Delivery of a multi-focus public health intervention in the paediatric emergency department: a feasibility and acceptability pilot study

ObjectiveThe objective was to see if it was feasible and acceptable to deliver a brief public health intervention as part of an attendance at the paediatric emergency department (PED).DesignA feasibility and acceptability pilot design was used as there is no previous work done in this clinical area, population or using this approach in children and young people (CYP). Quantitative and qualitative data were collected. Follow-up was at 1 week and 1, 3 and 6 months.SettingThis pilot took place in a single PED in Greater Manchester, England.ParticipantsParticipants were CYP (under 16 years old) and their parents/carers, attending the PED during a 2-week recruitment period in September 2019.InterventionsThe intervention was a brief conversation with a Consultant in Paediatric Public Health Medicine, using Screening, Brief Intervention and Referral to Treatment. The intervention focused on vaccination, dental health, household smoking and frequent attendance.Primary and secondary outcome measuresThe primary outcome measure was information to support the effective development of a larger-scale study. Secondary outcomes were measures of health, again intended to provide additional information prior to a larger study.ResultsThirty CYP were recruited from 29 households. Sixty per cent of CYP triggered at least one screening question, most commonly household smoking and dental health. It was not possible to accurately assess frequent attendance and 97% of parents/carers stated that they thought their child or young person was fully vaccinated for their age, which is likely to be an over-estimate.ConclusionsIt is feasible to deliver a brief public health intervention in the PED and such an approach is acceptable to a variety of stakeholders including CYP, parents/carers and nursing staff. The pilot revealed issues around data quality and access. Future work will focus on vaccination and dental health.

Risk factors for the frequent attendance of older patients at community health service centers in China: a cross-sectional study based on stratified sampling

Background This study aimed to investigate the characteristics of frequent attenders (FAs) among older patients in Shanghai, China, and explore the associated factors. Methods This cross-sectional study was conducted in six community health service centers in Shanghai, China, from August to December 2018 based on stratified sampling. On the basis of our preliminary study, FAs were defined as those attending at least four consultations in a month. A self-administered questionnaire was used to collect the clinicodemographic data of the participants. Social support, pain severity, depression, and anxiety were evaluated using the Social Support Revalued Scale, six-point Behavioral Rating Scale, Patient Health Questionnaire–9, and Generalized Anxiety Disorder Scale, respectively. Results This study included 619 patients aged > 60 years. Among these patients, 155 (25%) were FAs to a community health service center, 366 (59.1%) had 1 or 2 chronic diseases, 179 (28.9%) had ≥3 chronic diseases, 313 (50.4%) opted for a family doctor service, and 537 (86.8%) chose a community health service center for the first consultation. The following were identified as independent risk factors for frequent attendance: widowed status, unmarried status, the presence of > 3 chronic diseases, first consultation at a community health service center, high medical expenses, frequent attendance of the spouses, long-term medication, the use of both traditional Chinese and Western medicine services, and depression. Conclusions This study summarizes the characteristics of older FAs to community health service centers in China and identifies 10 risk factors significantly associated with frequent attendance.

Gaining Faith, Losing Faith: How Education Shapes the Relationship between Religious Transitions and Later Depression

Using the life course perspective, we assess the “resources” and “risks” to mental health associated with transitions in religious attendance between early life and midlife and how this process may be influenced by education. Drawing on over 35 years of prospective panel data from the National Longitudinal Study of Youth, baseline models suggest that stable, frequent attendance accumulated between adolescence to midlife and increases to frequent attendance by adulthood are associated with the lowest depression relative to consistent nonattenders. Individuals who declined in their religious participation report higher depression. Education conditioned this association, whereby declines in religious participation negatively impacted the health of those without a college degree more strongly and increases benefitted the well-educated to a greater extent. We combine insights from the life course perspective and work on social stratification and religiosity to interpret our results and offer directives for future research.

