Preventive Health Service Use among Rural Women

Preventive health services and screenings are an important component in the continuum of care provided to individuals across all ages. Yet, research has shown that rural residents generally use fewer preventive health services and screenings. This study used the National Health Interview Survey to examine receipt of preventive health services (cholesterol check, fasting blood sugar test, mammogram, pap smear, and receipt of the HPV vaccine) by rural and urban women over the age of 18. Findings indicate that rural women were less likely than their urban peers to receive preventive health services, and that some of the differences may be explained by rural-urban differences in sociodemographic characteristics. However, even when controlling for these characteristics, lower use of mammogram or HPV vaccine among rural remained. Outreach efforts targeted to rural women, along with policies and programs designed to improve access to rural women’s cancer screening and HPV participation, are needed

Capacity of Rural Counties to Address an HIV or Hepatitis C Outbreak

HIV and hepatitis C (HCV) are major public health concerns in the United States and are a focus of significant federal health policy attention. Rural counties may be potentially vulnerable to an HIV or HCV outbreak among persons who inject drugs due to greater prevalence of high-risk injection practices as well as limited public health capacity to prevent, prepare for, and respond to an HIV or HCV outbreak. This study identified states potentially at risk for an HIV or HCV outbreak and used data from the 2016 Association of State and Territorial Health Officials (ASTHO) Profile Survey, 2016 National Association of City and County Health Officials (NACCHO) National Profile of Local Health Departments (LHD), and 2016-2017 Area Health Resource File to examine rural-urban differences in (1) state-level infectious disease surveillance, prevention activities, and collaboration with stakeholders; (2) LHD-level activities related to preventing, preparing for, and responding to an HIV or HCV outbreak; and (3) socioeconomic characteristics and health resources of counties at potential risk for an HIV or HCV outbreak. LHDs located in rural counties in at-risk states were less likely to offer services that may help address an HIV or HCV outbreak, including HIV testing, HIV services, and infectious disease surveillance. Rural LHDs were also less likely to report a history of partnerships with community-based organizations that may be important resources during an outbreak, including community health centers and faith-based organizations

Plasma concentrations of per- and polyfluoroalkyl substances and body composition from mid-childhood to early adolescence

BACKGROUND • Per- and polyfluoroalkyl substances (PFAS) may alter body composition by lowering anabolic hormones and increasing inflammation. Prior studies have found positive, inverse, and null associations of PFAS concentrations with adiposity among children and adolescents. Few studies have examined associations of PFAS concentrations with changes in body composition longitudinally. No study has examined the association of PFAS plasma concentrations with lean mass.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1038/thumbnail.jp

The Maine Lung Cancer Coalition: A Statewide, Multi-Sector Partnership to Improve Evidence-Based Lung Cancer Prevention & Screening

MLCC has two primary goals: 1. Engage and educate about evidence based lung cancer prevention and screening practices 2. Develop, implement, and evaluate innovative programs to increase access to prevention, screening, and treatment services for all Mainershttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1051/thumbnail.jp

How well does the Surprise Question Predict 1-year Mortality for Patients Admitted with COPD

Abstract Background. COPD is the 4th leading cause of death and is characterized by significant functional decline, particularly near the end of life. COPD patients have lower rates of advance care planning than patients with other respiratory illnesses. Currently, there is no effective prognostic tool for COPD patients in the inpatient setting. The surprise question (SQ) (“Would you be surprised if this patient died in the next time frame”) has shown to be effective at predicting mortality in some patient populations but has not been studied in COPD. Objective. We sought to assess the performance of the SQ in estimating mortality and advance care planning among patients with acute exacerbation of COPD. Methods. We performed a retrospective observational analysis of patients admitted to Maine Medical Center for acute exacerbation of COPD between July 2015 and September 2018. Emergency department (ED) and inpatient clinicians answer the SQ when placing admitting orders. ED clinicians answered, “Would you be surprised if this patient died in the next 30 days?”, and inpatient clinicians answered, “Would you be surprised if this patient died in the next year?” Clinicians provided a binary response (“No, I would not be surprised” [SQ+] or “Yes, I would be surprised” [SQ-]). We used sensitivity, specificity, positive predictive value, negative predictive value, area under the receiver operator curve, and multivariate logistic regression to assess the performance of the SQ in estimating 30-day and one-year mortality. Our secondary outcome was to assess if the surprise question prompted goals of care conversations, palliative care consultation and/or completion of advance care planning documents. Results. A total of 381 patients had responses to the 30-day SQ, and 365 patients had responses to the one-year SQ. Five percent (n = 19) of 30-day SQ responses were positive, and 30% (n = 108) of one-year SQ responses were positive. The 30-day SQ had the following test characteristics in estimating 30-day mortality: sensitivity 12%, specificity 95%, positive predictive value (PPV) 11%, and negative predictive value (NPV) 96%. The one-year SQ had the following test characteristics in estimating one-year mortality: sensitivity 47%, specificity 75%, PPV 35%, and NPV 83%. Patients with a positive one-year SQ were 2.75 times more likely to die within one year than those with a negative SQ (95% CI 1.59, 4.77, p \u3c 0.000; area under receiver operator curve 0.69) and 3.01 times more likely to have received any advance care planning during admission (95% CI 1.88, 4.82, p \u3c 0.000; area under receiver operator curve 0.75). Patients with a positive 30-day SQ were 3.83 times more likely to receive advance care planning during admission than those with a negative SQ (95% CI 1.25, 11.77, p = 0.019; area under receiver operator curve 0.79). Conclusion. The one-year surprise question can be an effective component of prognostication and care planning for COPD patients in the inpatient setting

