Barriers to COVID-19 vaccine uptake among resource-limited adults diagnosed with chronic illness

Background Despite the use of interventions (e.g., monetary incentives, educational campaigns, on-site workplace vaccination) to increase COVID-19 vaccination, differences in uptake persist by poverty level, insurance status, geography, race, and ethnicity, suggesting that these interventions may not be adequately addressing the barriers faced by these populations. Among a sample of resource-limited individuals with chronic illnesses, we (1) described the prevalence of different types of barriers to the COVID-19 vaccination and (2) identified associations between patients' sociodemographic characteristics and barriers to vaccination. Methods We surveyed a national sample of patients with chronic illness and demonstrated healthcare affordability and/or access challenges about barriers to COVID-19 vaccination in July 2021. We categorized participant responses into cost, transportation, informational, and attitudinal barrier domains and assessed the prevalence of each domain, both overall and by self-reported vaccination status. Using logistic regression models, we examined unadjusted and adjusted associations between respondent characteristics (sociodemographic, geographic, and healthcare access) and self-reported barriers to vaccination. Results Of 1,342 respondents in the analytic sample, 20% (264/1,342) reported informational barriers and 9% (126/1,342) reported attitudinal barriers to COVID-19 vaccination. Transportation and cost barriers were reported much less commonly, by only 1.1% (15/1,342) and 0.7% (10/1,342) of the sample, respectively. Controlling for all other characteristics, respondents with either a specialist as their usual source of care or no usual source of care had an 8.4 (95% CI: 1.7–15.1) and 18.1 (95% CI: 4.3–32.0) percentage point higher predicted probability, respectively, of reporting informational barriers to care. Compared to females, males had an 8.4% point (95% CI: 5.5–11.4) lower predicted probability of reporting attitudinal barriers. Only attitudinal barriers were associated with COVID-19 vaccine uptake.ConclusionAmong a sample of adults with chronic illnesses who had received financial assistance and case management services from a national non-profit, informational and attitudinal barriers were more commonly reported than logistical or structural access barriers (i.e., transportation and cost barriers). Interventions should target attitudinal barriers among patients with chronic illness, who may have particular concerns about the interaction of the vaccine with ongoing medical care. Additionally, interventions targeting informational barriers are particularly needed among individuals without a usual source of care

Facing financial barriers to healthcare: patient-informed adaptation of a conceptual framework for adults with a history of cancer

Background Cancer-related financial hardship is associated with negative clinical outcomes, which may be partially explained by cost-related delayed or forgone care in response to financial barriers. We sought to understand patient experiences facing financial barriers to medical care following a cancer diagnosis. Methods We conducted virtual, semi-structured interviews in Fall 2022 with 20 adults with a history of cancer who had experienced cancer-related financial hardship in the prior year. We used template analysis within a pragmatic paradigm, combining constructivist and critical realist theoretical perspectives, to analyze interview transcripts and adapt an existing conceptual framework of financial barriers to care. Results The majority of interviewees identified as women (70%), non-Hispanic white (60%), and reported an annual household income of <$48,000 (60%). As interviewees sought to overcome financial barriers, they described substantial frustration at the limitations and complexities of United States health and social care systems, resulting in a reliance on a fragmented, uncertain resource landscape. The administrative burden resulting from bureaucratic systems and the advocacy responsibilities required to navigate them ultimately fell on interviewees and their caregivers. Thus, participants described their ability to overcome financial barriers as being influenced by individual and interpersonal factors, such as social support, comfort asking for help, time, prior experience navigating resources, and physical and mental health. However, participants noted health system organizational factors, such as whether all new patients proactively met with a social worker or financial navigator, as having the potential to lessen the administrative and financial burden experienced. Conclusion We present an adapted conceptual framework outlining multi-level factors influencing patient experiences coping with financial barriers to medical care. In addition to influencing whether a patient ultimately delays or forgoes care due to cost, financial barriers also have the potential to independently affect patient mental, physical, and financial health

Self organising maps for visualising and modelling

The paper describes the motivation of SOMs (Self Organising Maps) and how they are generally more accessible due to the wider available modern, more powerful, cost-effective computers. Their advantages compared to Principal Components Analysis and Partial Least Squares are discussed. These allow application to non-linear data, are not so dependent on least squares solutions, normality of errors and less influenced by outliers. In addition there are a wide variety of intuitive methods for visualisation that allow full use of the map space. Modern problems in analytical chemistry include applications to cultural heritage studies, environmental, metabolomic and biological problems result in complex datasets. Methods for visualising maps are described including best matching units, hit histograms, unified distance matrices and component planes. Supervised SOMs for classification including multifactor data and variable selection are discussed as is their use in Quality Control. The paper is illustrated using four case studies, namely the Near Infrared of food, the thermal analysis of polymers, metabolomic analysis of saliva using NMR, and on-line HPLC for pharmaceutical process monitoring

