Preventive medicine
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Preventive medicine · Dec 2020
Randomized Controlled TrialFit and strong! plus: Twelve and eighteen month follow-up results for a comparative effectiveness trial among overweight/obese older adults with osteoarthritis.
This comparative effectiveness trial compared the longer-term effectiveness (12 and 18 months) of the standard Fit & Strong! physical activity program to Fit & Strong. Plus, which combined physical activity and dietary weight loss. Outcomes were weight, diet quality, physical activity, osteoarthritis symptoms, performance measures, and anxiety/depression. ⋯ African American older adults in the F&S. Plus arm showed sustained modest improvements in weight, waist circumference, and lower extremity strength at 12 months and in lower extremity strength at 18 months compared to F&S!. Implications for the translation of evidence-based programs into community settings to support healthy behaviors in older adults are discussed.
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Preventive medicine · Dec 2020
ReviewSuicidal behaviors and ideation during emerging viral disease outbreaks before the COVID-19 pandemic: A systematic rapid review.
The current COVID-19 pandemic is the most severe pandemic of the 21st century, on track to having a rising death toll. Beyond causing respiratory distress, COVID-19 may also cause mortality by way of suicide. The pathways by which emerging viral disease outbreaks (EVDOs) and suicide are related are complex and not entirely understood. ⋯ Overall, we found scarce and weak evidence for an increased risk of deaths by suicide during EVDOs. Our results inform the need to orient public health policies toward suicide prevention strategies targeting the psychosocial effects of EVDOs. High-quality research on suicide risk and prevention are warranted during the current pandemic.
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Preventive medicine · Dec 2020
Private/marketplace insurance in community health centers 5 years post-affordable care act in medicaid expansion and non-expansion states.
Community health centers (CHCs) play an important role in providing care for the safety net population. After implementation of the Affordable Care Act, many patients gained insurance through state and federal marketplaces. Using electronic health record data from 702,663 patients in 257 clinics across 20 states, we sought to explore the following differences between Medicaid expansion and non-expansion state CHCs: (1) trends in private/marketplace insurance post-expansion, and (2) whether CHC patients retain private/marketplace insurance. ⋯ While a greater percentage of patients in non-expansion states retained private/marketplace insurance than in expansion states, a greater percentage of those who did not retain it became uninsured. In comparison, a greater percentage of patients in expansion states who lost private/marketplace insurance gained other types of health insurance. CHCs' ability to provide adequate care for vulnerable populations relies, in part, on federal grants as well as reimbursement from insurers: decreases in either could result in reduced capacity or quality of care for patients seen in CHCs.
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Preventive medicine · Dec 2020
Randomized Controlled TrialImplementation science: Scaling a training intervention to include IUDs and implants in contraceptive services in primary care.
Building capacity for contraceptive services in primary care settings, including for intrauterine devices (IUDs) and implants, can help to broaden contraceptive access across the US. Following a randomized trial in family planning clinics, we brought a provider training intervention to other clinical settings including primary care in all regions. This implementation science study evaluates a national scale-up of a contraceptive training intervention to varied practice settings from 2013 to 2019 among 3216 clinic staff serving an estimated 1.6 million annual contraceptive patients. ⋯ This intervention was effectively scaled, including in primary care settings with limited prior experience with these methods. Recent changes to Title X family planning funding rules exclude several large family planning providers, shifting greater responsibility to primary care and other settings. Scaling effective contraceptive interventions is one way to ensure capacity to offer patients full contraceptive services.
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Preventive medicine · Dec 2020
Association of neighborhood parks with child health in the United States.
While there is evidence that parks support pediatric health, there have been no national studies looking at both physical and mental health. We assessed whether the presence of a neighborhood park is associated with pediatric physical or mental health across the U. S. using a nationally representative cross-sectional random sample of American children ages 0-17. ⋯ Irrespective of sociodemographics, children lacking parks were more likely to be physically inactive (aOR1.36, 95% CI 1.24, 1.48), have excessive screen-time (aOR = 1.19, 95% CI 1.14, 1.25), or obtain inadequate sleep (aOR = 1.23, 95% CI 1.18, 1.29). Children without parks were more likely obese (aOR = 1.32, 95% CI 1.21, 1.43), overweight (aOR 1.25, 95%CI 1.17, 1.33), or diagnosed with ADHD (aOR 1.20, 95% CI 1.12, 1.29), but not more anxious or depressed (aOR = 1.04, 95%CI 0.97, 1.11). Associations between parks and pediatric physical and mental health suggests that the provision of neighborhood parks could represent a low-cost childhood health intervention.