Provision of chaplaincy services in U.S. hospitals: A strategic conformity perspective.

BACKGROUND: Increasingly, hospitals are expected to provide patient-centered care that attends to patients' health needs, including spiritual care needs. Chaplaincy services help to meet patients' spiritual care needs, which have been shown to have a positive impact on health outcomes. Variation in the provision of chaplaincy services suggests hospitals do not uniformly conform to the expectation of making chaplaincy services available. PURPOSE: The aim of this study was to examine the availability and factors that influence hospitals' provision of chaplaincy services. METHODOLOGY: Data were combined from the American Hospital Association annual surveys with the Area Health Resource File at the county level from 2010 to 2019. Observations on general, acute-care community hospitals were analyzed (45,384 hospital-year observations) using logistic regression that clustered standard errors at the hospital level. RESULTS: Hospitals with Joint Commission accreditation, more staffed beds, nonprofit and government ownership, teaching status, one or more intensive care units, a higher percentage of Medicare inpatient days, church affiliation, and system membership were more likely to provide chaplaincy services than their counterparts. Certification as a trauma hospital and market competition showed no influence on the provision of chaplaincy services. CONCLUSION: The lack of chaplaincy services in many hospitals may be due to limited resources, workforce shortage, or a lack of consensus on scope and nature of chaplaincy services. PRACTICE IMPLICATIONS: Chaplaincy services are an underutilized resource that influences patient experience, clinician burnout and turnover, and the goal of ensuring care is patient-centered. Administrators should consider stronger partnerships where services are provided; researchers and policymakers should consider how the lack of these services in some hospitals may reinforce existing health disparities.

An exploration of barriers to access to trial of labor and vaginal birth after cesarean in the United States: a scoping review.

INTRODUCTION: Increasing the number of vaginal birth after cesarean (VBAC) deliveries is one strategy to reduce the cesarean rate in the United States. Despite evidence of its safety, access to trial of labor after cesarean (TOLAC) and VBAC are limited by many clinical and non-clinical factors. We used a scoping review methodology to identify barriers to access of TOLAC and VBAC in the United States and extract potential leverage points from the literature. CONTENT: We searched PubMed, Embase, Cochrane, and CINAHL for peer-reviewed, English-language studies published after 1990, focusing on access to TOLAC and/or VBAC in the United States. Themes and potential leverage points were mapped onto the Minority Health and Health Disparities Research Framework. The search yielded 21 peer-reviewed papers. SUMMARY: Barriers varied across levels of influence and included factors related to restrictive clinical guidelines, provider reluctance, geographic disparities, and midwifery scopes of practice. While barriers varied in levels of influence, the majority were related to systemic and interpersonal factors. OUTLOOK: Barriers to TOLAC and VBAC exist at many levels and are both clinical and non-clinical in nature. The existing body of literature can benefit from more research examining the impact of recent revisions to clinical guidelines related to VBAC as well as additional qualitative studies to more deeply understand the complexity of provider reluctance.

[Choix thérapeutiques des hypertendus et diabétiques en milieu rural : Une étude mixte dans deux zones de santé de l'Est de la République Démocratique du Congo].

Therapeutic choices of hypertensive and diabetics in rural areas: A mixed study in two health zones in the East of the Democratic Republic of Congo. BACKGROUND: One third of patients in the Democratic Republic of Congo (DRC) do not use the formal health system to access healthcare. AIM: In this manuscript we analyse the therapeutic decisions of hypertensive and diabetic patients in rural eastern DRC and the reasons for these decisions. SETTING: The study was conduct in two health zones (HZ) in South Kivu (Bagira and Walungu), DRC. METHODS: A mixed-methods convergent study was conducted from November 2018 to December 2018. Quantitative data were collected using a questionnaire and qualitative data were collected using focus groups. The quantitative data were analysed using descriptive statistics and a Fischer exact test, while the qualitative data were analysed using thematic analysis. RESULTS: Out of 382 subjects declaring a chronic pathology, hypertensives and diabetics represented 21.5% and 7.9%, respectively. Health facilities were the first therapeutic choice of the chronically affected persons. The alternative therapeutic choices found were the use of prayer rooms, consultation with traditional healers and self-medication. Poverty, ignorance, the pharmaceutical business, and the socio-cultural dimension of the disease are the main causes of alternative therapeutic choices for hypertensives and diabetics. CONCLUSION: To ensure appropriate care for patients with chronic diseases in rural areas, it is important to establish a bridge of regulated collaboration between the formal and informal health sector.

