Search Results (30)

High-need populations face substantive barriers to accessing primary care, leading to disproportionately poor health outcomes. This descriptive, observational study details the implementation of a Federally Qualified Health Center (FQHC) program designed to improve engagement in care and enabling services by leveraging mobile health units (MHUs) to provide comprehensive, low-barrier primary care services to residents who were previously unable or unwilling to engage with the traditional healthcare system. The program sought to overcome common access challenges such as lack of transportation, lack of insurance, and mistrust of healthcare institutions. We describe the operational framework of this program, examine the types of care delivered, and offer recommendations from the perspective of a large multi-site FQHC experienced in reengaging people back to the healthcare system but new to providing mobile health care. We describe our program’s focus on prioritizing patient engagement and access and its consideration of operational and technical infrastructure. Based on our FQHC’s experience, we provide recommendations on how to address patients’ health and social needs. FQHCs have the potential to implement MHUs, drawing on their existing infrastructure and community relationships. Our MHU program is well-aligned with our FQHC’s commitment and priority to deliver essential care and foster continuity within hard-to-reach communities, strengthening the local healthcare safety net and improving healthcare for high-need populations. Full article

Women in vulnerable living situations with schizophrenia face intersecting challenges, including migration-related trauma, caregiving burdens, and systemic barriers such as cultural dislocation, limited healthcare access, and stigma. These factors heighten vulnerability compared with men and contribute to delayed diagnoses, poor treatment adherence, and adverse outcomes. Advances in artificial intelligence (AI) and digital tools offer potential support, though they should be regarded as complementary rather than stand-alone solutions. This review synthesizes literature on gender-specific care for women with schizophrenia, examining clinical, social, and reproductive needs alongside the impact of migration and psychosocial adversity. Emerging models, including women-focused psychiatric units, perinatal services, and community therapeutic spaces, illustrate holistic approaches that integrate the medical, psychological, and social dimensions of care. Digital interventions, such as smartphone applications, mobile health tools, and digital participation strategies, are considered supportive extensions that offer opportunities to improve access, reduce costs, and enhance continuity of care. Despite this promise, digital tools remain under-validated for women in precarious contexts. Ethical challenges, including algorithmic bias, data privacy risks, and the exclusion of undocumented or marginalized groups, further constrain equitable implementation. This review aims to articulate conceptual linkages among gender, migration, and digital innovation in schizophrenia care, identifying thematic patterns, ethical tensions, and structural limitations in the existing literature. The synthesis provides a foundation for future hypothesis development and interdisciplinary research to advance inclusive and equity-driven mental health interventions. Full article

Background/Objectives: The prevalence of Hepatitis C Virus (HCV) among men who have sex with men (MSM) is not negligible; however, data from Italy—especially regarding MSM who are not infected with Human Immunodeficiency Virus (HIV)—are limited. We report data from an HCV screening programme targeted at MSM in Rome, starting in 2019 in two hospital settings and in four urban community-based (CB) settings run by non-governmental organizations (NGOs). Methods: Adult MSM (>18 years old) who presented for HIV or sexually transmitted infection testing, or who attended CB activities, were invited to undergo a free-of-charge rapid HCV antibody test (OraQuick HCV^®), after providing informed consent. For all participants, demographic, clinical and behavioural data were collected using an anonymous questionnaire for all participants. Free confirmatory standard serology tests were offered for those found reactive at a rapid HCV test. Individuals with confirmed chronic HCV infection were referred through a dedicated “fast track” pathway for further clinical and laboratory assessment and direct-acting antiviral agents (DAAs) treatment according to the national treatment guidelines. Results: Between July 2019 and July 2023, 2714 MSM agreed to be screened for HCV infection. The median age was 36 years (interquartile range, IQR = 29–46), 91.0% were Italians, 58.0% enrolled in the two clinical centres and 10.7% reported living with HIV (people living with HIV, PLWH). Overall, 9 (0.33%) MSM tested reactive for HCV-specific antibodies using a rapid test. Eight MSM were retested and seven were confirmed to have chronic HCV infection (HCV viremia range: 8 × 10³–23 × 10⁶ IU/mL). The prevalence of confirmed cases was 0.26% (7/2714; 95%CI: 0.10–0.53) and was higher in PLWH compared to those not reporting HIV infection (1.04% vs. 0.17, p = 0.03). Four of seven confirmed HCV cases attended the STI clinic. All confirmed HCV cases reported high-risk behaviours for HCV infection and/or history of sexual transmitted infection (STI). Bening a PLWH (OR = 6.30) and current/former IDU (O = 17.02) resulted in being significantly associated with HCV infection. Other risk factors such as fisting, groupsex, chemsex and condomless anal intercourse were more common in the HCV case (OR > 2), but lacked statistical significance, likely due to small sample size. All seven individuals were linked to care, clinically assessed and started on DAAs treatment, achieving sustained viral response (SVR) in all cases. Conclusions: These data suggest the feasibility and potential effectiveness of a preventive programme targeting MSM living in Rome, combining HCV screening, case finding and prompt linkage to care. HCV prevalence in the screened population was lower than anticipated, although it is significantly higher in PLWH and in those with high-risk behaviours. Considering this condition of low prevalence of HCV infection among MSM in Italy, a targeted screening in PLWH and in individuals with high-risk behaviours may be more effective to achieve HCV eradication than universal screening in MSM. Full article

