Healthcare-Seeking Behaviors Among Medicare Beneficiaries by Functional Hearing Status

Objective: Hearing loss is associated with higher health expenditures and poor healthcare utilization. This study aims to build on these findings by characterizing the association between hearing status and healthcare-seeking behaviors among Medicare beneficiaries. Methods: Cross-sectional log-binominal regression was used to assess the association between self-report hearing and healthcare-seeking behaviors (avoidance or delay of care, personal health concerns, and sharing health status) using the 2016 Medicare Current Beneficiary Survey ( N = 12,140). Results: Beneficiaries with trouble hearing had significantly higher risks of avoiding and delaying health care compared to those without trouble hearing. Conversely, trouble hearing was not associated with concern for health status or sharing health status. Discussion: These findings may help explain higher costs associated with hearing loss as avoidance of care can exacerbate health problems. Further work is needed to understand underlying causes and whether addressing hearing loss modifies the observed association.

The Role of Delay of Care in Depression among US Middle-Aged and Older Adults during the COVID-19 Pandemic:: A Secondary Data Analysis (Preprint)

BACKGROUND The depression level among US adults significantly increased during the Coronavirus Disease 2019 (COVID-19) pandemic and age disparity in depression during the pandemic were reported in recent studies. Delay or avoidance of medical care is one of the collateral damages caused by the COVID-19 pandemic and it can lead to increased morbidity and mortality. OBJECTIVE The present study aims to assess the prevalence of depression and delay of care among US middle-aged adults and older adults during the pandemic, as well as investigate the role of delay of care in depression among those two age groups. METHODS This cross-sectional study used the 2020 Health and Retirement Study (HRS) COVID-19 Project (Early, Version 1.0) data. Univariate analyses, bivariate analyses, and binary logistic regression were applied. US adults older than 46 years old were included. Depression was measured by Composite International Diagnostic Interview Short Form (CIDI-SF). Delay of care were measured by four items: delay of surgery, delay of seeing a doctor, delay of dental care, and delay of other care. Univariate analyses, bivariate analyses, and binary logistic regression were conducted. RESULTS More than half of participants were older than 65 years old (58.23%) and 274 participants (8.75%) had depression during the pandemic. Delay of dental care was positively associated with depression among both middle-aged adults (OR=2.05, 95%CI=1.04-4.03, P<0.05) and older adults (OR=3.08, 95%CI=1.07-8.87, P<0.05). Delay of surgery was positively associated with depression among older adults (OR=3.69, 95%CI=1.06-12.90, P<0.05). Self-reported pain was positively related to depression among both age groups. Middle-aged adults who reported higher education level (some college of above) or worse self-reported health had higher likelihood to have depression. While perceived more loneliness was positively associated with depression among older adults, financial difficulty was positively associated with depression among middle-aged adults. CONCLUSIONS This study found that depression among middle-aged and older adults during the pandemic was also prevalent. The study highlighted the collateral damage of the COVID-19 pandemic by identifying the effect of delay of surgery and dental care on depression during the pandemic. Although surgery and dental care cannot be delivered by telehealth, telehealth services can still be provided to address patients’ concern on delay of surgery and dental care. Moreover, the implementation of tele-mental health services is also needed to address mental health symptoms among US middle-aged and older adults during the pandemic. Future research that uses more comprehensive CLINICALTRIAL N/A

Retinopathy of Prematurity—Using Electronic Medical Records to Efficiently Follow Patients at Multiple Hospitals

Purpose: To report the use of a centralized electronic medical record (EMR) to provide timely retinopathy of prematurity (ROP) screening in a previously fragmented monitoring system in a standalone children’s hospital in Connecticut. Methods: A chart review of 306 visits for ROP screening in 3 neonatal intensive care units (NICUs) over a time period of 24 months. Results: All infants born at <30 weeks gestational age or birth weight <1,500g (N = 107) at these NICUs were screened for ROP according to the American Academy of Pediatrics guidelines. Data was collected before the implementation of our centralized EMR list, during a transitional period, and once the list was established. Our analysis of the data found an improvement in delay of care from 16.85% to 10.83% of visits, and a decrease in number of visits done during off hours from 20.4% to 5% of visits. Conclusion: Our tool was a free and cost-efficient centralization of a once difficult-to-manage process for ROP screenings in Connecticut. The decrease in delay of care and improvement in physician scheduling will lead to better outcomes for our patients and better sustainability of practice for our providers.