A social network analysis of interorganisational collaboration: Efforts to improve social connectedness.

The Covid-19 pandemic has challenged public health practitioners and clinicians at multiple levels to intentionally consider the impact of social isolation on health outcomes. Many community-based programmes design interventions to address tangible challenges within the social determinants of health, such as asset insecurity or food insecurity, to address health inequities. The growing need to address social isolation within marginalised communities also requires organisations to collaborate and create community partnerships that strengthen their own social integration within the community. The present research reports on the results of a Social Network Analysis (SNA) of community programmes within three southern U.S. cities and their local collaborations to address social isolation. After interviewing representatives of 46 community organisations, it was found that social service organisations that also offer public health services play a central role in community efforts to improve social isolation. The participating organisations primarily collaborate through referrals and information sharing, and report inadequate resources. With a growing recognition that social services and supports play a considerable role in addressing health inequities, this study provides evidence of opportunities for interorganisational collaboration to promote individual and community health.

Musa Germplasm A and B Genomic Composition Differentially Affects Their Susceptibility to Banana Bunchy Top Virus and Its Aphid Vector, Pentalonia nigronervosa.

Banana bunchy top disease (BBTD), caused by the banana bunchy top virus (BBTV, genus Babuvirus), is the most destructive viral disease of banana and plantain (Musa spp.). The virus is transmitted persistently by the banana aphid, Pentalonia nigronervosa Coquerel (Hemiptera: Aphididae). While research efforts have focused on screening Musa genotypes for BBTD resistance, comparatively little work has been carried out to identify resistance to banana aphids. This study assessed 44 Musa germplasm of different A and B genome composition for the performance of banana aphids under semicontrolled environmental screenhouse conditions and in a field trial established in a BBTD endemic location. In the screenhouse, the AA diploid Calcutta 4 had the lowest apterous aphid density per plant (9.7 ± 4.6) compared with AAB triploid Waema, which had the highest aphid densities (395.6 ± 20.8). In the field, the highest apterous aphid density per plant (29.2 ± 6.7) occurred on the AAB triploid Batard and the lowest (0.4 ± 0.2) on the AA diploid Pisang Tongat. The AA diploid Tapo was highly susceptible to BBTD (100% infection) compared with the genotypes Balonkawe (ABB), PITA 21 (AAB), Calcutta 4 (AA), and Balbisiana Los Banos (BB), which remained uninfected. The Musa genotypes with apparent resistance to BBTD and least susceptibility to aphid population growth provide options for considering aphid and BBTD resistance in banana and plantain breeding programs.

Community-Based Asset Security: A Scoping Review.

OBJECTIVES: To explore how and what programs or projects address asset security at the community level as a social determinant of health. DATA SOURCES: To conduct a scoping review following Preferred Reporting Items for Systemic Reviews and Meta-analyses guidelines, the databases searched included CINAHL, EconLit, Embase, Pubmed/Medline, and the Sociological Collection of EBSCOhost. REVIEW METHODS: Keywords used for article identification were ("asset" AND "community") OR ("asset security" AND "community"). Studies were included if published between 1990 and 2019, written in English, and published in a peer-review journal. Reference lists of selected articles were also reviewed for additional articles. Two authors reviewed titles and abstracts separately, then reviewed full-texts for sample selection. RESULTS: After identifying 2,585 articles, researchers refined the final sample to 28 articles. Programs or projects within the sample focused on direct financial interventions or indirect interventions. Direct interventions included financial programs, such as Individual Development Accounts, or ownership opportunities, such as cooperatives or microenterprises. Indirect interventions included those focused on the built environment, such as asset mapping to identify a community's resources, or focused on education, such as those for social workers. CONCLUSIONS: Financial programs, ownership opportunities, assessments of the built environment, and targeted education complement one another to influence a community's assets from many angles. Income inequality has evolved from repeated institutionalized practices that inadvertently reinforce that inequality. Published literature emphasizes the local nature of needs and challenges, culturally responsive efforts, and that observing an impact often requires longitudinal efforts.