Sociodemographic characteristics and disability pensions of frequent attenders in occupational health primary care – a follow-up study in Finland

Background Work disability is a complex issue that requires preventive efforts from healthcare systems and individuals, and that too often results in disability pensions (DP). While many studies have attempted to characterize risk factors of work disability, many showing for example a link between socioeconomic positions, working conditions and frequent attendance to OH primary care it is not known if frequent attendance is associated with DP despite the sociodemographic factors. This study aims to address this gap and examine the association between frequent attendance to OH primary care and DP, when adjusted by sociodemographic factors. Methods This study combines routine medical record data of an occupational health service provider with comprehensive national registers. Medical record data were used to define groups of frequent attenders to OH primary care (FA) (1-year-FA, 2-year-FA, persistent-FA and non-FA) from 2014 to 2016. The sociodemographic factors (including i.e. educational level, occupational class, unemployment periods) were derived from Statistic Finland and DP decisions were derived from Finnish Centre for Pensions. Association of frequent attendance to OH primary care with DP decisions were analyzed and adjusted by sociodemographic factors. Results In total, 66,381 patients were included. Basic and intermediate education along with manual and lower non-manual work predicted frequent attendance to OH primary care. Unemployment in 2013 did not predict frequent attendance to OH primary care. Frequent attendance to OH primary care was associated with DP within next two years, even when adjusted for sociodemographic factors. The association of frequent attendance to OH primary care with DP grew stronger as high service use persisted over time. Conclusions Frequent attendance to OH primary care is associated with DP risk in the near future despite the underlying sociodemographic differences. Patients using OH primary care services extensively should be identified and rehabilitative needs and measures necessary to continue in the work force should be explored. Sociodemographic issues that co-exist should be explored and considered when planning interventions.

Characteristics of frequently attending children in hospital emergency departments: a systematic review

ObjectiveTo summarise the literature on frequent attendances to hospital emergency departments (EDs) and describe sociodemographic and clinical characteristics of children who attend EDs frequently.SettingHospital EDs.ParticipantsChildren <21 years, attending hospital EDs frequently.Primary outcome measuresOutcomes measures were defined separately in each study, and were predominantly the number of ED attendances per year.ResultsWe included 21 studies representing 6 513 627 children. Between 0.3% and 75% of all paediatric ED users were frequent users. Most studies defined four or more visits per year as a ‘frequent ED’ usage. Children who were frequent ED users were more likely to be less than 5 years old. In the USA, patients with public insurance were more likely to be frequent attenders. Frequent ED users more likely to be frequent users of primary care and have long-term conditions; the most common diagnoses were infections and gastroenteritis.ConclusionsThe review included a wide range of information across various health systems, however, children who were frequent ED users have some universal characteristics in common. Policies to reduce frequent attendance might usefully focus on preschool children and supporting primary care in responding to primary care oriented conditions.

Prospective associations between multidimensional religiosity/spirituality and cardiovascular risk factors in the English longitudinal study of ageing

