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Colocating Syringe Services, COVID-19 Vaccination, And Infectious Disease Testing: Baltimore's Experience. 集中注射器服务、COVID-19 疫苗接种和传染病检测:巴尔的摩的经验。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2024.00032
Omeid Heidari, Diane Meyer, Kelly Lowensen, Amita Patil, Katie J O'Conor, Jessica LaRicci, Derrick Hunt, Adam P Bocek, Victoria Cargill, Jason E Farley

People who inject drugs face many challenges that contribute to poor health outcomes, including drug overdose, HIV, and hepatitis C infections. These conditions require high-quality prevention and treatment services. Syringe services programs are evidence-based harm reduction programs, and they have established track records with people who inject drugs, earning them deep trust within this population. In Baltimore, Maryland, although many syringe support services were limited during the COVID-19 pandemic, the health department's syringe services programs remained operational, allowing for the continuation of harm reduction services, including naloxone distribution. This evaluation describes a collaborative effort to colocate infectious disease testing and COVID-19 vaccination with a syringe services program. Our evaluation demonstrated that colocation of important services with trusted community partners can facilitate engagement and is essential for service uptake. Maintaining adequate and consistent funding for these services is central to program success. Colocation of other services within syringe services programs, such as medications for opioid use disorder, wound care, and infectious disease treatment, would further expand health care access for people who inject drugs.

注射吸毒者面临着许多挑战,这些挑战导致了不良的健康后果,包括吸毒过量、艾滋病毒和丙型肝炎感染。这些情况需要高质量的预防和治疗服务。注射器服务计划是以证据为基础的减低伤害计划,它们在注射吸毒者中建立了良好的记录,在这一人群中赢得了深厚的信任。在马里兰州巴尔的摩市,尽管在 COVID-19 大流行期间许多注射器支持服务受到限制,但卫生部门的注射器服务计划仍在运行,从而使包括纳洛酮分发在内的减低危害服务得以继续。本评估介绍了将传染病检测和 COVID-19 疫苗接种与注射器服务计划同地进行的合作努力。我们的评估表明,将重要的服务与值得信赖的社区合作伙伴集中在一起可以促进参与,对服务的吸收至关重要。为这些服务保持充足、稳定的资金是计划成功的关键。在注射器服务计划内提供其他服务,如治疗阿片类药物使用障碍的药物、伤口护理和传染病治疗,将进一步扩大注射吸毒者获得医疗保健的机会。
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引用次数: 0
Prescription Digital Therapeutics: Evidence. 处方数字疗法:证据。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2024.00068
Frances P Thorndike
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引用次数: 0
Transforming Public Health Practice With Generative Artificial Intelligence. 用生成式人工智能改变公共卫生实践。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2024.00050
Monica Bharel, John Auerbach, Von Nguyen, Karen B DeSalvo

Public health practice appears poised to undergo a transformative shift as a result of the latest advancements in artificial intelligence (AI). These changes will usher in a new era of public health, charged with responding to deficiencies identified during the COVID-19 pandemic and managing investments required to meet the health needs of the twenty-first century. In this Commentary, we explore how AI is being used in public health, and we describe the advanced capabilities of generative AI models capable of producing synthetic content such as images, videos, audio, text, and other digital content. Viewing the use of AI from the perspective of health departments in the United States, we examine how this new technology can support core public health functions with a focus on near-term opportunities to improve communication, optimize organizational performance, and generate novel insights to drive decision making. Finally, we review the challenges and risks associated with these technologies, offering suggestions for health officials to harness the new tools to accomplish public health goals.

