self‐care, and null for caregiver burden. Heterogeneity and complexity of studies limited attribution of effects.
Conclusion
Behavioural interventions designed to enhance dyadic caregiver interpersonal communication to be autonomy supportive may positively influence caregiver skills and chronic illness outcomes. Future studies of autonomy support are needed to identify core intervention components.
Impact
This is the first systematic review examining interventions promoting caregiver to care‐receiver autonomy support. Modifying interpersonal communication to be autonomy supportive has potential to improve chronic illness outcomes. Findings can inform how clinicians and investigators enlist caregiver autonomy support to encourage behaviour change.
摘要
慢性病导致成年人死亡率显著增加。照料人员 (配偶、成年子女、朋友) 以多种方式支持患有慢性病的成年人, 例如支持他们自主决定如何进行自我照顾以及自我照顾的原因。
目的
研究旨在通过加强照料人员自主支持行为来改善患有慢性病的成年人的健康福祉的干预措施。
设计
随机对照试验的系统化评估和叙述性综合。
数据来源
截至2020年8月在PubMed、Medline、Ageline、PsychInfo和CINAHL发布的所有出版物的可用日期。
方法
纳入了对患有慢性病的成年人及其照料人员的随机对照干预 (干预旨在加强照料人员自主性支持) 。排除了涉及医疗服务提供者、无自理能力的成人或未用英文发表的干预。采用乔安娜·布里格斯研究所的建议, 对质量进行评估。综合了自主性支持和相关结果 (如自我照顾、社会支持) 的共同主题。
结果
检索确定了1,426项研究, 其中16项纳入评估 (N=2,486对) 。方法学质量适宜。成功的干预措施以技能为基础, 针对不同的沟通方式, 包含个人要素, 并且涉及护士参与。半数干预措施对自主支持结果进行了评价; 其中63%(5/8) 的干预措施改善了自主支持。研究结果是普遍对社会支持持肯定态度, 对自我护理持综合态度, 对照料人员负担持否定态度。研究的异质性和复杂性限制了效应的归因。
结论
行为干预旨在加强双人照料人员的人际沟通, 使其具有自主支持, 这可能会对照料人员的技能和慢性病结果产生积极影响。今后需要对自主支持进行研究, 以确定核心干预内容。
影响
这是首次系统化评估, 研究了促进照料人员对被照料人员自主支持的干预措施。将人际沟通变更为自主支持有可能改善慢性病结果。研究结果可以为临床医生和调查人员寻求照料人员自主支持以鼓励行为改变提供参考。
Oral preexposure prophylaxis (PrEP) has been proven to be a safe and effective means of preventing HIV. The purpose of our literature review was to examine primary care provider knowledge and ...attitudes about prescribing PrEP. PubMed, CINAHL, Web of Science, and Scopus were searched and additional articles were identified through other sources, yielding 11 articles that met inclusion criteria. Overall, there was high variability among providers regarding attitudes, knowledge, and prescriptive practices related to PrEP. PrEP continues to be an underutilized HIV prevention intervention and more research focusing on provider-specific factors is warranted.
•Childhood adversity is associated with depressive and anxiety disorders in adulthood.•Genetic polymorphisms in serotonergic genes moderate the relationship between childhood adversity and depression ...in adults.•SSRIs may result in poor treatment outcomes in adults with a history of childhood adversity.•The role of positive life events and SSRI treatment response needs to be studied in this population.•More studies need to be conducted in adulthood who have co-morbid depressive and anxiety disorders.
Recent studies have examined the role that the serotonergic system plays in moderating the association between adverse childhood experiences (ACEs) and depressive and anxiety disorders in adulthood. The aim of this literature review is to synthesize studies that examined serotonin’s impact in relation to ACEs, and depressive and anxiety disorders in this population.
Published studies from 2008 to 2018 were retrieved from PubMed, CINAHL, and PsychINFO databases, and were included if ACEs, the serotonergic system, and depressive and or anxiety disorders were assessed in those with a mean age between nineteen and forty.
Twenty-eight studies were included. Various genetic polymorphisms in the serotonergic signaling system moderated the association between ACEs and depression. Additionally, selective serotonin reuptake inhibitors with a high affinity for the serotonin transporter, resulted in poor treatment outcomes for those with history of ACEs.
Additional research is needed in order to further define the role that the serotonergic genes play in the association between ACEs and depressive and anxiety disorders in adulthood.
The burden of heart failure (HF) is unequally distributed among population groups. Few study authors have described social determinants of health (SDoH) enabling/impeding self-care.
The aim of this ...study was to explore the relationship between SDoH and self-care in patients with HF.
Using a convergent mixed-methods design, we assessed SDoH and self-care in 104 patients with HF using the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) and the Self-Care of HF Index v7.2 with self-care maintenance, symptom perception, and self-care management scales. Multiple regression was used to assess the relationship between SDoH and self-care. One-on-one in-depth interviews were conducted in patients with poor (standardized score ≤ 60, n = 17) or excellent (standardized score ≥ 80, n = 20) self-care maintenance. Quantitative and qualitative results were integrated.
Participants were predominantly male (57.7%), with a mean age of 62.4 ± 11.6 years, with health insurance (91.4%) and some college education (62%). Half were White (50%), many were married (43%), and most reported adequate income (53%). The money and resources core domain of PRAPARE significantly predicted self-care maintenance ( P = .019), and symptom perception ( P = .049) trended significantly after adjusting for other PRAPARE core domains (personal characteristics, family and home, and social and emotional health) and comorbidity. Participants discussed social connectedness, health insurance coverage, individual upbringing, and personal experiences as facilitators of self-care behavior.
Several SDoH influence HF self-care. Patient-specific interventions that address the broader effects of these factors may promote self-care in patients with HF.
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