Examining Factors Associated with Utilization of Chaplains in the Acute Care Setting.

Hospitalized persons want their spiritual needs addressed and discussed by the healthcare team, but medical providers and nurses lack the necessary training. Patients want chaplaincy care, but very few receive it, and little is known about utilization factors. To identify the population characteristics associated with the utilization of chaplaincy services, hospitalization data from March 2012 to July 2017 were analyzed (N = 15,242 patients). Religiously affiliated individuals and those with the most acute health needs were more likely to receive chaplaincy care and received more total care. Patient-centered healthcare models may need to evaluate strategic integration of spiritual care beyond reactive spiritual care provision.

Choix thérapeutiques des hypertendus et diabétiques en milieu rural: Une étude mixte dans deux zones de santé de l'Est de la République Démocratique du Congo / Therapeutic choices of hypertensive and diabetics in rural areas: A mixed study in two health zones in the East of the Democratic Republic of Congo

Background: One third of patients in the Democratic Republic of Congo (DRC) do not use the formal health system to access healthcare. Aim: In this manuscript we analyse the therapeutic decisions of hypertensive and diabetic patients in rural eastern DRC and the reasons for these decisions. Setting: The study was conduct in two health zones (HZ) in South Kivu (Bagira and Walungu), DRC. Methods: A mixed-methods convergent study was conducted from November 2018 to December 2018. Quantitative data were collected using a questionnaire and qualitative data were collected using focus groups. The quantitative data were analysed using descriptive statistics and a Fischer exact test, while the qualitative data were analysed using thematic analysis. Results: Out of 382 subjects declaring a chronic pathology, hypertensives and diabetics represented 21.5% and 7.9%, respectively. Health facilities were the first therapeutic choice of the chronically affected persons. The alternative therapeutic choices found were the use of prayer rooms, consultation with traditional healers and self-medication. Poverty, ignorance, the pharmaceutical business, and the socio-cultural dimension of the disease are the main causes of alternative therapeutic choices for hypertensives and diabetics. Conclusion: To ensure appropriate care for patients with chronic diseases in rural areas, it is important to establish a bridge of regulated collaboration between the formal and informal health sector.

Asynchronous telepsychiatry: A systematic review.

INTRODUCTION: Healthcare providers and systems increasingly utilize telehealth modalities to address barriers and challenges for healthcare delivery. Specialties, such as psychiatry, are testing asynchronous methods for telehealth delivery. The National Quality Forum (NQF) developed a framework with which to assess the quality of telemedicine according to measures and measure concepts within four domains. This review assesses existing asynchronous telepsychiatry (ATP) research according to the telehealth domains established by NQF, evaluates the prevalence and quality of ATP, and identifies the areas in which more research must be conducted. METHODS: A systematic review of ATP methods was conducted according to PRISMA guidelines. Studies were categorized according to NQF telehealth domains and subdomains to further examine study outcomes. RESULTS: The review initially identified 205 studies that were narrowed down to a final sample of 11 articles. Of the final articles, most studies addressed the effectiveness of ATP or users' experience with ATP. DISCUSSION: The initial investigation of published ATP literature suggests promising results. ATP studies suggest that these services improve access to care, can be feasibly implemented by the clinical team, maintain patient/family satisfaction, and potentially reduce the cost of services. The limited sample of published literature necessitates further study of the practice in order to assess ATP according to the quality domains identified by NQF, especially access to care for patients and caregivers, the financial costs incurred by both providers and patients, and barriers to uptake.

Organizational and environmental factors influencing hospital community orientation.

