The Intersection of Research and Community Health: Using Evidence to Inform Population Health Strategy

Background: Social determinants of health (SDoH) are the conditions in which people are born, grow, live, and work, and they significantly impact an individual’s health and wellbeing. With robust connections to community partners, access to data, and touch points with patients, healthcare systems are ideally positioned to address SDoH, yet systems struggle to identify how best to capture and manage SDoH needs. The hospital within our academic medical center leveraged a partnership with our medical library to create an evidence review program, specifically aimed at informing the health system’s population health strategy and implementation tactics using best research evidence. Description: When tasked with developing a comprehensive population health strategy, the hospital within our academic medical center partnered with our medical library to create an evidence synthesis service aimed at infusing best research practices into strategy development and implementation. The hospital’s executive leadership team identified clinical and policy questions, and members of the hospital’s population health department worked closely with a medical librarian to complete literature searches, appraise evidence and summarize findings for leaders. These findings were used to inform strategy and implementation decisions. Examples of topics searched included the following: the most effective way to screen for SDoH needs, the best clinical data to use for predictive risk assessments, approaches to outreaching high-risk patients, and the effectiveness of integrating behavioral health resources into clinics for patients with complex medical conditions. Conclusion: This program led to the successful implementation of population health strategies for our healthcare system, and has benefited our community. The evidence synthesis service helped secure grant funding for two behavioral health resources for our adult and pediatric sickle cell disease clinics. This program also informed our enterprise-wide roll-out of SDoH screening and referral management. These are a few demonstrable ways the program has resulted in improvements in care delivery. Our population health strategy tactics each have metrics of success, which are monitored on our health system’s scorecard. Achievement of these measures will also serve as a way to monitor our program’s effectiveness going forward

Mental Health Status and Perceived Barriers to Seeking Treatment in Rural Reserve Component Veterans

National Guard and Reserve (RC) troops (N=617) primarily from the Appalachian Region in Southwestern Pennsylvania who recently returned from deployment in support of current military conflicts responded to a survey that assessed their demographics, mental health symptoms, help-seeking behaviors, barriers for not seeking treatment, deployment history, and stressors. Veterans were classified as rural (N = 334) or non-rural (N = 283). Rural participants reported a significantly greater number of issues with transportation/access in seeking mental health treatment, were more likely to perceive others as worse off as a reason not to seek treatment, had a more negative attitude toward seeking treatment for mental health problems, and reported fewer concerns about a mental health problem affecting their career. Recommendations for mental health care providers and policymakers are offered based on the results, including the importance of recognizing the distinctive barriers to care that RC Appalachian veterans face when they come back into civilian communities, many of them rural

Disease-modifying therapies alter gut microbial composition in MS.

Objective:To determine the effects of the disease-modifying therapies, glatiramer acetate (GA) and dimethyl fumarate (DMF), on the gut microbiota in patients with MS. Methods:Participants with relapsing MS who were either treatment-naive or treated with GA or DMF were recruited. Peripheral blood mononuclear cells were immunophenotyped. Bacterial DNA was extracted from stool, and amplicons targeting the V4 region of the bacterial/archaeal 16S rRNA gene were sequenced (Illumina MiSeq). Raw reads were clustered into Operational Taxonomic Units using the GreenGenes database. Differential abundance analysis was performed using linear discriminant analysis effect size. Phylogenetic investigation of communities by reconstruction of unobserved states was used to investigate changes to functional pathways resulting from differential taxon abundance. Results:One hundred sixty-eight participants were included (treatment-naive n = 75, DMF n = 33, and GA n = 60). Disease-modifying therapies were associated with changes in the fecal microbiota composition. Both therapies were associated with decreased relative abundance of the Lachnospiraceae and Veillonellaceae families. In addition, DMF was associated with decreased relative abundance of the phyla Firmicutes and Fusobacteria and the order Clostridiales and an increase in the phylum Bacteroidetes. Despite the different changes in bacterial taxa, there was an overlap between functional pathways affected by both therapies. Interpretation:Administration of GA or DMF is associated with differences in gut microbial composition in patients with MS. Because those changes affect critical metabolic pathways, we hypothesize that our findings may highlight mechanisms of pathophysiology and potential therapeutic intervention requiring further investigation