The rescue of the polytraumatized victims due to violence in transit in the city of Chapecó-SC: the “golden hour”

Trauma is considered the third cause of death, being understood as a disease with endemic character in modern society is not only affecting the field of public health, but also, the socio-political society. According to the Advanced Trauma Life Support - ATLS, in emergencies, the first hour, called the "Golden Hour" (Golden hour), this is the moment in which more deaths occur. However, this is also the time for more if you can avoid them. This study aimed to understand how the pre-hospital care and hospital conducted both by the Fire Department of the west of SC, and by nurses from the emergency department of a regional hospital in the west of Santa Catarina, whereas the reception and customer service in the first hour of trauma ("golden hour") the polytraumatized patients. It is a qualitative, with data collection in the first half of October 2016, through semi structured interviews held with nine Militarized Firemen and four nurses to an emergency room, using as analytical method to Content Analysis of Bardin. In this study, it was observed that within 60 minutes that comprise the golden hour, first medical care which is since the so-called redemption until the reached the hospital, is done quickly and properly in most of the times, ignoring the factors that may delay the answer, as transit, incarceration and away from the occurrence, being the victim transported in a timely manner. This delay in care is often caused by delay of complementary examinations, delay of care by the medical team, deficiency of structure and overcrowding, these factors generate a cascade of delay, which consequently worsen the situation of the patient, increasing morbidity and mortality. You will notice that the golden hour is valuable in that it concerns the maintenance of life and consequences for patients. A quick and effective way can increase the chances of survival of same. It is known that the development of services of APH, whether public or private, culminate with the need for trained and qualified professionals that meet the specific needs of the nursing care during the pre-hospital care, with a view to prevention, protection and recovery to healthIt is of great importance to discuss more about the topic and conduct further studies to develop mechanisms that reduce this time-response thus lowering the risk of sequelae and mortality due to trauma.

Predictors of splenectomy after failure of non-operative management: An analysis of the nation trauma database from 2013 to 2014

Introduction There is practice variability in non-operative management (NOM) of blunt splenic trauma. This is particularly true for management decisions following failure of NOM, i.e. splenectomy versus angioembolization (AE). The objective of this study was to identify predictors of splenectomy versus AE in patients who failed NOM. Methods We included adult patients from the National Trauma Data Bank for 2013–2014, who had a splenic injury and who were admitted to a Level I Trauma Center (L1TC). Patients undergoing splenectomy after 2 h of emergency department arrival were deemed to have failed NOM. Multivariate logistic regression modeling was used to identify independent predictors of intervention after failed NOM. Results There were 2284 patients admitted for splenic injury between 2013 and 2014 who failed NOM. A total of 1253 patients underwent AE and 1031 patients underwent splenectomy. Seven independent factors were identified that predicted failure of NOM: penetrating injury, community L1TC, hospital bed size, number of trauma surgeons on call, functional dependence, chronic steroid use, and cirrhosis. Conclusions Seven independent variables were identified that predicted failure of NOM. These results contribute to the body of data regarding management of blunt splenic injury. Knowing predictive factors could help personalize management of patients, minimize delay of care, efficient resource allocation, and inform future studies.

Financial Distress Is Associated With Delay in Seeking Care for Hand Conditions

Background: As medical costs continue to rise, financial distress due to these costs has led to poorer health outcomes and patient cost-coping behavior. Here, we test the null hypothesis that financial distress is not associated with delay of seeking care for hand conditions. Methods: Eighty-seven new patients presenting to the hand clinic for nontraumatic conditions completed our study. Patients completed validated instruments for measuring financial distress, pain catastrophizing, and pain. Questions regarding delay of care were included. The primary outcome was self-reported delay of the current hand clinic visit. Results: Patients who experience high financial distress differed significantly from those who experience low financial distress with respect to age, race, annual household income, and employment status. Those experiencing high financial distress were more likely to report having delayed their visit to the hand clinic (57% vs 30%), higher pain catastrophizing scores (17.7 vs 7.6), and higher average pain in the preceding week (4.5 vs 2.3). After adjusting for age, sex, and pain, high financial distress (adjusted odds ratio [OR] = 4.90) and pain catastrophizing score (adjusted OR = 0.96) were found to be independent predictors of delay. Financial distress was highly associated with annual household income in a multivariable linear regression model. Conclusions: Patients with nontraumatic hand conditions who experience higher financial distress are more likely to delay their visit to the hand clinic. Within health care systems, identification of patients with high financial distress and targeted interventions (eg, social or financial services) may help prevent unnecessary delays in care.