We sought to incorporate a community-based solution with a family health history (FHH) clinical support program (MeTree) integrated into well-patient appointments with the novel partnership of a public health state-level health information exchange (HIE). The Arkansas—Making History pilot project tested informatics compatibility among these systems and the patients’ electronic medical record (EPIC) in a rural clinic in the north central region of the state, having the state HIE as a means for patients to store and share their FHHs across multiple healthcare providers with updates in real time. We monitored for unexpected issues during the pilot and asked for the perspectives of patients and healthcare providers throughout the project to have a clear understanding of how to implement this project on a larger scale. The greatest barrier to project implementation was the inability of the state HIE to host or share the FHH data. We compensated for the lack of systems compatibility and documented valuable information about patient acceptability and usability of the MeTree platform, as well as gleaning important clinical outcome data from those who completed MeTree FHH accounts in an underserved area. Rural patients need additional technological support in the larger scaling of this project, both in available linkages to community clinics with patient-controlled options for how their data is stored and shared and in Internet connectivity and software options available for ease of use. Full article

Background/Objectives: Egg consumption in adults has been linked with a modestly increased risk of all-cause and CVD mortality. However, evidence on adults aged 65 y+ is limited. The objective of this study was to investigate the association between egg intake and mortality in community-dwelling older adults. Methods: In this prospective cohort study, 8756 adults aged 70+ years, participants in the ASPirin in Reducing Events in the Elderly (ASPREE) Longitudinal Study of Older Persons, self-reported the frequency of their total egg intake: never/infrequently (rarely/never, 1–2 times/month), weekly (1–6 times/week), and daily (daily/several times per day). All-cause and cause-specific (cardiovascular disease [CVD] and cancer) mortality was established from at least two sources: medical records, death notices, next of kin, or death registry linkage. The association between egg intake and mortality was assessed using Cox proportional hazards regression analysis, adjusted for socio-demographic, health-related, and clinical factors and overall dietary quality. Results: Over the median 5.9-year follow-up period, a total of 1034 all-cause deaths (11.8%) were documented. A 29% lower risk of CVD mortality (HR (95% CI): 0.71 [0.54–0.92]) and a 17% (HR (95% CI): 0.83 [0.71–0.96]) lower risk of all-cause mortality were observed among those who consumed eggs weekly, compared to those who consumed eggs never/infrequently; no statistically significant association was observed for weekly consumption and cancer mortality. In contrast, compared to those that never or infrequently consumed eggs, daily consumption had slightly higher odds of mortality, though these results did not reach statistical significance. Conclusions: The consumption of eggs 1–6 times per week was associated with a lower risk of all-cause mortality and CVD mortality in community-dwelling adults aged 70 years and over. These findings may be important to inform the development of evidence-based guidelines for egg consumption. Full article

Background: The COVID-19 pandemic made people face the fact that we are all vulnerable. This vulnerability can be measured through the Basic Variables of Care (BVC) using the Care Vulnerability Index (CVI). Health systems work with indicators that nurses can consult to understand the care and health situation of their population. These indicators provide valuable information on the vulnerability of the population. Objective: to determine the level of community vulnerability of a population group using health indicators from the computerized clinical records of Primary Care. Methods: observational, retrospective study from March 2023 to January 2024, with a sample of 2106 people assigned to a nurse at the Meco Health Centre (Madrid, Spain). Phases: selection of dashboard indicators, linkage to BVC, score assignment, population adjustment and calculation of the CVI. Results: The sample of indicators selects 18 out of 376 included in the Specific Dashboard; each indicator is related to 6 to 10 BCVs, with different rank values. Each score is adjusted by a Vulnerability Correction Factor according to the number of people included in the indicator. Finally, the population-adjusted CVI scores 1.95 points (percentile 37.90). Conclusions: community vulnerability is an essential tool in community health diagnostics and can be measured through health indicators that reflect the care situation of a population group at a given time, including changes in the situation in the face of health crises such as the COVID-19 pandemic. Full article

