Stakeholder Analysis: Medicare Diabetes Prevention Program Awareness and Implementation

Study Design: We conducted a qualitative stakeholder analysis project with suppliers of the MDPP and health care providers. Am J Manag Care. 2023;29(6):In Press _____ Takeaway Points More than 5 years after CMS enacted coverage of the CDC-approved Medicare Diabetes Prevention Program (MDPP) in 2018, little is known about why MDPP uptake is so limited. * Findings of our stakeholder analysis with program suppliers and health care providers reinforced existing evidence on insufficient reimbursement and low awareness of the program. * Newer insights include recommendations about lagged payments, ongoing virtual delivery, and formally diagnosing prediabetes among MDPP participants. * Our findings on barriers and facilitators can inform policy to refine the MDPP and research on the MDPP, particularly within the field of implementation science. _____ Population-level strategies to prevent type 2 diabetes are urgently needed for the more than 24 million older adults with prediabetes in the United States.1 Evidence-based lifestyle interventions can prevent diabetes onset, per evidence from the landmark Diabetes Prevention Program trial.2 Thus, the CDC launched the National Diabetes Prevention Program (NDPP) in 2010.3 Significant reductions in weight and medical spending were observed among Medicare beneficiaries who participated in the NDPP,4 prompting CMS to fully cover the Medicare Diabetes Prevention Program (MDPP) starting in 2018.5 Despite unprecedented Medicare coverage for a disease prevention program, MDPP uptake is limited. Regarding awareness, national guidelines recommend referral to lifestyle intervention for adults aged 40 to 70 years with prediabetes.9 Yet less than 5% of adults eligible for a NDPP reported receiving a referral,10 which may stem from limited awareness among health care providers.11 Thus, we conducted a qualitative stakeholder analysis to learn about regional awareness of, referral to, facilitators of, and barriers to the MDPP. The 8 interviewees included 5 program directors (3 from YMCAs, 1 from a private organization, and 1 from a hospital system) and 3 health care providers (2 family physicians and 1 dietitian).

Students' sense of belonging at a South African university during COVID-19

The research on students' sense of belonging in higher education has evolved into a prominent theme worldwide. Institutional research focuses on the institution understanding itself and helps leaders to rethink improvement initiatives. Moreover, the COVID-19 pandemic has required of institutions to revise student support programmes and approaches to maintain a strong sense of belonging. The theories of belonging by Strayhorn (2012) and Dumford et al. (2019) were adopted to analyse student responses. The aim of the study was to understand students' sense of belonging and how the university responded to the challenges presented by the COVID-19 pandemic to ensure a strong sense of belonging. Data were generated through in-depth interviews with 45 undergraduate students from all seven faculties. The findings highlight notable prevention measures intended to limit the spread of the virus on campus and student support in the form of study devices and data. The post-lockdown changes included a return to face-to-face mental health support, drafting COVID-19 catchup plans for first year orientation of 2020 and 2021 cohorts, improving the student voice. Finally, notable principles for responding to a future higher education crisis are highlighted. These initiatives contributed towards establishing and maintaining a strong students' sense of belonging.

Coronavirus (COVID-19) pandemic implications on nursing care: A short review

The Coronavirus (COVID-19) disease is a global pandemic infectious disease caused by a novel coronavirus, which affects all age groups with a higher incidence in the geriatric population and people with chronic diseases. The outbreak of the virus is a serious public health challenge including to nurses at the various health care facilities around the world. The outbreak of the coronavirus has been a huge threat to nursing and nursing care globally. Nurses are experiencing a high level of daily emotional stress in their activities in preventing disease infections, promoting health, and saving lives. Many nurses have lost their lives to the deadly disease in their fight to save their patients, many feel stressed and burnout, and many feeling discouraged because of the protracted effects of the disease. The psychological health of the nurses as frontline health care workers should be safeguarded owing to their crucial roles in mitigating disease pandemics. Thus, adequate training of nurses would better equip them with the necessary information regarding the preventive measures, and management approaches to foster the mitigation of the disease, mitigate the disease burden on healthcare facilities, and enhance the recovery rate of the infected populations. Andfurther better prepare nurses on prioritizing personal psychological health.