Bone Mineral Density Corrected for Size in Childhood Leukaemia Survivors Treated with Haematopoietic Stem Cell Transplantation and Total Body Irradiation

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Childhood leukaemia survivors treated with haematopoietic stem cell transplantation and total body irradiation (HSCT-TBI) have multiple risk factors for reduced bone mineral density (BMD) and growth failure; hence, BMD assessment must take body size into consideration. This study aimed to evaluate size-corrected BMD in leukaemia survivors treated with and without HSCT-TBI. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Childhood leukaemia survivors treated with HSCT-TBI (&lt;i&gt;n&lt;/i&gt; = 35), aged 17.3 (10.5–20.9) years, were compared with those treated with chemotherapy only, (&lt;i&gt;n&lt;/i&gt; = 16) aged 18.5 (16.1–20.9) years, and population references. Outcome measures included anthropometric measurements and BMD by dual-energy X-ray absorptiometry. BMD was corrected for size as bone mineral apparent density (BMAD). Statistical analysis was performed by 1- and 2-sample &lt;i&gt;t&lt;/i&gt; tests as well as regression analysis (5% significance). &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; HSCT-TBI survivors were lighter and shorter with reduced spinal heights compared with chemotherapy-only subjects and population references. Compared with population references, HSCT-TBI survivors showed lower BMD standard deviation scores (SDS) (&lt;i&gt;p&lt;/i&gt; = 0.008), but no difference in BMAD-SDS, and chemotherapy-only survivors showed no differences in neither BMD-SDS nor BMAD-SDS. All HSCT-TBI participants with BMD-SDS &amp;#x3c;–2 had BMAD-SDS &amp;#x3e;–2. BMAD-SDS was negatively associated with age (&lt;i&gt;r&lt;/i&gt; = –0.38, &lt;i&gt;p&lt;/i&gt; = 0.029) in HSCT-TBI survivors. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; Size-corrected BMD are normal in HSCT-TBI survivors in young adulthood, but may reduce overtime. BMD measurements should be corrected for size in these patients to be clinically meaningful.</jats:p

Investigating the Role of Hypothalamic Tumor Involvement in Sleep and Cognitive Outcomes Among Children Treated for Craniopharyngioma

Objective: Despite excellent survival prognosis, children treated for craniopharyngioma experience significant morbidity. We examined the role of hypothalamic involvement (HI) in excessive daytime sleepiness (EDS) and attention regulation in children enrolled on a Phase II trial of limited surgery and proton therapy. Methods: Participants completed a sleep evaluation (N = 62) and a continuous performance test (CPT) during functional magnetic resonance imaging (fMRI; n = 29) prior to proton therapy. Results: EDS was identified in 76% of the patients and was significantly related to increased HI extent (p = .04). There was no relationship between CPT performance during fMRI and HI or EDS. Visual examination of group composite fMRI images revealed greater spatial extent of activation in frontal cortical regions in patients with EDS, consistent with a compensatory activation hypothesis. Conclusion: Routine screening for sleep problems during therapy is indicated for children with craniopharyngioma, to optimize the timing of interventions and reduce long-term morbidity

Consensus in Guidelines for Evaluation of DSD by the Texas Children's Hospital Multidisciplinary Gender Medicine Team

The Gender Medicine Team (GMT), comprised of members with expertise in endocrinology, ethics, genetics, gynecology, pediatric surgery, psychology, and urology, at Texas Children's Hospital and Baylor College of Medicine formed a task force to formulate a consensus statement on practice guidelines for managing disorders of sexual differentiation (DSD) and for making sex assignments. The GMT task force reviewed published evidence and incorporated findings from clinical experience. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence presented in the literature for establishing evidence-based guidelines. The task force presents a consensus statement regarding specific diagnostic and therapeutic issues in the management of individuals who present with DSD. The consensus statement includes recommendations for (1) laboratory workup, (2) acute management, (3) sex assignment in an ethical framework that includes education and involvement of the parents, and (4) surgical management