Genetic Differences in the Immediate Transcriptome Response to Stress Predict Risk-Related Brain Function and Psychiatric Disorders

Depression risk is exacerbated by genetic factors and stress exposure; however, the biological mechanisms through which these factors interact to confer depression risk are poorly understood. One putative biological mechanism implicates variability in the ability of cortisol, released in response to stress, to trigger a cascade of adaptive genomic and non-genomic processes through glucocorticoid receptor (GR) activation. Here, we demonstrate that common genetic variants in long-range enhancer elements modulate the immediate transcriptional response to GR activation in human blood cells. These functional genetic variants increase risk for depression and co-heritable psychiatric disorders. Moreover, these risk variants are associated with inappropriate amygdala reactivity, a transdiagnostic psychiatric endophenotype and an important stress hormone response trigger. Network modeling and animal experiments suggest that these genetic differences in GR-induced transcriptional activation may mediate the risk for depression and other psychiatric disorders by altering a network of functionally related stress-sensitive genes in blood and brain

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Outcomes in Obese and Overweight Acute Myeloid Leukemia (AML) Patients Receiving Chemotherapy Dosed According to Actual Body Weight

Abstract Abstract 1496 Background: Cytotoxic chemotherapy (CT) dosages are traditionally calculated according to body surface area (BSA). There are no recommendations for the dosing of CT in obese (OB) and overweight (OV) patients (pts) with AML. In solid tumor malignancies, use of actual body weight to calculate CT dosages in OB pts did not result in increased toxicities. Due to the lack of data in leukemia pts, we investigated efficacy and safety outcomes between underweight and normal weight (NW), OV, and OB pts when CT was dosed according to BSA based on actual body weight. Methods: We identified AML pts treated with anthracycline and cytarabine-based remission induction CT dosed according to actual body weight from 2002 to 2009 at Cleveland Clinic. Pts were divided into three groups according to body mass index (BMI): NW (BMI 30.0). Cytogenetics were categorized according to CALGB. Complete remission (CR) rates, overall survival (OS), and safety outcomes were compared between groups. Means, percentages, and median survival time were compared among groups using ANOVA, chi-square tests, survival analysis with log-rank tests and Cox regressions, as appropriate. Results: Of the 247 AML pts included, 81 were NW, 81 were OV, and 85 were OB. Baseline characteristics were not different between groups; within the entire study population, the mean age was 55.6 years (SD 14.3), 49.0% were female, and 69.2% had de novo AML. Favorable, intermediate, and unfavorable cytogenetics were not significantly different in NW (6.2%, 55.6%, and 30.9%), OV (18.5%, 38.3%, and 29.5%), and OB pts (15.3%, 42.4%, and 27.1%; p=0.107), respectively. Among NW, OV, and OB pts, CR rates were similar (69.1%, 79.0%, and 76.5%, respectively; p=0.321), as was median OS (10.7, 16.7, and 14.2 months, respectively, p=0.352) and early mortality within 30 days of induction CT (3.7%, 2.5%, and 7.1%, respectively, p=0.331). There was no difference in days to neutrophil recovery (34.4, 31.9, and 32.7, respectively, p=0.134) or days to platelet recovery (34.2, 31.7, and 31.2, respectively, p=0.490). Days spent in the hospital during initial induction CT (p=0.095) and incidence of documented bacteremia (p=0.288) also did not differ among groups. Post-therapy left ventricular ejection fraction < 40% or symptomatic heart failure was documented in 12.3% of NW, 3.7% OV, and 4.7% OB pts (p=0.058). After adjustment for confounders (age, cytogenetic risk, and etiology), the OS was significantly shorter for NW compared to OB (p=0.016), but was not different between NW and OV (p=0.104). Conclusions: CR rates and CT-associated adverse events were not significantly different among NW, OV, and OB AML pts when standard induction CT was dosed according to actual body weight. This demonstrates that standard induction CT can be safely dosed using actual body weight in these pts. Although not significant, NW patients had the lowest CR rate and shortest median OS. Low BMI could be a marker of worse performance status. Disclosures: No relevant conflicts of interest to declare