Savings groups and the COVID-19 pandemic in Zimbabwe: Critical assessment of the informal social protection scheme

The COVID-19 pandemic has ravaged nations and people's lives throughout the globe across multiple dimensions. Measures to curtail the spread of the disease in Zimbabwe have stifled the capacity of the majority of the population, relegated to the informal sector, to source a living. In the absence of robust social protection interventions from the state, these measures pose a more immediate threat to the lives of marginalised and vulnerable communities than the pandemic itself. Savings groups (SGs), which have providedfinancial relief andprotection from economic shocks and stressors to such population groups, have been entrapped by the preventive and containment measures employed by the Zimbabwean authorities. It is unclear how and to what degree such conditions leave underserved populations exposed to socioeconomic shocks as such vital informal social protection alternatives have been rendered ineffectual. Using documentary review, this study examines the fate of SGs in such socially restricted and economically debilitating circumstances. In addition, the authors discuss strategies for improving the sustainability of such grassroots micro-finance initiatives under COVID-19 induced contraptions. Programmatic andpolicy measures necessary for retaining and protecting the viability of (SGs) as alternatives for informal social protection for marginalised and vulnerable groups under COVID-19 are advanced.

Best practices for pediatricians in diagnosing and treating asthma

Additionally, they can treat atopic comorbidities such as atopic dermatitis, chronic urticaria, nasal polyps, eosinophilic esophagitis, and hypereosinophilic syndrome, resulting in improved quality of life for our patients. Parents should be made aware of its updated black box warning for possible effects on mental health and behavior changes,3 including but not limited to suicidal ideation. FDA requires boxed warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair);advises restricting use for allergic rhinitis.

Improving Prevention: From Screening to Qualified Rehabilitation

In recent health care studies an alarming increase of lifestyle-associated risk factors (such as obesity and physical inactivity) was observed in general population;the corona pandemic will increase this development. Therefore, better educational efforts (particularly in populations with low socioeconomic status) and governmental measures (e.g. smoking prevention and regulations for healthy diet) are needed.For cardiovascular screening and risk stratification in individuals, the European guidelines recommend SCORE2 and risk modifiers (imaging by carotid ultrasound or coronary computer tomography, psychosocial and ethnic factors, comorbidities). More complex tools of risk stratification (including genetics, artificial intelligence) can be expected in the future;however, they are currently not recommended for routine use.In most patients with cardiovascular diseases long-term risk factor control does not meet the targets of international guidelines. Intensive prevention programs, performed by prevention assistants under physician supervision, have demonstrated in clinical studies that they are effective to improve risk factor control and reduce events as well as costs. Therefore, a curriculum for cardiovascular prevention assistance was introduced in the last year in Germany as a standard of education for prevention assistants, who can now improve long-term prevention efforts in clinical practice.

Traumatic pediatric firearm injuries during the COVID-19 pandemic

Statement of Purpose: The purpose of this study is to epidemiologically describe firearms injuries treated at a Level 1 pediatric trauma center occurring during the COVID-19 pandemic and compare them to injuries seen in the year prior.Methods: This is a retrospective chart review of patients seen by pediatric trauma surgery for a firearm injury between February 1, 2019 and March 30, 2021;the pre-pandemic time period included February 1, 2019 – March 9, 2020 and the pandemic period included March 10, 2020 – March 31, 2021. We excluded patients with firearms injuries that were not assessed by trauma surgery and patients with injuries from non-powder guns.Results: Twenty-eight patients were seen for firearm injuries in the pre-pandemic period;22 (78.5%) were male, and the mean age was 13.3 years, with 17.8% of patients < 10 years old. Sixteen (57.1%) were black, 8 (28.6%) white, and 4 (14.3%) multiracial. The pandemic period included 80 patients with firearm injuries, with 59 (74%) male, and a mean age of 12.5 years. Seventeen (21.5%) were < 10 years old. Fifty-six (70%) of patients during the pandemic period were black, 15 (20%) white, 6 (7.5%) multiracial, and 2 (2.5%) Hispanic. There was no statistically significant difference between the two groups demographically. No patients were identified as having an intentional self-inflicted firearm injury.Conclusion: While there was a nearly threefold increase in pediatric firearm injuries seen during the pandemic, the demographics of the victims have not changed compared to pre-pandemic patterns. This reflects a need for ongoing and targeted preventive measures to reduce these extremely high-risk injuries.Key Take Away Points [list] [list] [list_item] Since the World Health Organization (WHO) declared a pandemic from the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2 or COVID-19), there has been a dramatic increase in the number of pediatric firearm injuries identified when compared to the preceding year. [/list_item] [list_item] A continued pattern of racial distribution before and during the pandemic with black children being overrepresented in the population with firearm injury as compared to all injuries seen was identified, with an overwhelming majority of firearm injuries occurring in urban areas. [/list_item] [list_item] The profound escalation of firearm injury in the pediatric population during the pandemic demonstrates the critical need for intensive community intervention and prevention efforts. [/list_item] [/list]