BACKGROUND: Community orientation refers to hospitals' efforts to assess and meet the health needs of the local population. Variations in the number of community orientation-related activities offered by hospitals may be attributed to differences in organizational and environmental characteristics. Therefore, hospitals have to strategically respond to these internal and external constraints to improve community health. Understanding the facilitators and barriers of hospital community orientation is important to health care managers facing pressure from the external environment to meet the expectations of the community as well as Affordable Care Act guidelines. PURPOSE: The purpose of this study was to examine the organizational and environmental factors that promote or impede hospital community orientation. METHODOLOGY: A multivariate regression with random effects was conducted using data from the American Hospital Association Annual Survey from 2007 to 2010 and county level data from the Area Health Resource Files. FINDINGS: Not-for-profit, system-affiliated, network-affiliated, and larger hospitals have a higher degree of community orientation. In addition, the percentage of the county residents under the age of 65 years with health insurance and hospitals in states with certificate-of-need laws were also positively related to the degree of community orientation. During the study period, it appears that organizational factors mattered more in determining the degree of community orientation. PRACTICE IMPLICATIONS: Overall, a better understanding of the factors that influence community orientation can assist hospital administrators and policymakers in stimulating the hospital's role in improving population health and its responsiveness to community health needs. These efforts may occur by building interorganizational relationships or by incentivizing those hospitals that are least likely to be community oriented.

Who and Where Are Kentucky's Remaining Uninsured?

BACKGROUND: While most research has focused on insurance uptake and describing the makeup of the newly insured, less is known about the characteristics among the remaining uninsured in expansion states. OBJECTIVES: Using Kentucky as a case study, we evaluate individual and contextual characteristics to learn more about groups who-despite expanded access to coverage options through US health care reform-reported being uninsured at the end of 2014. RESEARCH DESIGN: Cross-sectional data from Kentucky's Behavioral Risk Factor Surveillance System was linked to county data from the Area Health Resource File, and we used logistic regression models to assess relationships between both person-level and county-level characteristics with uninsured status. SUBJECTS: The study sample included nonelderly adults aged 18-64 residing in Kentucky during the time of the survey. RESULTS: Before the implementation of the Medicaid expansion and rollout of the state-based health insurance marketplace, adults who were younger (aged 18-47), unmarried, had lower levels of educational attainment, and considered to be low income were more likely to be uninsured. However, many but not all of these differences faded away by the end of 2014 when only unemployment, low-income status, and Hispanic ethnicity were positively correlated with being uninsured. CONCLUSIONS: At the end of 2014, Kentucky's adult uninsured rate was below 5% and few statistically meaningful coverage gaps remain, suggesting Kentucky's experience under health reform may contribute to long-run closures in disparities in health care access and outcomes.

An aqueous one-pot route to gold/quantum rod heterostructured nanoparticles functionalized with DNA.

We report an original approach exploiting the photoelectrochemical properties of quantum rods and the versatility of Au(I) organometallic chemistry to control DNA surface grafting. This one-pot aqueous approach provides Janus biofunctionalized nanoparticles, the assembly of which should results in the emergence of synergistic properties.

In situ three-dimensional monitoring of collagen fibrillogenesis using SHG microscopy.

We implemented in situ time-lapse Second Harmonic Generation (SHG) microscopy to monitor the three-dimensional (3D) self-assembly of collagen in solution. As a proof of concept, we tuned the kinetics of fibril formation by varying the pH and measured the subsequent exponential increase of fibril volume density in SHG images. We obtained significantly different time constants at pH = 6.5 ± 0.3 and at pH = 7.5 ± 0.3. Moreover, we showed that we could focus on the growth of a single isolated collagen fibril because SHG microscopy is sensitive to well-organized fibrils with diameter below the optical resolution. This work illustrates the potential of SHG microscopy for the rational design and characterization of collagen-based biomaterials.

Why pesticides could be a common cause of prostate and breast cancers in the French Caribbean Island, Martinique. An overview on key mechanisms of pesticide-induced cancer.

