Preventive medicine
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Preventive medicine · Sep 2021
Substance use and deaths by suicide: A latent class analysis of the National Violent Death Reporting System.
Substance use is strongly associated with suicide completions. However, little is known about the patterns of substances used in suicide deaths. The purpose of this analysis is to determine latent classes of toxicology-reported substances among individuals who completed suicide. ⋯ Homelessness was associated with classification in the "Marijuana and other substance" class and the "Opiate use" class compared to the "No substance/single substance" class. IPV was associated with both polysubstance use classes ("Alcohol plus other substance" and "Marijuana plus other substance") along with the "Opiate use" class compared to the "No substance/single substance" class. These classes highlight profiles of suicide descendants and emphasize the importance of polysubstance use prevention among females, homeless individuals, and those who experience IPV.
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Preventive medicine · Sep 2021
The association between mental health and shift work: Findings from the Atlantic PATH study.
We evaluated the relationship between mental health and shift work in the Atlantic Partnership for Tomorrow's Health (PATH) cohort study. In a matched study with 12,413 participants, including 4155 shift workers and 8258 non-shift workers, we utilized general linear models and logistic regression models to assess the differences in depression, anxiety, and self-rated health. ⋯ Shift workers were more likely to have increased rates of depression and poor self-rated health, as well as depressive and anxiety symptom scores compared to non-shift workers. As a result, shift workers may be at increased risk of comorbidity, poor quality of life, missed work, and early retirement.
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Preventive medicine · Sep 2021
COVID-19 and family planning service delivery: Findings from a survey of U.S. physicians.
Equitable access to contraception is critical for reproductive autonomy. Using cross-sectional data from the DocStyles survey administered September-October 2020 (68% response rate), we compared changes in family planning-related clinical services and healthcare delivery strategies before and during the COVID-19 pandemic and assessed service provision issues among 1063 U. S. physicians whose practice provided family planning services just before the pandemic. ⋯ Discontinuation of key family planning services during the COVID-19 pandemic may limit contraception access and impede reproductive autonomy. Implementing healthcare service delivery strategies that reduce the need for in-person visits (e.g., telehealth for contraception, providing or prescribing ECPs in advance) may decrease disruptions in care. Resources exist for public health and clinical efforts to ensure contraception access during the pandemic.
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Preventive medicine · Sep 2021
Obesity, putative biological mediators, and cognitive function in a national sample of children and adolescents.
Childhood obesity has reached epidemic rates nationwide and may be associated with impaired cognitive function. A growing body of evidence suggests that poorer academic performance for children with obesity and overweight is related to declines in executive function skills. This study aimed to identify biological mediators between obesity and overweight and cognitive function among children and adolescents. ⋯ Obesity and overweight were also associated with biological mediators such as iron deficiency, elevated c-reactive protein and glycosylated hemoglobin. Several biomarkers of iron status were also related to measures of cognitive function. Early declines in cognitive function are associated with biomarkers of iron deficiency and inflammation in children and adolescents, and while some biological linkages between obesity and overweight and cognitive function are identified herein, further study is needed to identify additional biological mediators between obesity and overweight and cognitive function in pediatric populations.
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Preventive medicine · Sep 2021
Out-of-pocket costs for preventive care persist almost a decade after the Affordable Care Act.
Higher cost-sharing reduces the amount of high-value health care that patients use, such as preventive care. Despite a sharp reduction in out-of-pocket (OOP) costs for preventive care after the implementation of the Affordable Care Act (ACA), patients often still get unexpected bills after receiving preventive services. We examined out-of-pocket costs for preventive care in 2018, almost ten years after the implementation of the ACA. ⋯ We found that in addition to premium costs meant to cover preventive care, Americans with employer-sponsored insurance were still charged between $75 million and $219 million in total for services that ought to be free to them ($0.50 to $1.40 per ESI-covered individual and $0.75 to $2.17 per ESI-covered individual using preventive care). However, some enrollees still faced OOP costs for eligible preventive services ranging into the hundreds of dollars. OOP costs are most likely to be incurred for women's services (e.g., contraception) and basic screenings (e.g., diabetes and cholesterol screenings), and by patients in the South or in rural areas.