COVID-19 Fears and Preventive Behaviors among Prison Staff

This study focused on COVID-19 preventive behaviors and fears among prison staff members after the first wave of the pandemic. Cross-sectional data from 171 participants were collected in Switzerland. The level of fears (58.5%) and protective behaviors (100%) were high. Correctional officers adhered less to preventive measures than other staff members (p = .001). Fears were related to a reduction of social contacts (p = .006) and worries about physical health was related to preventive behaviors in general (p = .006). There is a need to raise prison staff awareness regarding their vulnerability to the SARS-CoV-2 in order to improve the effectiveness of health campaigns in prison settings. Special attention should be given to correctional officers.

Preventing Non-Ventilator Hospital-Acquired Pneumonia: A Survey of Medical-Surgical Nurses

In 2008, the Centers for Disease Control and Prevention (CDC, n.d.) National Healthcare Safety Network (NHSN) announced new requirements, enforced with fiscal penalties, for hospitals to address hospital-acquired infections (HAIs). [...]nurse leaders across the United States supported design of new protocols and procedures to reduce central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP), surgical site infection (SSI), and more. Recognizing the impact of NVHAP on patient safety and the lack of requirements for hospitals to monitor or report NVHAP, a group of U.S. healthcare leaders sponsored by the Department of Veterans Affairs formed the nurse-led National Organization to Prevent Hospital-Acquired Pneumonia (NOHAP) in 2020. The survey also included questions related to known NVHAP prevention practices on policy, training, monitoring and documentation, family involvement, supply availability, and specific oral care practices related to the COVID19 pandemic. Because recent research demonstrated some promise in the use of antiseptic mouth rinses in eradicating SARS-CoV-2 virus, two questions were included related to use of mouth rinses (Casale et al., 2020;Pelletier et al., 2021).

