Randomized trials and cohort studies have shown sex differences in the implantation and response to Cardiac Resynchronization Therapy (CRT). Furthermore, gender roles are associated with precipitants of congestive heart failure. Cohort studies are well-suited to assessing implantation rates, long-term outcomes, and the role of sex and gender. Therefore, we systematically identified cohort studies that reported outcomes of CRT and evaluated the following: 1) prevalence and temporal changes in sex and gender reporting and analysis; and 2) sex differences in the implantation and response to CRT. Sex was increasingly considered but remained inadequately reported and analyzed. Gender was not considered in the studies. In clinical practice, fewer women received devices, despite benefiting from CRT more than men. Of note, the difference in response may be confounded by differences in the clinical profiles of men and women. There is a need for better integration of sex and gender in studies to understand better the reasons leading to the observed differences.

Background: People who use drugs (PWUD) are disproportionately burdened by rates of HIV and Hepatitis C, more likely to experience stigma, social exclusion, and as a result, have poorer health outcomes. To mitigate these inequities in health, people with lived experience of drug use are, and should be, included in decisions that affect them. There is evidence that including PWUD in the development and delivery of harm reduction programs, services, and drug policy ensures such initiatives addresses their needs most effectively. As such, the purpose of this thesis is to present the findings of a scoping review of the peer-reviewed literature examining the involvement of people who use drugs (PWUD) in the development and delivery of harm reduction programs, services, and drug policy. Methods: Scoping reviews represent an increasingly popular method used to review the literature of a particular topic. It is a process of summarizing, or ‘mapping’, a range of evidence in order to convey the breadth and depth of a particular field. This scoping review implemented a search strategy focused on three categories: search terms that describe ‘peer engagement’, search terms that describe ‘substance use’ and finally search terms that describe ‘harm reduction programs/services/policy’. Searches of five academic electronic databases were conducted. Peer-reviewed literature published between 2010 and 2020 that discussed the involvement of PWUD in the development and/or delivery of harm reduction programs, services, or drug policy was included in the scoping review. Results: The search strategy produced a total of 1902 references. After duplicates were removed, thirty-two references met the inclusion criteria and were included for analysis. This scoping review identified five characteristics from each study: 1) type of study, 2) location of study, 3) year of publication, 4) type of engagement/participation, and 5) peer roles. Conclusion: One critical finding of this scoping review is the highest level of participation among PWUD was achieved when drug-user organizations were involved. / Graduate

Background Equity is rarely included in health economic evaluations, partly because the techniques for addressing equity have been inadequate. Since 2013 health economists have developed two competing health economic technologies: distributional costeffectiveness analysis (DCEA) and extended cost-effectiveness analysis (ECEA). Both technologies represent a significant advance, and each provides a framework to address equity considerations in cost-effectiveness analysis. Methods A scoping literature review was used to identify and synthesise the relevant literature on incorporating equity concerns into economic evaluations. A second focused review identified literature which discussed or applied DCEA and ECEA. Key themes in the literature were identified using NVivo qualitative data analysis software. Results The review revealed three key areas of difference between DCEA and ECEA: First, the analysis of trade-offs between improving health and reducing inequity; second, the analysis of financial impacts of health policies; and third, the incorporation of opportunity costs. ECEA can analyse financial risk protection while DCEA can analyse opportunity costs and trade-offs between improving equity and reducing health. ECEA is designed for low- and middle-income countries, whereas DCEA is better suited to developed health systems such as the National Health Service in the United Kingdom. To date, there have been 27 studies using ECEA and five studies using DCEA. Future developments for DCEA and ECEA include incorporating alternative methods to simplify the data requirements for the techniques, providing methods to assist decision makers to clarify their equity concerns, and improving the presentation of outcomes to make them accessible to non-specialists. Conclusions DCEA and ECEA are both economic frameworks which address equity considerations in cost-effectiveness analysis. This study examines and compares these two techniques in order to assist policymakers and decision makers to determine which of the two methods is best able to address their specific needs for their particular circumstances.