PCP\u27s Lung Cancer Screening Attitudes and Practices: Results of a Statewide Survey

Context: Lung cancer screening is a relatively newly recommended preventive service. We have observed that involvement of primary care clinicians in lung cancer screening varied around the state. We wondered whether this variation might be partially due to the fact that the American Academy of Family Physicians (AAFP) has not endorsed lung cancer screening while the US Preventive Services Task Force (USPSTF) has. We surveyed primary care physicians in Maine to understand their knowledge, attitudes and current practices regarding lung cancer screening. Objective: To understand the knowledge, attitudes and current practices of family physicians in Maine related to lung cancer screening using low dose CT (LDCT) scans. Study Design: A cross-sectional survey was conducted using an online survey platform (REDCap™). Eligible participants were invited by email and provided an electronic link to the survey. Non-responders received three weekly email reminders. Setting or Dataset: Statewide survey of primary care attending physicians and residents in Maine. Population studied: Practicing attending physician members of three primary care organizations in Maine—Maine Academy of Family Physicians, Maine chapter of the American College of Physicians, and Maine Primary Care Association (consisting of primary care clinicians working in Federally Qualified Health Centers)—as well as residents at 4 family medicine residency programs in Maine (Central Maine FM Residency, Maine Medical Center FM Residency, Maine-Dartmouth FM Residency and Northern Light FM Residency) and one internal medicine residency program (Maine Medical Center). Intervention/instrument: Self-administered questionnaire utilizing both established and newly developed measures of several constructs. Outcome measures: Knowledge of lung cancer screening using LDCT, including eligibility criteria and potential benefits and harms of screening; attitudes towards lung cancer screening and people who use tobacco; and current lung cancer screening practices including provision of shared decision making. Our results showed that respondents knew the eligibility criteria for screening but most were not familiar with the information about benefits and risks of the test. Knowledge, attitudes and current practices did not vary based on whether respondents endorsed the AAFP guideline or not. In general, PCP\u27s endorsed an active role in all aspects of lung cancer screening, with the exception of following up on abnormal findings. PCP\u27s wanted assistance from their specialist colleagues to make sure that people with abnormalities on screening ,especially more worrisome findings, got the appropriate follow up care. These data will help identify potential barriers to lung cancer screening among primary care physicians, as well as unmet educational needs. We will use the results to design interventions to better engage PCP\u27s in lung cancer screening

Outcomes of Infective Endocarditis Cases Among People Who Inject Drugs: Assessing the effects of an inpatient addiction medicine consult service

Purpose/Background: Infective endocarditis (IE), an infection of the cardiac endothelium, is a significant complication of injection drug use (IDU) that is increasing among people who inject drugs. Once considered to be rare, the incidence of IE has increased twelve-fold in the past ten years. To treat and prevent complications from IDU, hospitals have begun to provide inpatient addiction consults, including Maine Medical Center (MMC), which developed an integrated medication for addiction treatment (IMAT) team in 2016. Our objectives are to 1) describe demographics, clinical characteristics among patients who presented to MMC with IE by IDU from 2016-2019 and 2) using a previous study by Dr. Thakarar et al involving 107 patients admitted with IE at MMC from 2013-2016, compare health service utilization and health outcomes in individuals admitted for IE before and after the implementation of MMC’s addiction medicine consult service. Based on local and national IDU-IE trends, we expect there to be an increased number of IDU-IE cases from 2016-2019. We also hypothesize that the implementation of an IMAT team will be associated with reduced health service utilization and reduced 90-day mortality among patients with IDU-IE. Methods/Approach: This study will be a retrospective analysis of patients who presented for care to MMC with definite or probable IE from January 1, 2013 to January 1, 2019. Data will be collected from MMCs electronic medical record. We will describe various demographic variables, health characteristics, hospitalization data, IE characteristics, IMAT service utilization data, and health care utilization data among people with IDU versus non-IDU IE. In a subgroup analysis among patients with IDU-IE, we will also stratify data pre- and post-IMAT implementation. In this subgroup analysis, we will assess for the following primary outcomes: 1) 90-day post-discharge ED utilization, 2) 30-day readmission rates, and 3) 90-day mortality rates, with IMAT consultation as the main exposure of interest. Secondary outcomes assessed include percentage of patient discharged against medical advice and number of overdoses after hospital discharge. Results: Data collection is in progress and has already been collected for 2013-2016. We will examine the incidence of IE cases from MMC between 2016 and 2019, as well as overall trends from 2013-2019. We will assess the demographics, clinical characteristics, and healthcare utilization of patients with IDU versus non-IDU-IE. Among people with IDU-IE, we will stratify by IMAT service and examine any differences in 90-day post-discharge ED visits, 30-day readmission rates, and 90-day mortality rates. Conclusions: We will review our major findings here and make assessments of how IMAT services have been utilized among the vulnerable IDU population as well as suggest areas for future study

Petroleum industry in Illinois, 1984. Oil and gas developments

pt. 1. Oil and gas developments / Jacob Van Den Berg and Janis D. Treworgy -- pt.2. Waterflood operations / Jaclyn Rendall Elyn

Behavioral Health in Rural America: Challenges and Opportunities [EXECUTIVE SUMMARY]

Full report available at: http://www.rupri.org/wp-content/uploads/Behavioral-Health-in-Rural-America-Challenges-and-Opportunities.pd