Background Religiosity/Spirituality (R/S) is usually associated with improved cardiovascular disease (CVD) outcomes. If such findings are genuine, they may be explained by the relationship between different R/S dimensions and CVD behavioural and biological risk factors. However, previous studies were mostly cross-sectional, used attendance as main R/S measure and dealt with cofounders inadequately. Hence, more longitudinal research is needed. Purpose This study explored whether multidimensional R/S predicted improvements in future CVD behavioural and physiological risk factors. Methods Participants were 6,844 adults aged 50+ from the English Longitudinal Study of Ageing. Smoking, exercising, drinking, eating fruits/vegetables and R/S were evaluated by self-report at waves 5 (2010/11) and 7 (2014/15). Physical examination and blood samples at waves 4 (2008/09) and 6 (2012/13) involved measurement of blood pressure (BP), body-mass index (BMI), C-reactive Protein (CRP), fibrinogen and HbA1c. Hierarchical multiple regressions controlled for age, gender, wealth, education and ethnicity. Models assessing biomarkers were further adjusted for the four health behaviours and BMI. Data on HbA1c, drinking and eating fruits/vegetables were log-transformed to ensure normal distribution. Results Greater reported spirituality (B=−0.018; CI: −0.035, −0.002; p=.029), praying/meditating daily (B=−0.017; CI: −0.033, −0.002; p=.025) and involvement in organised religion (B=−0.018; CI: −0.033, −0.003; p=0.017) were independently associated with lower fibrinogen at wave 6. Daily prayer/meditation also predicted a higher intake of fruits and vegetables at wave 7 (B=0.004; CI: 0.000, 0.008; p=0.049). However, frequent attendance (OR=0.846; CI: 0.730, 0.982; p=0.027), importance of faith (OR=0.935; CI: 0.879, 0.994; p=0.031) and religious purpose (OR=0.939; CI=0.884, 0.997; p=0.040) independently reduced the odds of meeting exercise recommendations at wave 7. Similarly, frequent attendance predicted higher HbA1c at wave 6 (B=0.002; CI: 0.000, 0.005; p=0.033). R/S was associated with lower systolic and diastolic BP, lower alcohol consumption and greater sedentary behaviour, but these relationships were explained by covariates. Smoking and CRP were unrelated to R/S. Conclusions We found that higher R/S offered partial future cardiovascular protection as it was independently associated with lower fibrinogen and greater intake of fruits and vegetables. However, somewhat unexpectedly, higher R/S also aggravated some CVD risk factors such as HbA1c and engagement in moderate/vigorous exercise. Besides, R/S was associated with lower BP and alcohol consumption at follow-up, but this relationship did not survive adjustment for covariates. Finally, we found no prospective association between R/S and smoking status and CRP. R/S is complicated, and further research should include measures of adverse aspects of religious involvement to clarify the drivers of these detrimental effects of R/S on CVD risk factors. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute on AgeingUK Government Departments

High prevalence of previous infection with SARS-CoV-2 and persistent symptoms at a large university

Importance: Universities are unique settings with large populations, congregate housing, and frequent attendance of events in large groups. However, the prevalence of previous infection with SARS-CoV-2 in university students, including symptomatic and asymptomatic disease, is unknown. Objective: To determine the prevalence of previous infection, risk factors for infection, and the prevalence of persistent symptoms following infection among university students. Design: This was a cross-sectional study that surveyed students about demographics, risk factors, and symptoms, and simultaneously tested their saliva for IgA antibodies to SARS-CoV-2. To estimate the prevalence of previous infection we adjusted our intentional sample of a diverse student population for year in school and age to resemble the composition of the entire student body, and adjusted for the imperfect sensitivity and specificity of the antibody test. Univariate and multivariate analysis was used to identify independent risk factors for infection. Setting: A large public university in Athens, Georgia between January 22 and March 22, 2021. Participants: Undergraduate and graduate students; 488 completed the survey, 432 had a valid antibody result. and 428 had both. Exposure: Previous infection with SARS-CoV-2 based on measurement of IgA antibodies in saliva and adjustment for sample characteristics and test accuracy. Main Outcomes and Measures: The primary outcome was the estimated prevalence of previous infection with SARS-CoV-2. Secondary outcomes were independent risk factors for infection, and the prevalence of persistent symptoms among persons reporting a previous symptomatic infection. Results: The estimated prevalence of previous infection for 432 participants with valid antibody results was between 41% and 42%. Independent risk factors for infection included male sex, having a roommate with a known symptomatic infection, and having 2 or fewer roommates. More frequent attendance of parties and bars was a univariate risk factor, but not in the multivariate analysis. Of 122 students reporting a previous symptomatic infection, 14 (11.4%) reported persistent symptoms a median of 132 days later. Conclusions and Relevance: Previous infection with SARS-CoV-2, both symptomatic and asymptomatic, was common at a large university. Measures that could prevent resurgence of the infection when students return to campus include mandatory vaccination policies, mass surveillance testing, and testing of sewage for antigen to SARS-CoV-2.