Despite the growing emphasis on collaboration in public health, there remains a dearth of literature providing tools for the evaluation of coalitions and councils. This study employed social network gap analysis as an evaluation tool. Survey data collected from the Southeastern Health Equity Council members were used to assess connections among members as a whole, by committee, by state, and by health specialty area. Analysis of how well Southeastern Health Equity Council met the representation outlined in its strategic plan was also conducted. Recommendations for improving the network and opportunities to effectively recruit and advance the work of Southeastern Health Equity Council are discussed.

Prior to the coronavirus disease-2019 (COVID-19) pandemic people with chronic obstructive pulmonary disease (COPD) were already experiencing social isolation due to the complex intersection of symptoms, and perceptions towards the illness. COPD is a chronic lung illness characterized by progressive shortness of breath, and decreasing lung function, with influenza and other respiratory illnesses more likely to have fatal consequences for this population. Societal beliefs and assumptions around behavioural risk factors, and in particular smoking, contribute to perceptions that COPD diagnosis, outcomes and experiences are self-inflicted and an individual responsibility. This is a perspective that fails to take into the account the complex contextual factors of the social determinants of health, where structural inequities result in higher smoking rates among populations with lower socioeconomic status. Further, these underlying societal values may compound the isolation experienced with COPD in which ongoing stigma towards the illness discourages people from identifying with a COPD diagnosis. The lack of identity may discourage developing a community where people can share experiences and strategies in living with COPD, and form a collective group that can advocate for change. Digital technologies (DTs), such as Facebook and Zoom offer new avenues to support social connectedness. However, little focus has been given on how people with COPD may (or may not) be using DTs to support their illness. This study explored the role DTs could serve in addressing social connectedness and experiences and outcomes for the COPD community. The study was informed by Mertens (2003, 2007) transformative approach where the knowledge of people living with COPD was prioritized in finding out what DTs they may be using to maintain social connectedness and to support their illness. The three stage mixed methods research design consisted of interviews, patient-reported outcome measures, patient-reported experience measures and a DT survey. Bazeley's (2018) approach was used to guide the integrative mixed analysis on data collected across the three stages. The overall findings were: 1) Participants’ experiences in living with COPD had uniquely prepared them for the COVID-19 pandemic, and it was the community that lacked capacity; 2) Dominant discourse around technology may be creating further harms to the COPD population that extend beyond the digital world; 3) Current digital health monitoring strategies for other chronic illnesses do not fully translate to the interests and needs for people living with COPD; 4) People living with COPD are using DTs, but prefer to keep their virtual world separate from their illness world; and 5) Considerations for DTs for COPD should move beyond managing outcomes, and include supporting experiences of living. Conducted between December 2018 and July 2020, and concurrent with the COVID-19 pandemic, the study demonstrated even greater importance with the onset of the pandemic in understanding how DTs may support social connectedness for people living with life-limiting chronic lung conditions. / Graduate / 2022-02-07

No description available.

Where you are born, the school you attend, your highest level of education, your race, age, and sex, these are all things that can directly, or indirectly impact your health. The social determinants of health is a phrase that can better be used to sum them all up. It refers to the social situation you exist in, and how that affects your ability to purchase healthy foods or obtain the medical care you need, and so much more. When it comes to certain measurements of health, people who fall within certain groups or populations, for example, minorities, or people of lower socio-economic statuses (SES), tend to have worse results than their white, or higher SES counterparts. These differences in health outcomes are referred to as disparities. As social scientists, healthcare professionals, and anyone with the means to address these disparities, we are ethically obligated to do so. There are already several initiatives aimed at addressing the social determinants of health. Through these initiatives, those in need are provided with things such as food vouchers, ride vouchers, and health education. What is missing, are organized studies with specific goals and appropriate sample sizes to address the efficacy of these initiatives. Once we have more such studies to provide us with data that supports the efficacy of these interventions, we can then advocate for policies that will make these resources widely available and encourage health equity. / Urban Bioethics