Background: Black adults have higher incidence of all-cause mortality and worse cardiovascular disease (CVD) outcomes when compared to other U.S. populations. The Duffy chemokine receptor is not expressed on erythrocytes in a large majority of Black adults, but the clinical implications of this are unclear. Methods: Here, we investigated the relationship of Duffy receptor status, high-sensitivity C-reactive protein (hs-CRP), and mortality and incident CVD events (coronary heart disease, stroke, and heart failure) in self-identified Black members of three contemporary, longitudinal cohort studies (the Women’s Health Initiative, Jackson Heart Study, and Multi-Ethnic Study of Atherosclerosis). Data on 14,358 Black participants (9023 Duffy-null and 5335 Duffy-receptor-positive, as defined using single-nucleotide polymorphism (SNP) rs2814778) were included in this analysis. Results: Duffy null was strongly associated with higher hs-CRP (meta-analysis p = 2.62 × 10⁻⁹), but the association was largely attenuated, though still marginally significant (p = 0.005), after conditioning on known CRP locus alleles in linkage disequilibrium with the Duffy gene. In our discovery cohorts, Duffy-null status appeared to be associated with a higher risk of all-cause mortality and incident stroke, though these associations were attenuated and non-significant following adjustment for traditional risk factors including hs-CRP. Moreover, the association of Duffy-null status with mortality could not be replicated in an independent sample of Black adults from the UK Biobank. Conclusions: These findings suggest that the higher levels of hs-CRP found in Duffy-null individuals may be in part independent of CRP alleles known to influence circulating levels of hs-CRP. During the follow-up of this community-based sample of Black participants, Duffy-null status was not associated with mortality or incident CVD events independently of traditional risk factors including hs-CRP. Full article

Background: In physiotherapy, the classic muscle–bone concept is used to translate basic and clinical anatomy. By defining the anatomical structures from superficial to deeper layers which frame the ArthroMyoFascial complex, our aim is to offer clinicians a comprehensive concept of within the muscle–bone concept. Method: This study is a narrative review and ultrasound observation. Results: Based on the literature and ultrasound skeletonization, the ArthroMyoFascial complex is defined. This model clarifies fascial continuity at the joint level, describing anatomical structures from skin to deeper layers, including superficial fascia, deep fascia, myofascia including skeletal muscle fibers, and arthrofascia all connected via connective tissue linkages. This model enhances the understanding of the muscle–bone concept within the larger ArthroMyoFascial complex. Conclusion: The ArthroMyoFascial complex consists of multiple anatomical structures from superficial to deeper layers, namely the skin, superficial fascia, deep fascia, myofascia including muscle fibers, and arthrofascia, all linked within a connective tissue matrix. This model indicates that it is a force-transmitting system between the skin and the bone. This information is crucial for manual therapists, including physiotherapists, osteopaths, chiropractors, and massage therapists, as they all work with fascial tissues within the musculoskeletal domain. Understanding fascia within the muscle–bone concept enhances clinical practice, aiding in therapeutic testing, treatment, reporting, and multidisciplinary communication, which is vital for musculoskeletal and orthopedic rehabilitation. Full article

Electronic patient portals represent a promising means of integrating mental health assessments into HIV care where anxiety and depression are highly prevalent. Patient attitudes toward portal-based mental health screening within HIV clinics have not been well described. The aim of this formative qualitative study is to characterize the patient-perceived facilitators and barriers to portal-based anxiety and depression screening within HIV care in order to inform implementation strategies for mental health screening. Twelve adult HIV clinic patients participated in semi-structured interviews that were audio recorded and transcribed. The transcripts were coded using constructs from the Consolidated Framework for Implementation Research and analyzed thematically to identify the barriers to and facilitators of portal-based anxiety and depression screening. Facilitators included an absence of alternative screening methods, an approachable design, perceived adaptability, high compatibility with HIV care, the potential for linkage to treatment, an increased self-awareness of mental health conditions, the ability to bundle screening with clinic visits, and communicating an action plan for results. The barriers included difficulty navigating the patient portal system, a lack of technical support, stigmatization from the healthcare system, care team response times, and the novelty of using patient portals for communication. The patients in the HIV clinic viewed the use of a portal-based anxiety and depression screening tool as highly compatible with routine HIV care. Technical difficulties, follow-up concerns, and a fear of stigmatization were commonly perceived as barriers to portal use. The results of this study can be used to inform implementation strategies when designing or incorporating portal-based mental health screening into other HIV care settings. Full article

