Methodology to estimate natural- and vaccine-induced antibodies to SARS-CoV-2 in a large geographic region.

Accurate estimates of natural and/or vaccine-induced antibodies to SARS-CoV-2 are difficult to obtain. Although model-based estimates of seroprevalence have been proposed, they require inputting unknown parameters including viral reproduction number, longevity of immune response, and other dynamic factors. In contrast to a model-based approach, the current study presents a data-driven detailed statistical procedure for estimating total seroprevalence (defined as antibodies from natural infection or from full vaccination) in a region using prospectively collected serological data and state-level vaccination data. Specifically, we conducted a longitudinal statewide serological survey with 88,605 participants 5 years or older with 3 prospective blood draws beginning September 30, 2020. Along with state vaccination data, as of October 31, 2021, the estimated percentage of those 5 years or older with naturally occurring antibodies to SARS-CoV-2 in Texas is 35.0% (95% CI = (33.1%, 36.9%)). This is 3× higher than, state-confirmed COVID-19 cases (11.83%) for all ages. The percentage with naturally occurring or vaccine-induced antibodies (total seroprevalence) is 77.42%. This methodology is integral to pandemic preparedness as accurate estimates of seroprevalence can inform policy-making decisions relevant to SARS-CoV-2.

Mental Healthcare: Experiences of Rural Women With Disabilities Following Interpersonal Violence.

Women with disabilities are at increased risk of interpersonal violence compared to women without disabilities. Little is known, however, about women with disabilities' experience accessing and participating in counseling and other mental health services during and following their victimization, particularly when living in a rural setting. This study involved qualitative interviews with 33 women with diverse disabilities who experienced interpersonal violence in rural communities. Researchers used thematic content analysis to identify three key themes from the findings: (a) experiences learning about mental health service options, (b) challenges to finding an appropriate "fit" and therapy approach, and (c) access barriers to mental health services. Participants emphasized the need for provider training specific to disability, the inclusion of people with disabilities more prominently in the mental health workforce, and the importance of advancements in accessible telemental health. We discuss implications for improving mental health services.

"They Didn't Ask." Rural Women With Disabilities and Experiences of Violence Describe Interactions With the Healthcare System.

Women with disabilities are at risk of experiencing multiple forms of severe and prolonged violence, yet guidelines for screening this population are unclear, screening rates are historically low, and screening tools may be inadequate to capture disability-related aspects of abuse. We conducted qualitative in-depth interviews with 33 rural women in the United States with diverse disabilities and experiences of violence. They described overarching healthcare provider and system factors that influenced their trust and confidence in healthcare delivery as an avenue to support their safety. Women described interactions with the healthcare system during their experience of violence as a missed opportunity for identifying and responding to their abuse and connecting them with resources. We conclude with policy and practice recommendations based on women with disabilities' perspectives and insights.

"Helping Somebody Else Has Helped Me Too": Resilience in Rural Women With Disabilities With Experiences of Interpersonal Violence.

The concept of resilience, the ability to "bounce back," from adversity, can inform interpersonal violence interventions and victim assistance services. Unfortunately, though women with disabilities (WWD) experience high rates of all forms of violence and multiple layers of adversity, existing resilience research overlooks this populations' experiences, perspectives, and resilience strategies. The impairment, socially misperceived as a personal tragedy, precludes individuals with disabilities from being considered resilient; rather, they are designated almost universally as "at risk" or "vulnerable." This study aims to remedy this gap in understanding and scholarship. This qualitative study engaged 33 rural women with diverse disabilities who experienced violence to learn about how they cultivated resilience to support recovery and growth after experiencing abuse. Women described key personal qualities and supportive networks and services, such as internal drive, connectedness, dedication, healthy and helpful outlets, and an evolution of thoughts and behaviors. Counter to prevailing perceptions of WWD as dependent and helpless, women described how living with a disability honed strengths fundamental to their resilience. Women also described an "altruism born of suffering" wherein their experiences of violence contributed to a desire to give back and help others in difficult circumstances.Women's insights help to build a more comprehensive understanding of effective strategies and supports to bolster WWD's resilience. These findings inform interventions and promote approaches to build on women's strengths and resourcefulness.