Background: There is a 3-fold risk of developing end stage kidney disease in Non-Hispanic African Americans compared to Non-Hispanic White Americans (Centers for Disease Control and Prevention, 2017). Estimated glomerular filtration rate (eGFR), one of the fundamental algorithms for coordinating treatment for kidney disease which factors in age, race, gender, and levels of creatinine, may pose an issue in this vulnerable population. Currently African Americans receive a correction factor between 1.21 and 1.16 to their eGFR to adjusting the value higher, potentially impacting appropriate kidney disease classification, and delaying beneficial interventions (National Kidney Foundation, 2020). Methods: A systematic literature search of four databases was completed. Eligibility criteria included 1) published in a peer reviewed journal, 2) English language, 3) the use of race correction in calculating eGFR, and 4) a quantitative study design. A total of 47 articles were screened with 17 selected for final review. The Johns-Hopkins Nursing Evidence - Based Practice evidence guide was then used to rate the strength and quality of the evidence. Results: Early evidence of the unreliability of race based eGFR equations emerged in 2008, and the body of evidence continues to grow. Recent studies have found eGFR calculated with no race corrections correlate best with directly measured iothalmate GFR in black patients (Zelnick et al., 2021), and that a potential 1,066,026 Black Americans may be reclassified to a more severe stage of CKD (Bragg-Gresham et al., 2021). Use of the race correction in GFR equations has been poorly supported in studies conducted in Africa and Brazil. For those with HIV, an accurate eGFR is doubly important yet all eGFR equations have marked variability. Some medical facilities have successfully updated to calculating eGFR without the racial coefficient (Shi et al., 2021). Conclusion: Nurses should be aware of the implications of using race correction in eGFR equations, educate their patients on its use, and advocate for those near threshold targets to ensure equitable and timely access to appropriate kidney disease interventions.

<p>Public health infrastructure (PHI) serves as the core foundation for essential public health and its services. However, the U.S. PHI has been weakened by understaffing, underfunding, limited resources and partnerships, and outdated data and information systems over the past few decades. The recent COVID-19 pandemic exacerbated its vulnerability and weakened nature, resulting in increased health disparities and worse health outcomes in general for the nation. The goal of this study was to identify elements of local PHI that are associated with the completion of 20 key public health activities while adjusting for state differences. Cross-sectional secondary data were acquired and linked from two national surveys of local health departments, the National Profile of Local Health Departments survey and the National Longitudinal Survey of Public Health Systems. In total, 20 multivariable logistic regression models were created to analyze the relationships between variables. State fixed effects were used in multivariable models to control for state differences. It was found that state differences affected the correlations of infrastructure variables. Several staffing elements, abilities to provide certain services, and participation in certain types of actions were strongly correlated with the completion of best practice activities. These findings will add to the discussion of what the minimum necessary elements of PHI may be.</p>

Since 2021, some state legislators have passed laws that limit what public institutions can teach about discrimination. The number of these laws, also called gag orders, is increasing despite a national outcry against racism, homophobia and transphobia, and other forms of discrimination. Many nursing and other professional healthcare organizations have recognized and published statements decrying racism in healthcare and calling for an increased focus on health disparities and advancing health equity. Similarly, national research institutions and private grant funders are funding health disparities research. Nursing and other faculty in higher education, however, are being gagged by laws and executive orders which prevent them from teaching and conducting research about historic and contemporary health disparities. This commentary seeks to highlight the immediate and long-term impact of academic gag orders and to encourage action in opposition of such legislation. Supported by professional codes of ethics and discipline-specific education, we present concrete activities readers can use to address gag order legislation and in doing so, protect patient and community health outcomes.