Prostate and breast cancers have become very frequent in Martinique. We previously conducted a multifactorial analysis in the French Caribbean Island, Martinique, in order to elucidate the aetiology of prostate cancer. Using a linear regression analysis, we found that the growth curves of incidence rates for Martinique and metropolitan France have been significantly diverging since 1983. Although a Caribbean genetic susceptibility factor may be involved in prostate carcinogenesis: this factor, because it could not have changed during the observation period, cannot per se account for the growing incidence of this cancer in the island. We therefore suggested that among possible environmental factors, the intensive and prolonged exposure to Carcinogenic, Mutagenic and/or Reprotoxic (CMR) or presumed CMR pesticides may account for the observed growing incidence of prostate cancer and thus may be involved in prostate carcinogenesis. In this study, we further attempt to show that due to their carcinogenic properties, pesticides and especially organochlorine pesticides may in fact be causally implicated in the growing incidence of prostate cancer in Martinique. Also, we suggest that CMR or presumed CMR pesticides may be causally involved in the growing incidence of breast cancer through a common endocrine disruption mechanism. We therefore propose that protective medical recommendations should be immediately set up and carried out by general practitioners, paediatricians, obstetricians, gynaecologists and urologists; and that public health measures of primary precaution and prevention should be urgently taken in close collaboration with health professionals in order to protect population, more especially pregnant women and children, with the final objective perhaps that these medical recommendations and public health measures will stop Martinique's cancer epidemic.

Comparison of two genotypic algorithms to determine HIV-1 tropism.

OBJECTIVES: One or both of two co-receptors, CCR5 (R5) and CXCR4 (X4), are used by HIV-1 to enter into host cells. The glycoprotein 120 (gp120) V3 sequence is correlated with the R5 and X4 phenotype. CCR5 inhibitors are specifically active against R5 viruses, suggesting the need to determine tropism before the use of these antagonists. A comparison of the position-specific scoring matrices (PSSM) and Geno2pheno algorithms based on the V3 loop gp120 sequences and previously described to be correlated to the R5 or X4 phenotype was carried out. METHODS: V3 envelope (env) genes from 83 plasma samples were amplified and sequenced, and 69 sequences were analysed with the PSSM and Geno2pheno algorithms. RESULTS: These two algorithms were concordant in 86.5% of cases. The Geno2pheno algorithm gave a tropism result more frequently than the PSSM algorithm, but R5X4 or X4 viruses were less frequently detected by the Geno2pheno algorithm. R5X4 or X4 tropism was predicted in 29.9% of samples. There was more R5X4 co-receptor use in the antiretroviral-treated group than in the antiretroviral-naïve group. CONCLUSIONS: It is advisable to run a validated co-receptor use prediction tool before using co-receptor antagonists. If genotyping methods are considered, the PSSM and Geno2pheno algorithms are complementary and both are necessary. The association between predicted co-receptor use and virological response to co-receptor antagonists needs to be thoroughly evaluated.

10-year educational programme aimed at rheumatic fever in two French Caribbean islands.

