Preventive medicine
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Preventive medicine · Feb 2021
Aligning social and health care services: The case of community care connections.
The Community Care Connections (CCC) program aims to align social and healthcare services to improve health outcomes in older adults with complex medical and social needs. This study assessed changes in healthcare utilization before and after CCC program participation. Between June 2016 and March 2019, 1214 adults with complete data who provided informed consent participated in the CCC program. ⋯ ED visits decreased by 37% (Change = -0.140, 95% CI = -0.209, -0.070) for those with hypertension and by 30% (Change = -0.109, 95% CI = -0.199, -0.020) for those with high cholesterol, while observation stays decreased by 46% (Change = -0.118, 95% CI = -0.185, -0.052) for those with diabetes and by 44% (Change = -0.082, 95% CI = -0.150, -0.014) for those with high cholesterol during the post period. Connecting older adults with social services through the healthcare delivery system may lead to decreases in hospitalizations, ED visits, and observation stays. Implementation of cross-sector partnerships that address non-clinical factors that impact the health of older adults may reduce the use of costly healthcare services.
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Preventive medicine · Feb 2021
Optimizing preventive medicine to bridge the gap between clinical medicine and public health for disease control in China: A lesson from COVID-19.
The pandemic of Coronavirus Disease 2019 (COVID-19) highlights the importance of early detection of disease outbreaks, taking swift and decisive public health actions, and strengthening public health systems. Preventive medicine, as a specialty of medicine, trains students on both clinical medicine and public health and is of a particular need in battling against this pandemic. In China, preventive medicine plays a unique role in the disease control system where preventive medicine graduates represent a large share of the workforce. ⋯ From the human resource perspective, the undergraduate preventive medicine curricula and exclusive public health training for preventive medicine postgraduates limit their clinical capacities. A series of disease control and public health education reforms may further incapacitate preventive medicine graduates' clinical skills, unintentionally widening the gap between public health and clinical medicine and thus posing threats to effective disease detection and control. The authors call for reforming and optimizing preventive medicine to bridge the gap between clinical medicine and public health by strengthening curricula on clinical medicine, diversifying curricula on public health, enhancing preventive medicine residency programs, and rectifying regulations that restrict preventive medicine graduates from practicing curative medicine.
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Preventive medicine · Feb 2021
Vaccination against seasonal influenza and socio-economic and environmental factors as determinants of the geographic variation of COVID-19 incidence and mortality in the Italian elderly.
A possible protective effect of seasonal influenza vaccination against the spread of the COVID-19 epidemic has been suggested. ⋯ Extending influenza vaccination coverage particularly among the elderly, vulnerable individuals with specific chronic medical conditions, health care workers, and workers in other essential services, early in the upcoming 2020 influenza season, might help reduce the health impact of a second epidemic wave of COVID-19.
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Preventive medicine · Feb 2021
Maternal folic acid supplementation mediates the associations between maternal socioeconomic status and congenital heart diseases in offspring.
Low maternal socioeconomic status (SES) is considered as a risk factor of congenital heart diseases (CHDs) in offspring. However, the pathways underpinning the SES-CHDs associations are unclear. We assessed if first trimester maternal folic acid supplementation (FAS) is a mediator of the SES-CHDs associations. ⋯ In addition, FAS mediated the highest proportion of the associations between income and multiple critical CHDs [46.9%, 95%CI:24.7%,77%] and conotruncal defects [31.5%, 95%CI:17.1%,52.0%], respectively. Maternal FAS partially mediated the SES-CHDs associations, especially among the most critical and common CHDs. Promoting FAS in low SES women of childbearing age may be a feasible intervention to help prevent CHDs.
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Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) has the potential to improve reproductive health by allowing low-income women access to healthcare before and early in pregnancy. The aim of this study was to examine the effects of Oregon's Medicaid expansion on timely and adequate prenatal care. We included live births in Oregon from 2012 to 2015 and used individually-linked birth certificate and Medicaid eligibility data. ⋯ Pre-pregnancy Medicaid enrollment increased following Medicaid expansion (β = 0.55, p < 0.001) and was associated with both timely (β = 0.48, p < 0.001) and adequate receipt of prenatal care (β = 0.14, p < 0.001). Using two years of post-ACA data we found that Medicaid expansion had significant positive associations with Medicaid enrollment prior to pregnancy, which subsequently increased receipt of timely and adequate prenatal care. Our study provides evidence that expanding Medicaid has positive effects on women's use of healthcare.