Frequent attendance at the emergency department shows typical features of complex systems: analysis of multicentre linked data

ObjectiveFrequent attendance at the ED is a worldwide problem. We hypothesised that frequent attendance could be understood as a feature of a complex system comprising patients, healthcare and society. Complex systems have characteristic statistical properties, with stable patterns at the level of the system emerging from unstable patterns at the level of individuals who make up the system.MethodsAnalysis of a linked dataset of routinely collected health records from all 13 hospital trusts providing ED care in the Yorkshire and Humber region of the UK (population 5.5 million). We analysed the distribution of attendances per person in each of 3 years and measured the transition of individual patients between frequent, infrequent and non-attendance. We fitted data to power law distributions typically seen in complex systems using maximum likelihood estimation.ResultsThe data included 3.6 million attendances at EDs in 13 hospital trusts. 29/39 (74.3%) analyses showed a statistical fit to a power law; 2 (5.1%) fitted an alternative distribution. All trusts’ data fitted a power law in at least 1 year. Differences over time and between hospital trusts were small and partly explained by demographics. In contrast, individual patients’ frequent attendance was unstable between years.ConclusionsED attendance patterns are stable at the level of the system, but unstable at the level of individual frequent attenders. Attendances follow a power law distribution typical of complex systems. Interventions to address ED frequent attendance need to consider the whole system and not just the individual frequent attenders.

Determinants of Frequent Attendance in Primary Care. A Systematic Review of Longitudinal Studies

Introduction: There is a lack of a systematic review synthesizing longitudinal studies investigating the determinants of frequent attendance in primary care. The goal of our systematic review was to fill this gap in knowledge.Methods: Three electronic databases (Medline, PsycINFO, and CINAHL) were searched. Longitudinal observational studies analyzing the predictors of frequent attendance in primary care were included. Data extraction covered methods, sample characteristics, and main findings. Selection of the studies, extracting the data and evaluation of study quality was performed by two reviewers. In the results section, the determinants of frequent attendance were presented based on the (extended) Andersen model.Results: In total, 11 longitudinal studies have been included in our systematic review. The majority of studies showed that frequent attendance was positively associated with the predisposing characteristics lower age, and unemployment. Moreover, it was mainly not associated with enabling resources. Most of the studies showed that need factors, and in particular worse self-rated health, lower physical functioning and physical illnesses were associated with an increased likelihood of frequent attendance. While most studies were of good quality, several of the included studies did not perform sensitivity analysis or described how they dealt with missing data.Discussion: Our systematic review showed that particularly lower age, unemployment and need factors are associated with the likelihood of becoming a frequent attender. Enabling resources are mainly not associated with the outcome measure. Future research should concentrate on the determinants of persistent frequent attendance due to the high economic burden associated with it.

Equal Protection? Differential Effects of Religious Attendance on Black-White Older Adult Mortality

Social determinants of later life population health are “the circumstances in which we are born, grow up, live, work, and age” usually identified as power and status determinants: income, wealth, and education. Although rarely considered a social determinant of health, religious social ties are a familiar “circumstance” for many older persons, and there is considerable evidence linking religious attendance to all-cause mortality. There are race differences in both religiosity and mortality patterns: Black Americans show higher levels of both religious attendance and mortality compared with white Americans. This raises the question of equal protection of religious attendance: Is the protective effect of religious attendance on mortality weaker, stronger, or the same for whites and African Americans? The analysis employs 10-year longitudinal data from the Health and Retirement Study, 2004-2014 (N=18,346). In stratified models, after adjustment for sociodemographic factors and health, African Americans have a hazard ratio (HR) for frequent attendance at services that is more protective than for whites: .48 (95%CI: .35, .67) compared with .61 (95%CI: .53, .70). Health behaviors mediate 19% of the effect for blacks and 26% for whites; other social ties mediate 12.5% of the effect for blacks and 7% for whites. An interaction test shows a more protective effect of frequent attendance for blacks compared with whites (p&lt;.000). Religious attendance may be more beneficial for African Americans who are multiply disadvantaged with respect to other social determinants of health. The mediation patterns also suggest that the mechanisms of effect for blacks and whites may differ.