No abstract

The aim of this study was to evaluate an automated trigger algorithm designed to detect potentially adverse events in children with Attention-Deficit/Hyperactivity Disorder (ADHD), who were monitored remotely between visits. We embedded a trigger algorithm derived from parent-reported ADHD rating scales within an electronic patient monitoring system. We categorized clinicians’ alert resolution outcomes and compared Vanderbilt ADHD rating scale scores between patients who did or did not have triggered alerts. A total of 146 out of 1738 parent reports (8%) triggered alerts for 98 patients. One hundred and eleven alerts (76%) required immediate clinician review. Nurses successfully contacted parents for 68 (61%) of actionable alerts; 46% (31/68) led to a change in care plan prior to the next scheduled appointment. Compared to patients without alerts, patients with alerts demonstrated worsened ADHD severity (β = 5.8, 95% CI: 3.5–8.1 [p < 0.001] within 90 days prior to an alert. The trigger algorithm facilitated timely changes in the care plan in between face-to-face visits.

Unintentional drug overdose has become a grave and sustained public health burden in the US. 1 The US Centers for Disease Control and Prevention (CDC) defines unintentional drug overdose as occurring "…when no harm is intended." 2(p1) and inclusive of "…overdoses resulting from drug misuse, drug abuse, and taking too much of a drug for medical reasons." 2(p1) Adult decedents have been the focus of most overdose mortality reports, despite the fact that adolescents (aged 10-19 years) and young people (aged 10-24 years) are increasingly dying of unintentional drug overdose. 3 This troubling trend requires further study, given that adolescents and young people are deprived of many more years of work, community life, and family life than are older individuals dying of unintentional drug overdose.To our knowledge, no prior study has assessed unintentional drug overdose mortality among adolescents and young people in years of life lost (YLL). YLL is an epidemiologic descriptor that gives weight to deaths among the young. 4 YLL analysis has the potential to provide important context to the overdose crisis by better representing what is meant to society by the loss of adolescents and young people to unintentional drug overdose. The present work aimed to fill this important gap in the literature by calculating unintentional drug overdose YLL in this vulnerable population.

HIV/AIDS related stigma remains a major global health issue with detrimental consequences for the treatment and health of people with HIV/AIDS (PWHA), especially when manifested by health professionals. Research on HIV/AIDS stigma has successfully documented negative attitudes towards PWHA among health professionals. However, fewer studies have examined how stigma is manifested behaviorally by health professionals during clinical interactions. Therefore, this study aimed to: (1) examine the behavioral manifestations of HIV/AIDS stigma among physicians in training during clinical interactions, and (2) document the interrelation between HIV/AIDS stigma attitudes and behaviors. We implemented an experimental design using Standardized Patient (SP) simulations, observational techniques, and quantitative questionnaires. The sample consisted of 66 physicians in training in Puerto Rico who engaged in SP encounters with two scenarios: (1) PWHA infected via illegal drug use (experimental condition), and (2) a person with a common cold (control condition). Results evidenced statistically significant differences between both simulations (p = .047), with a higher number of stigma behaviors manifested in the experimental condition. HIV/AIDS stigma attitudes were not correlated with stigma behaviors. Negative emotions associated with drug use were positively associated with drug-related stigmatizing behaviors.

This aims to highlight the electrophysiological evidence supporting a critical role of insulin in regulating glucose-sensing neurones. Electrophysiological techniques have been used for over a half of a century to investigate the responses of neurones to extracellular glucose, as well as other nutrients and hormones. These techniques have evolved significantly over time, leading to a variety of different recording configurations. The distinctions between the different configurations are subtle and can be confusing to individuals who are not electrophysiologists. For this reason, we begin the discussion of glucose-sensing and insulin-responsive neurones with a brief

Environmental and community context earliest in the life course have a profound effect on life-long health outcomes. Yet, standard needs assessments for maternal and child health (MCH) programs often overlook the full range of influences affecting health in-utero and early childhood. To address this, we developed a methodology for assessing community risk in MCH based on six domains integrating 66 indicators across community, environment, socioeconomic indicators, and MCH outcomes. We pilot this methodology in Pennsylvania, and share examples of how local governments, planners, and public health officials across the geographic spectrum can integrate this data into community planning for improved maternal and child health.

To the Editor In their study of fatal drug overdoses among young people aged 10 to 24 years, Hall and colleagues 1 report 21 689 deaths from 2015 to 2019, which resulted in 1.23 million years of lost life (YLL). This averages to 57 YLL per overdose death, a devastating statistic.The authors' life expectancy data source, the Social Security Administration Period Life Table, did not include information on race; therefore, race-specific YLLs were not provided. However, we can be reasonably sure that the burden of YLL is rapidly changing in ways that are closely tied to race. From 2015 to 2020, the age-adjusted drug overdose death rate for young White male individuals increased by 37%, rising from 9.1 to 12.5 per 100 000 people. By contrast, the rate quadrupled for young Black male individuals, rising from 2.7 to 10.8. Similarly, for young White female individuals, the overdose death rate increased by 41%, rising from 4.1 to 5.8. For young Black female individuals, the rate more than tripled, rising from 1.4 to 4.6. 2 Young Black individuals have experienced a staggering increase in overdose deaths and YLL since 2015, with rates now approximating those of young White individuals. A better understanding of the race-specific drivers of overdose mortality among young people is an urgent priority.

Objective: To characterise perceptions of the Philadelphia Beverage Tax among low-income parents. Design: We conducted semi-structured interviews and administered demographic questions via telephone. We based the interview guide and initial codebook on a conceptual model illustrating perceived fairness and effectiveness as essential for successfully adopting food policies. We performed thematic analysis using NVivo 12. Setting: We recruited from a primary care paediatrics clinic in Philadelphia, Pennsylvania from July to August 2020. Participants: Philadelphia parents/caregivers of 2- to 11-year-old children with Medicaid insurance. Results: Participants were predominantly African American (97 %), female (100 %), and had annual household incomes <$50 000 (80 %). Participants were 26- to 72-years old, with an average aged child of 5 years (range 7 months to 20 years). Themes emerged regarding tax perceptions, revenue use and behaviour change due to the tax. Using revenue for highly valued programmes and accountability of city government to use revenue as promised were critical elements in perceptions of tax fairness. Some parents avoided the tax through cross-border shopping and buying drink powders or concentrates, influencing perceptions of tax effectiveness. The tax signalled the health dangers of sweetened beverage consumption to most parents. Conclusion: Our findings bring to light four key takeaways for policymakers designing sweetened beverage taxes. (1) Dedication of tax revenue to programmes highly valued by parents and (2) transparency in revenue spending may improve acceptability. (3) State or national taxes may be more effective at decreasing consumption due to cross-border shopping. (4) Pairing taxes with health promotion campaigns may enhance behaviour change.