由于人工智能(AI)的最新进展,公共卫生实践似乎准备经历一场变革。这些变化将开创公共卫生的新时代,负责应对 COVID-19 大流行期间发现的不足,并管理满足 21 世纪卫生需求所需的投资。在本评论中,我们将探讨人工智能在公共卫生领域的应用,并介绍能够生成合成内容(如图像、视频、音频、文本和其他数字内容)的人工智能生成模型的先进功能。从美国卫生部门的角度来看人工智能的应用,我们研究了这项新技术如何支持核心公共卫生职能,重点关注改善沟通、优化组织绩效和产生新见解以推动决策制定的近期机遇。最后,我们回顾了与这些技术相关的挑战和风险,为卫生官员利用新工具实现公共卫生目标提供了建议。
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引用次数: 0
Community Power-Building Groups And Public Health NGOs: Reimagining Public Health Advocacy. 社区权力建设团体与公共卫生非政府组织:重新认识公共卫生宣传。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2024.00035
Sophia Simon-Ortiz, Sari Bilick, Maddy Frey, Solange Gould, Clara Long, Emma Waugh, Lili Farhang

Public health frameworks have grappled with the inequitable distribution of power as a driver of the social conditions that determine health. However, these frameworks have not adequately considered building community power as a strategy to shift the distribution of power. Community power-building organizations build and organize a base of affected people to take collective action to transform their material conditions, using advocacy and other tactics. We conducted qualitative interviews with representatives of twenty-two national nongovernmental public health organizations (public health NGOs) and thirteen community power-building organizations to explore the nature and potential of partnerships between public health and community power-building organizations. Our findings suggest ways to close advocacy gaps within the public health ecosystem and ways in which public health can strategically leverage its power, resources, and expertise to support social justice campaigns and movements.

公共卫生框架一直在努力解决权力分配不公这一决定健康的社会条件的驱动因素。然而,这些框架并没有充分考虑将建设社区权力作为改变权力分配的战略。社区权力建设组织利用宣传和其他策略,建立并组织受影响人群的基础,采取集体行动改变他们的物质条件。我们对 22 个国家非政府公共卫生组织(公共卫生非政府组织)和 13 个社区权力建设组织的代表进行了定性访谈,以探讨公共卫生组织和社区权力建设组织之间伙伴关系的性质和潜力。我们的研究结果提出了在公共卫生生态系统中缩小宣传差距的方法,以及公共卫生可以战略性地利用其权力、资源和专业知识来支持社会正义运动的方法。
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引用次数: 0
Medicare Advantage Versus Traditional Medicare Resource Use. 医疗保险优势计划与传统医疗保险的资源使用。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2023.01304
John Andrew Updike
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引用次数: 0
Spirituality As A Determinant Of Health: Emerging Policies, Practices, And Systems. 精神是健康的决定因素:新兴政策、实践和系统。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2023.01643
Katelyn N G Long, Xavier Symons, Tyler J VanderWeele, Tracy A Balboni, David H Rosmarin, Christina Puchalski, Teresa Cutts, Gary R Gunderson, Ellen Idler, Doug Oman, Michael J Balboni, Laura S Tuach, Howard K Koh

Reimagining public health's future should include explicitly considering spirituality as a social determinant of health that is linked to human goods and is deeply valued by people and their communities. Spirituality includes a sense of ultimate meaning, purpose, transcendence, and connectedness. With that end in mind, we assessed how recommendations recently issued by an expert panel for integrating spiritual factors into public health and medicine are being adopted in current practice in the United States. These recommendations emerged from a systematic review of empirical evidence on spirituality, serious illness, and population health published between 2000 and 2022. For each recommendation, we reviewed current federal, state, and local policies and practices recognizing spiritual factors, and we considered the ways in which they reflected the panel's recommendations. In this article, we highlight opportunities for broader application and scale while also noting the potential harms and benefits associated with incorporating these recommendations in various contexts. This analysis, while respecting the spiritual and religious diversity of the US population, identifies promising approaches for strengthening US public health by integrating spiritual considerations to inform person- and community-centered policy and practice.