BACKGROUND: In less developed countries, rheumatic fever still occurs. We started a long-term educational programme in two French Caribbean islands that was directed at the public and at health-care workers to see whether we could reduce the incidence of rheumatic fever. METHODS: Our 10-year programme started in 1981 in Martinique and Guadeloupe, and was based in the community and in clinics and hospitals. The programme established a registry of all cases of primary and secondary rheumatic fever (diagnosed by Jones' modified criteria), with systematic hospital admission of children. We graded carditis as severe, mild, or subclinical, and acute glomerulonephritis was defined by oedema, proteinuria, and haematuria for less than 3 months. The educational part of the programme targeted the public and health-care workers, including doctors, with written information distributed in schools or via radio and television broadcasts or videotapes. For the public, the benign clinical presentation of the initial streptococcal infection was contrasted with the severity of later heart disease. FINDINGS: The first months of the programme led to a 10-20% increase in the number of rheumatic fever cases admitted to hospital, because of the renewed attention paid to the disease. Therefore we took 1982 as the baseline year. In 1982-83 the incidence of rheumatic fever was 19.6 per 100 000 inhabitants aged under 20 in Martinique, and 17.4 per 100 000 in Guadeloupe. In 100 Martinique children and 97 Guadeloupe children in 1982-83, 40 and 71% had carditis, respectively (severe in 10 and 32%). Rheumatic fever was preceded by symptomatic sore throat in 52 and 41% of cases, respectively. The disease was not seen in children with active streptococcal cutaneous infections. Disease frequency was highest in the poorest areas and families, a finding that persisted over time. The programme was associated with a progressive decline in the frequency of rheumatic fever: final reduction of 78% in Martinique and 74% in Guadeloupe. The frequency of carditis also fell. Apart from two outbreaks in one hospital, the frequency of acute glomerulonephritis also declined; 31% of cases had had sore throat, while 56% had skin infections. The cost of the programme during the 4 most intensive years was FFr 250 000 (US$ 44 500) in each island. The cost of childhood rheumatic fever, excluding late sequelae, was initially (in 1982) about FFr 7.8 million (US$ 1426 000). The cost fell to an average of Ffr 550 000 (US$ 100 000) per year in 1991-92. INTERPRETATION: A rapid decline in rheumatic fever incidence was achieved at modest cost. Such a programme needs to be continued because of the risk of disease resurgence.

IL-1 mRNA expression detected by in situ hybridization and polymerase chain reaction in human thymus and thymoma. Correlation with late T-cell maturation in normal versus neoplastic thymus.

Interleukin-1 has long been suggested to participate in the development of T-cells in the thymus. To determine whether IL-1 was produced in the human thymus, we used the technique of in situ hybridization and PCR amplification of mRNA. High levels of IL-1 mRNA were detected in cells at the cortico-medullary border, which separates immature from mature T-cells, suggesting a role for IL-1 in a late stage in T-cell maturation. IL-1 transcripts were detectable by a single step PCR reaction in these samples. We examined a series thymomas (human thymic epithelial tumors) that induce partial T-cell maturation: In this group of thymomas T-cells develop to the cortical stage but not beyond. We failed to detect high levels of IL-1 mRNA expression in these tumors by in-situ hybridization, IL-1 mRNA was detected only in one of these samples by a single step PCR amplification. However, all of the samples were positive, when analyzed with a more sensitive, two step amplification of IL-1 mRNA by the use of nested primers. These results are consistent with the hypothesis that higher level of IL-1 expression is either the consequence of, or required for late T-cell maturation.

[Cystic dilatation of the seminal vesicle associated with renal agenesis. Contribution of different types of imaging]. / La dilatation kystique de la vésicule séminale associée à une agénésie rénale. Apport des différents types d'imagerie.

The authors report a case of cystic disease of the seminal vesicle associated with renal agenesis. This young patient presented only with cystitis. Developmental malformation of the mesonephric duct is the cause of this uncommon abnormality. The value of modern imaging (IVU, US, CT, MRI) is related.

[Evaluation of a new rapid ELISA technique for detecting human cytomegalovirus antibodies (CMV). Applications in emergency blood transfusion and in organ transplantation]. / Evaluation d'une nouvelle technique rapide par Elisa de dépistage des anticorps anticytomégalovirus humain (CMV). Applications pour les transfusions sanguines en urgence et dans un contexte de transplantation d'organes.

Immunocubes can detect very low HCMV IgG levels with at least the same sensitivity as the reference technique: ELISA. Samples containing bacteria showed no particular interference on the test, and results for non-infected material were in agreement with those of ELISA. The rapid test did not give any false positive reactions even with samples from patients with very high antiherpes immunoglobulins levels. Samples from transplant patients at the beginning of seroconversion or diluted to IgG titers corresponding to ELISA cut-off values were always detected as positive by immunocubes. In view of the rapidity of the test, its high specificity, its ability to detect levels corresponding to extremely low IgG signals in ELISA, and the possibility of conserving objective proof of the test, we conclude that this rapid immunocube technique is of great interest for current serologic screening in an emergency context, especially for transfusion and organ transplantation.