DEVELOPMENT OF AN ADVANCED PRACTICE PROVIDER (APP) LED HIGH-RISK CANCER PREVENTION PROGRAM IN A COMMUNITY SETTING

Many individuals are at an increased risk for developing cancer due to their genetics, environmental factors, prior diagnoses, lifestyle or demographics. Disparities in healthcare access and available services further increase cancer risk in certain communities. The COVID pandemic exacerbated these disparities with decreases in cancer screening rates. Those at increased cancer risk may be eligible for earlier, more frequent, or enhanced screenings, genetic testing, preventive medications, or surgeries. The purpose was to highlight the development of a High-Risk Cancer Prevention Program led by advanced practice providers (APPs) within a community healthcare system that aims to reduce disparities in cancer care by targeting underserved areas and populations within the community. The program provides patient-centered care focused on improving outcomes by performing comprehensive genetic, medical, and lifestyle risk assessments across the continuum from preventative care through survivorship. APPs provide smoking cessation services and work in partnership with registered dieticians to provide nutrition counseling and with genetic counselors, bariatrics, primary care, and oncology to provide access to comprehensive services needed to address the patients individualized risk factors. Partnerships with local community organizations provide collaborative services in areas with disparate outcomes to promote cancer screening awareness, education about cancer risk factors, and facilitate entrance into the healthcare system. As part of a community healthcare system APPs are positioned to serve both urban and rural populations where there is greatest need. Impact of these activities are measured utilizing a database tracking the demographics of patients served, services provided, adherence to surveillance recommendations, testing performed, and outcomes including cancers detected. APPs are uniquely trained to operate this clinic due to their ability to perform the comprehensive risk assessments, prescribe the necessary testing and interventions, educate and collaborate with the patient on lifestyle risk modification. The longitudinal care management provided in partnership with other healthcare providers ensures that risk assessment remains dynamic and care is provided in accordance with the latest guidelines. An APP driven program successfully focuses on the individual patient, in addition to the disparate needs of the community abling the to have a positive impact on cancer outcomes by delivering truly personalized care. While many high-risk programs focus on one specific cancer type, our program will be one of the first in Wisconsin to offer a comprehensive high-risk program for multiple cancer types.

How political orientation, economic precarity, and participant demographics impact compliance with COVID-19 prevention measures in a Dutch representative sample

We examine the relationship between individuals' political orientations and their compliance with and attitudes towards COVID-19 prevention measures using a Dutch nationally representative online sample. Due to ideological differences, we predict that people with left-wing and progressive orientations will comply more with and have more favourable attitudes towards COVID-19 prevention measures than people with right-wing, populist, and conservative orientations, while right-wing extremists will have lowest levels of compliance and least favourable attitudes towards prevention measures. Our results support these predictions. Furthermore, we test the effect of individuals' economic precarity and demographic characteristics on compliance and attitudes towards prevention measures. Results show that people experiencing economic difficulties do comply yet have less favourable attitudes towards the measures, while fear of economic loss is related to both lower compliance and less favourable attitudes towards measures. Older citizens have higher levels of compliance and more positive attitudes, whereas gender and education are not consistently related to compliance and attitudes. We further explore how these three sets of factors (political orientation, economic precarity, and demographics) are related to policy preferences for either reducing infection rates or reducing the economic impact of the pandemic. Our results suggest that all three sets of predictors are important in shaping measure compliance as well as attitudes and policy support and should all be considered for a comprehensive understanding of individuals' responses to COVID-19 measures.

Outcomes of building a lasting connection: A pilot study

This pilot study used a quantitative design with a two-year follow-up to evaluate the effect couples participation in the early relationship education program, Building a Lasting Connection (BLC), had on participants' relationship satisfaction and dyadic adjustment and whether outcomes differed between those who practiced with a post-workshop take-home tool, and those who did not. The Revised Dyadic Adjustment Scale (RDAS) and a researcher-created measure of stress to account for COVID-related stressors were used. The sample of participants was not randomized and there was no control group. The means of pretest scores (n = 73) taken at the start of workshops held shortly before the onset of COVID were compared to the means of scores (n = 15) at two-year follow-up. The follow-up sample consisted of six men and nine women who participated in a BLC workshop with their intimate partner. The average length of relationship was 4.8 years. Results showed statistically significant improvement in the RDAS measures of cohesion, satisfaction and total RDAS composite score. Cohesion improved most, with scores increasing from distressed to non-distressed levels. Consensus, which did not improve, had an inverse relationship with the amount of stress couples experienced after attending the workshop. Participants who used the take-home tool at least one to two times after completing the workshop improved in all areas compared to those who did not use the tool, but with statistical significance for the RDAS composite score only. There was no statistically significant association between the demographic variables (age and gender) and study outcomes. These findings provide preliminary support for the effectiveness of the BLC program in bolstering couples dyadic adjustment and relationship satisfaction, and the use of a take-home tool as a mechanism to improve outcomes and support long-term change in relationship satisfaction. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

China in 2022: Political Power, Zero-COVID Policy, and Economic Slump

In 2022, president Xi Jinping's prolonged one-man rule was formalized, further concentrating political authority in the Communist Party of China. Unemployment increased sharply because of the continued zero-COVID policy, and the economy declined significantly, generating pain and dissatisfaction and leading to anti-government protests and demonstrations in several cities. At the end of the year, the Party recognized the crisis and eased the preventive measures. Internationally, the United States maintained its technology blockade, hampering China's economy.