重新构想公共卫生的未来应包括明确考虑精神因素,将其作为健康的一个社会决定因素,它与人类产品相关联,并深受人们及其社区的重视。灵性包括一种终极意义、目的、超越和联系感。有鉴于此,我们评估了一个专家小组最近提出的将精神因素纳入公共卫生和医疗的建议在美国目前的实践中是如何被采纳的。这些建议来自于对 2000 年至 2022 年间发表的有关灵性、严重疾病和人口健康的实证证据的系统性回顾。对于每项建议,我们都回顾了当前联邦、州和地方承认精神因素的政策和实践,并考虑了这些政策和实践反映小组建议的方式。在本文中,我们强调了更广泛应用和推广的机会,同时也指出了在不同情况下采纳这些建议的潜在危害和益处。这项分析在尊重美国人口的精神和宗教多样性的同时,通过整合精神因素,为以个人和社区为中心的政策和实践提供信息,确定了加强美国公共卫生的可行方法。
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引用次数: 0
Prescription Digital Therapeutics: Devices. 处方数字疗法:设备。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2024.00159
Eran Bashan
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引用次数: 0
Rural Hospitals Experienced More Patient Volume Variability Than Urban Hospitals During The COVID-19 Pandemic, 2020-21. 2020-21 年 COVID-19 大流行期间,农村医院比城市医院的患者量变化更大。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1377/hlthaff.2023.00678
H Joanna Jiang, Rachel Mosher Henke, Kathryn R Fingar, Lan Liang, Denis Agniel, Marc I Roemer

Fluctuations in patient volume during the COVID-19 pandemic may have been particularly concerning for rural hospitals. We examined hospital discharge data from the Healthcare Cost and Utilization Project State Inpatient Databases to compare data from the COVID-19 pandemic period (March 8, 2020-December 31, 2021) with data from the prepandemic period (January 1, 2017-March 7, 2020). Changes in average daily medical volume at rural hospitals showed a dose-response relationship with community COVID-19 burden, ranging from a 13.2 percent decrease in patient volume in periods of low transmission to a 16.5 percent increase in volume in periods of high transmission. Overall, about 35 percent of rural hospitals experienced fluctuations exceeding 20 percent (in either direction) in average daily total volume, in contrast to only 13 percent of urban hospitals experiencing similar magnitudes of changes. Rural hospitals with a large change in average daily volume were more likely to be smaller, government-owned, and critical access hospitals and to have significantly lower operating margins. Our findings suggest that rural hospitals may have been more vulnerable operationally and financially to volume shifts during the pandemic, which warrants attention because of the potential impact on these hospitals' long-term sustainability.

在 COVID-19 大流行期间,病人数量的波动可能尤其令农村医院担忧。我们研究了医疗成本与利用项目州住院病人数据库(Healthcare Cost and Utilization Project State Inpatient Databases)中的医院出院数据,将 COVID-19 大流行期间(2020 年 3 月 8 日至 2021 年 12 月 31 日)的数据与大流行前(2017 年 1 月 1 日至 2020 年 3 月 7 日)的数据进行了比较。乡镇医院日均医疗量的变化与社区 COVID-19 负担呈剂量反应关系,从低传播期患者量减少 13.2% 到高传播期患者量增加 16.5%。总体而言,约 35% 的农村医院的日均总诊疗量波动超过 20%(无论向哪个方向),相比之下,只有 13% 的城市医院经历过类似幅度的变化。日均总诊疗量变化幅度较大的农村医院更有可能是规模较小的政府所有医院和关键通道医院,其运营利润率也明显较低。我们的研究结果表明,在大流行期间,农村医院可能在运营和财务上更容易受到病例量变化的影响,这一点值得关注,因为这可能会影响这些医院的长期可持续性。
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引用次数: 0
Guaranteed Cash Incentives Boosted COVID-19 Vaccinations Of Young Adults: Evidence From West Virginia. 有保证的现金奖励促进了年轻人接种 COVID-19 疫苗:来自西弗吉尼亚州的证据
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1377/hlthaff.2023.00734
Yin Wang, Charles Stoecker, Kevin Callison, Julie Hernandez