Strategies to Estimate Prevalence of SARS-CoV-2 Antibodies in a Texas Vulnerable Population: Results From Phase I of the Texas Coronavirus Antibody Response Survey.

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and immunity remains uncertain in populations. The state of Texas ranks 2nd in infection with over 2.71 million cases and has seen a disproportionate rate of death across the state. The Texas CARES project was funded by the state of Texas to estimate the prevalence of SARS-CoV-2 antibody status in children and adults. Identifying strategies to understand natural as well as vaccine induced antibody response to COVID-19 is critical. Materials and Methods: The Texas CARES (Texas Coronavirus Antibody Response Survey) is an ongoing prospective population-based convenience sample from the Texas general population that commenced in October 2020. Volunteer participants are recruited across the state to participate in a 3-time point data collection Texas CARES to assess antibody response over time. We use the Roche Elecsys® Anti-SARS-CoV-2 Immunoassay to determine SARS-CoV-2 antibody status. Results: The crude antibody positivity prevalence in Phase I was 26.1% (80/307). The fully adjusted seroprevalence of the sample was 31.5%. Specifically, 41.1% of males and 21.9% of females were seropositive. For age categories, 33.5% of those 18-34; 24.4% of those 35-44; 33.2% of those 45-54; and 32.8% of those 55+ were seropositive. In this sample, 42.2% (89/211) of those negative for the antibody test reported having had a COVID-19 test. Conclusions: In this survey we enrolled and analyzed data for 307 participants, demonstrating a high survey and antibody test completion rate, and ability to implement a questionnaire and SARS-CoV-2 antibody testing within clinical settings. We were also able to determine our capability to estimate the cross-sectional seroprevalence within Texas's federally qualified community centers (FQHCs). The crude positivity prevalence for SARS-CoV-2 antibodies in this sample was 26.1% indicating potentially high exposure to COVID-19 for clinic employees and patients. Data will also allow us to understand sex, age and chronic illness variation in seroprevalence by natural and vaccine induced. These methods are being used to guide the completion of a large longitudinal survey in the state of Texas with implications for practice and population health.

Patient Use of Cardiovascular Devices and Apps: Are We Getting Our Money's Worth?

The evolution of technology makes it likely that a large number of people will invest in and use health-related mobile applications and wearable devices. Yet the question remains: Do these technology-based interventions modify health behavior and improve health…and are we getting our money's worth? The vast majority of studies concerning health-related apps and wearable devices have small sample sizes and short time spans of 6 months or less, so it is not clear if these durations were determined by lack of consistent use over time. Furthermore, many of the most popular applications have not been subjected to randomized trials. Overall, the small demonstrated improvements in outcomes are often associated with professional involvement from clinicians, coaches, or diabetes educators provided in conjunction with use of mobile health (mHealth) platforms. This paper explores the use of mHealth technologies that address cardiovascular disease/prevention (eg, diabetes, diet, physical activity, and associated weight loss) and discusses the lack of adequate evidence to support even minimal patient investment in mobile applications or wearable devices at this time.

Reducing the Cost of Medicaid: A Multistate Simulation.

According to some estimates, the United States wastes as much as 30% of health care dollars. Some of that waste can be mitigated by reducing certain costs associated with Medicaid. We chose 5 areas of savings applicable to Medicaid: (1) modification of physician payment models to reduce unnecessary care, (2) development of a medication adherence program for patients dually eligible for Medicaid and Medicare support ("dual eligibles"), (3) improvement in unnecessary admissions and readmissions for dual eligibles, (4) reduction in emergency department visits among children in Medicaid and dual-eligible beneficiaries, and (5) improvement in adoption of end-of-life advance directives. We chose the states from both ends of the spending spectrum: the 5 with the lowest annual Medicaid expenditures: Wyoming, South Dakota, Montana, Vermont, and Alaska, and those with the highest: California, New York, Texas, Pennsylvania, and Florida. This spectrum demonstrates the range of potential cost-saving measures, from US $23.6 million in Wyoming to US $3.4 billion in California. We conclude that there are a number of ways to reduce Medicaid spending and improve quality. To the extent that states have already adopted programs addressing the same problems, our approach may be supplementary but the total savings may be achieved with a combination of current initiative and those described here. As Medicaid creates savings, physician payment could be increased to attract more physicians into caring for Medicaid patients.