Who benefits most from suicide prevention workshops in schools?

To improve suicide prevention in schools, we implemented workshops for students in grades 8-10. The students (N=200) were randomly assigned to either a training or a control group and were surveyed regarding their help-seeking and help-giving behavior and their depressive symptoms both before and after the training as well as 3 months later. The results indicate that especially those students assessed to be at a higher risk for suicide benefitted most from the training. Their number of depressive symptoms decreased significantly and remained stable. Participants undergoing the training tended to be more likely to ask a teacher for help and to initiate more crisis counseling interactions with peers in need than did untrained controls;these differences, however, were not statistically significant. Though hampered by high dropout rates because of the Covid-19 pandemic and a restrictive prescreening process, these results indicate the positive effects of an extracurricular suicide prevention program on students' well-being and behavior. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (German) Um die Suizidpravention an Schulen zu verbessern, wurden psychoedukative Workshops fur Schuler_innen implementiert und angeboten. N=200 Schuler_innen der 8.-10. Jahrgangsstufe wurden zufallig einer Experimental- oder Kontrollgruppe zugewiesen. Vor und nach dem Training sowie nach drei Monaten wurden sie zu ihrem hilfesuchenden und hilfegebendem Verhalten sowie ihrer depressiven Symptomatik befragt. Die Ergebnisse weisen darauf hin, dass besonders die als starker suizidgefahrdet eingestuften Jugendlichen von dem Training durch eine Abnahme ihrer depressiven Symptomatik profitierten. Schuler_innen der Kontrollgruppe verbesserten sich demgegenuber nicht signifikant in ihrer depressiven Symptomatik. Fur das hilfesuchende ebenso wie das hilfegebende Verhalten zeigten sich positive Trends, die jedoch nicht statistisch signifikant wurden. Diese Ergebnisse zeigen - wenn auch mit Limitationen aufgrund von Ausfallen durch die Coronapandemie 2020 und durch ein restriktives Vor-Screening - die Wirksamkeit einer aufwandigen auserschulischen Suizidpravention auf Befinden und Verhalten. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

COVID-19 complications and entrepreneurial intention among the entrepreneurs of Pakistan: evidence from the second wave of the pandemic

PurposeAt present, nearly the whole globe is facing a severe threat of COVID-19. This study aims to examine the COVID-19 complications and entrepreneurial intention among the entrepreneurs of Pakistan.Design/methodology/approachThe study used a deductive approach. An online survey is conducted to collect cross-sectional data from entrepreneurs of Pakistan. Convenience sampling is applied to target the respondents. In total, 278 usable answers proceed for final analysis. The structural equation model (SEM) is used to infer the results.FindingsThe findings of the study highlight a significant negative effect of fear of COVID-19 (FO19), perceived susceptibility (PSU) and perceived severity (PSE) on entrepreneurial intention (EI) among the entrepreneurs.Practical implicationsThe study would provide the guidelines for policymakers and planners to combat the barriers of fear, PSU and PSE during a pandemic. The findings of the second wave of COVID-19 may provide a warning to the government to take preventive measures to face the severe effect of the pandemic. Finally, the outcomes of the study may enrich the depth of COVID-19 literature globally.Originality/valueThis study is the first study highlighting factors such as fear, PSU and PSE toward EI in COVID-19 second wave.