Guaranteed small cash incentives were widely employed by policy makers during the COVID-19 vaccination campaign, but the impact of these programs has been largely understudied. We were the first to exploit a statewide natural experiment of one such program implemented in West Virginia in 2021 that provided a $100 incentive to fully vaccinated adults ages 16-35. Using individual-level data from the Census Bureau's Household Pulse Survey, we isolated the policy effect through a difference-in-discontinuities design that exploited the discontinuity in incentive eligibility at age thirty-five. We found that the $100 incentive was associated with a robust increase in the proportion of people ever vaccinated against COVID-19 and the proportion who completed or intended to complete the primary series of COVID-19 vaccines. The policy effects were also likely to be more pronounced among people with low incomes, those who were unemployed, and those with no prior COVID-19 infection. The guaranteed cash incentive program may have created more equitable access to vaccines for disadvantaged populations. Additional outreach may also be needed, especially to unvaccinated people with prior COVID-19 infections.

在 COVID-19 疫苗接种活动中,政策制定者广泛采用了小额现金奖励措施,但这些计划的影响在很大程度上未得到充分研究。我们首次在全州范围内对 2021 年在西弗吉尼亚州实施的一项此类计划进行了自然实验,该计划为年龄在 16-35 岁之间完全接种疫苗的成年人提供了 100 美元的奖励。利用人口普查局家庭脉搏调查的个人层面数据,我们通过 "间断性差异设计"(differences-in-discontinuities design)分离出了政策效应,该设计利用了 35 岁时奖励资格的间断性。我们发现,100 美元的奖励与曾经接种过 COVID-19 疫苗的人数比例以及完成或打算完成 COVID-19 疫苗初级系列接种的人数比例的显著增加有关。在低收入人群、失业人群和未感染过 COVID-19 的人群中,政策效果也可能更加明显。有保障的现金奖励计划可能会使弱势群体更公平地获得疫苗。可能还需要开展更多的宣传活动,尤其是针对未接种疫苗且曾感染 COVID-19 的人群。
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引用次数: 0
States' Abortion Laws Associated With Intimate Partner Violence-Related Homicide Of Women And Girls In The US, 2014-20. 2014-20年美国各州堕胎法与亲密伴侣暴力导致的妇女和女童凶杀案的相关性。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1377/hlthaff.2023.01098
Maeve E Wallace, Charles Stoecker, Sydney Sauter, Dovile Vilda

Women who are pregnant or recently gave birth are significantly more likely to be killed by an intimate partner than nonpregnant, nonpostpartum women of reproductive age, implicating the risk of fatal violence conferred by pregnancy itself. The rapidly increasing passage of state legislation has restricted or banned access to abortion care across the US. We used the most recent and only source of population-based data to examine the association between state laws that restrict access to abortion and trends in intimate partner violence-related homicide among women and girls ages 10-44 during the period 2014-20. Using robust difference-in-differences ecologic modeling, we found that enforcement of each additional Targeted Regulation of Abortion Providers (TRAP) law was associated with a 3.4 percent increase in the rate of intimate partner violence-related homicide in this population. We estimated that 24.3 intimate partner violence-related homicides of women and girls ages 10-44 were associated with TRAP laws implemented in the states and years included in this analysis. Assessment of policies that restrict access to abortion should consider their potential harm to reproductive-age women through the risk for violent death.

与未怀孕、未产后的育龄妇女相比,怀孕或刚生完孩子的妇女被亲密伴侣杀害的可能性要大得多,这说明怀孕本身就存在致命暴力的风险。在美国,越来越多的州立法限制或禁止堕胎。我们利用最新且唯一的人口数据来源,研究了限制堕胎的州法律与 2014-20 年间 10-44 岁妇女和女孩中与亲密伴侣暴力相关的凶杀案趋势之间的关联。利用稳健的差分生态模型,我们发现,每执行一项额外的《针对堕胎提供者的监管》(TRAP)法律,该人群中与亲密伴侣暴力相关的凶杀案发生率就会增加 3.4%。据估计,在本分析所涉及的州和年份中,有 24.3 起针对 10-44 岁妇女和女童的亲密伴侣暴力杀人案与实施 TRAP 法律有关。在对限制堕胎的政策进行评估时,应考虑其通过暴力死亡风险对育龄妇女造成的潜在伤害。
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引用次数: 0
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Health Affairs
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