Standing up for Myself (STORM): Adapting and piloting a web-delivered psychosocial group intervention for people with intellectual disabilities

BACKGROUND: Our STORM intervention was developed for people (16 +) with intellectual disabilities to enhance their capacity to manage and resist stigma. The current study describes the adaptation of STORM for (synchronous) on-line delivery in the context of the Covid-19 pandemic. AIMS: To adapt the manualised face-to-face STORM group intervention for delivery via web-based meeting platforms and to conduct an initial pilot study to consider its acceptability and feasibility. METHODS AND PROCEDURES: The 5-session STORM intervention was carefully adapted for online delivery. In a pilot study with four community groups (N = 22), outcome, health economics and attendance data were collected, and fidelity of delivery assessed. Focus groups with participants, and interviews with facilitators provided data on acceptability and feasibility. OUTCOMES AND RESULTS: The intervention was adapted with minimal changes to the content required. In the pilot study, 95% of participants were retained at follow-up, 91% attended at least three of the five sessions. Outcome measure completion and fidelity were excellent, and facilitators reported implementation to be feasible. The intervention was reported to be acceptable by participants. CONCLUSIONS AND IMPLICATIONS: When provided with the necessary resources and support, people with intellectual disabilities participate actively in web-delivered group interventions

Standing up for Myself (STORM): Adapting and piloting a web-delivered psychosocial group intervention for people with intellectual disabilities

Background: Our STORM intervention was developed for people (16 +) with intellectual disabilities to enhance their capacity to manage and resist stigma. The current study describes the adaptation of STORM for (synchronous) on-line delivery in the context of the Covid-19 pandemic. Aims: To adapt the manualised face-to-face STORM group intervention for delivery via web-based meeting platforms and to conduct an initial pilot study to consider its acceptability and feasibility. Methods and procedures: The 5-session STORM intervention was carefully adapted for online delivery. In a pilot study with four community groups (N = 22), outcome, health economics and attendance data were collected, and fidelity of delivery assessed. Focus groups with participants, and interviews with facilitators provided data on acceptability and feasibility. Outcomes and results: The intervention was adapted with minimal changes to the content required. In the pilot study, 95% of participants were retained at follow-up, 91% attended at least three of the five sessions. Outcome measure completion and fidelity were excellent, and facilitators reported implementation to be feasible. The intervention was reported to be acceptable by participants. Conclusions and implications: When provided with the necessary resources and support, people with intellectual disabilities participate actively in web-delivered group interventions

Children\u27s experiences of companion animal maltreatment in households characterized by intimate partner violence

Cruelty toward companion animals is a well-documented, coercive tactic used by abusive partners to intimidate and control their intimate partners. Experiences of co-occurring violence are common for children living in families with intimate partner violence (IPV) and surveys show that more than half are also exposed to abuse of their pets. Given children\u27s relationships with their pets, witnessing such abuse may be traumatic for them. Yet little is known about the prevalence and significance of this issue for children. The present study examines the experiences of children in families with co-occurring pet abuse and IPV. Using qualitative methods, 58 children ages 7–12 who were exposed to IPV were asked to describe their experiences of threats to and harm of their companion animals. Following the interviews, template analysis was employed to systematically develop codes and themes. Coding reliability was assessed using Randolph\u27s free-marginal multirater kappa (kfree = .90). Five themes emerged from the qualitative data, the most common being children\u27s exposure to pet abuse as a power and control tactic against their mother in the context of IPV. Other themes were animal maltreatment to discipline or punish the pet, animal cruelty by a sibling, children intervening to prevent pet abuse, and children intervening to protect the pet during a violent episode. Results indicate that children\u27s experiences of pet abuse are multifaceted, potentially traumatic, and may involve multiple family members with diverse motives