Shared and Crowded Housing in the Bay Area: Where Gentrification and the Housing Crisis Meet COVID-19

Amid the growing affordable housing crisis and widespread gentrification over the last decade, people have been moving less than before and increasingly live in shared and often crowded households across the U.S. Crowded housing has various negative health implications, including stress, sleep disorders, and infectious diseases. Difference-in-difference analysis of a unique, large-scale longitudinal consumer credit database of over 450,000 San Francisco Bay Area residents from 2002 to 2020 shows gentrification affects the probability of residents shifting to crowded households across the socioeconomic spectrum but in different ways than expected. Gentrification is negatively associated with low- socioeconomic status (SES) residents' probability of entering crowded households, and this is largely explained by increased shifts to crowded households in neighborhoods outside of major cities showing early signs of gentrification. Conversely, gentrification is associated with increases in the probability that middle-SES residents enter crowded households, primarily in Silicon Valley. Lastly, crowding is positively associated with COVID-19 case rates, beyond density and socioeconomic and racial composition in neighborhoods, although the role of gentrification remains unclear. Housing policies that mitigate crowding can serve as early interventions in displacement prevention and reducing health inequities.

Virtual Versus In-Person Suicide Prevention Training in the Workplace: Evaluation of the VitalCog Program.

Most suicides occur among adults of working age and workplace suicide prevention is a public health priority. Workplace suicide prevention efforts, however, remain limited. This paper describes and evaluates a workplace-based suicide prevention gatekeeper training delivered in-person and virtually. VitalCog is a 2-h suicide prevention program designed specifically for the workplace and based on best practices for gatekeeper training. It is designed to be practical and interactive, with four modules (why prevention matters, what to do if someone is suicidal, conversations about suicide, and postvention), each containing related video, group discussion, and role play exercise components. It was delivered live by experienced trainers either in-person or using synchronous technologies between 2018 and 2021. A mixed methods pre- and post-training design with no control group was used to evaluate in-person vs. virtual delivery to determine knowledge gain, confidence identifying warning signs, and comfort levels talking about suicide. One thousand two-hundred and forty-four (1244) pre- and post-training responses were analyzed, with no significant (p > .05) socio-economic differences between the pre-training and post-training respondent samples. Both in-person (n = 841) and virtual (n = 403) training groups demonstrated statistically significant increases in knowledge about suicide prevention and seeking help, confidence to identify suicide warning signs, and comfort levels talking to someone about getting help. Interestingly, the virtual group showed higher post-training outcome scores than the in-person group. While COVID-19 significantly reduced in-person training opportunities, these results suggest that offering VitalCog virtually is as effective as in-person, and potentially has advantages over in-person training.

Masks and emotional distance: a visual study of human relationships in the Covid-19 pandemic

This study addresses the social impact of the pandemic in terms of its effects on communication and emotion in spaces of everyday domestic activity. The aim is to visually and formally portray the personal, professional and citizen reality in the daily use of face masks. The analysis includes the adoption, advocacy or resistance to them, through various representative characters of different, referential social sectors. The effect of masks on communication and emotional relationships is explored through photo portraits and qualitative interviews developed in a small community in Southern Spain. This work seeks to better understand the communicative, personal and social consequences of such preventive measures.

Emotional distress and quality of life among adults with developmental coordination disorder during COVID-19

Introduction: Individuals with developmental coordination disorder frequently report emotional and functional difficulties. A stressful era as COVID-19 pandemic may enhance emotional load. The present study aimed to (1) examine the emotional distress and quality of life among adults with developmental coordination disorder during COVID-19 as compared to typical controls, and (2) examine the relationships between these factors in adults with developmental coordination disorder. Method: Participants were 317 adults, aged 18–66, recruited during the first year of COVID-19: 227 were included in the developmental coordination disorder group, and 90 in the control group (normal motor performance) based on the Adult Developmental Co-ordination Disorders/Dyspraxia Checklist cutoff score. Participants completed a sociodemographic health status/daily life under COVID-19 questionnaire and self-reports about their emotional status (depression, anxiety, stress) and a quality of life. Results: The developmental coordination disorder group had significantly greater depression, anxiety, stress, and lower quality of life. Participants with developmental coordination disorder who were infected by COVID-19 or reported reduction of working hours due to COVID-19 had the lowest social and environmental quality of life. Depression significantly predicted reduced quality of life and mediated between developmental coordination disorder severity and quality of life. Conclusions: Prevention and intervention programs for adults with developmental coordination disorder should be elaborated, with reference to emotional load and to implications on daily life, especially in times of crisis, like COVID-19.