Background: Pharmacogenomic knowledge as a biomarker for cancer care has transformed clinical practice, however, as current guidelines are primarily derived from Eurocentric populations, this limits their application in Latin America, particularly among Hispanic or Latino groups. Despite advancements, systemic chemotherapy still poses challenges in drug toxicity and suboptimal response. This study explores pharmacogenetic markers related to anticancer drugs in a Chilean cohort, filling a gap in Latin American research. Notably, the influence of native South American Mapuche-Huilliche ancestry. Methods: To explore pharmacogenetic markers related to anticancer drugs, we utilized an ethnically Admixed Chilean genome-wide association studies (GWAS) dataset of 1095 unrelated individuals. Pharmacogenomic markers were selected from PharmGKB, totaling 36 level 1 and 2 evidence single nucleotide polymorphisms (SNPs) and 571 level 3 SNPs. Comparative analyses involved assessing SNP frequencies across diverse populations from the 1000 Genomes Project. Haplotypes were estimated, and linkage disequilibrium was examined. Ancestry-based association analyses explored relationships between SNPs and Mapuche-Huilliche and European ancestries. Chi-square distribution with p ≤ 0.05 and Bonferroni’s multiple adjustment tests determined statistical differences between allele frequencies. Results: Our study reveals significant disparities in SNP frequency within the Chilean population. Notably, dihydropyrimidine dehydrogenase (DPYD) variants (rs75017182 and rs67376798), linked to an increased risk of severe fluoropyrimidine toxicity, exhibit an exceptionally low frequency (minor allele frequency (MAF) < 0.005). Nudix hydrolase 15 (NUDT15) rs116855232, associated with hematological mercaptopurine toxicity, is relatively common (MAF = 0.062), and is further linked to Mapuche-Huilliche ancestry. Thiopurine methyltransferase enzyme (TPMT), implicated in severe toxicity to mercaptopurines, SNPs rs1142345 and rs1800460 of TMPT gene demonstrate higher MAFs in Admixed Americans and the Chilean population (MAF range 0.031–0.057). Finally, the variant in the UDP-glucuronosyltransferase 1 gene (UGT1A1) rs4148323, correlated with irinotecan neutropenia, exhibits the highest MAF in East Asian (MAF = 0.136) and Chilean (MAF = 0.025) populations, distinguishing them from other investigated populations. Conclusions: This study provides the first comprehensive pharmacogenetic characterization of cancer therapy-related SNPs and highlights significant disparities in SNP frequencies within the Chilean population. Our findings underscore the necessity for inclusive research and personalized therapeutic strategies to ensure the equitable and effective application of precision medicine across diverse global communities. Full article

Despite significant progress in the prevention, screening, diagnosis, prognosis, and therapy of breast cancer (BC), it remains a highly prevalent and life-threatening disease affecting millions worldwide. Molecular subtyping of BC is crucial for predictive and prognostic purposes due to the diverse clinical behaviors observed across various types. The molecular heterogeneity of BC poses uncertainties in its impact on diagnosis, prognosis, and treatment. Numerous studies have highlighted genetic and environmental differences between patients from different geographic regions, emphasizing the need for localized research. International studies have revealed that patients with African heritage are often diagnosed at a more advanced stage and exhibit poorer responses to treatment and lower survival rates. Despite these global findings, there is a dearth of in-depth studies focusing on communities in the African region. Early diagnosis and timely treatment are paramount to improving survival rates. In this context, radiogenomics emerges as a promising field within precision medicine. By associating genetic patterns with image attributes or features, radiogenomics has the potential to significantly improve early detection, prognosis, and diagnosis. It can provide valuable insights into potential treatment options and predict the likelihood of survival, progression, and relapse. Radiogenomics allows for visual features and genetic marker linkage that promises to eliminate the need for biopsy and sequencing. The application of radiogenomics not only contributes to advancing precision oncology and individualized patient treatment but also streamlines clinical workflows. This review aims to delve into the theoretical underpinnings of radiogenomics and explore its practical applications in the diagnosis, management, and treatment of BC and to put radiogenomics on a path towards fully integrated diagnostics. Full article

Studies at the juncture of development economics and public health take on considerable responsibility in addressing inequality and related mental health distress. Mental healthcare in economically marginalized populations requires depicting the linkages between socioeconomic status and psychological distress. In the present work, a sequential mixed-methods design was used to study 190 people in such communities in India. Gender-dependent psychological distress was found according to the Kessler Psychological Distress Scale (K-10) with moderate distress in women (M = 26.30, SD = 9.15) and mild distress in men (M = 21.04, SD = 8.35). Regression analysis indicated that gender significantly predicted psychological distress, followed by age, marital status, and the level of education of the head of the family. The Interpretative Phenomenological Analysis of semi-structured interviews of the six women who scored the highest on the distress scale unveiled three master themes: (1) manifestation of psychological distress, (2) contextual challenges, and (3) sources of strength and resilience. Overall, participants reported a lack of resources, community violence, gender discrimination, and widespread substance use as major contributors to the ongoing distress. These findings can pave the way for future studies to expand beyond independent economic indicators and curate clinical interventions for culturally competent mental healthcare. Full article

Mobile health clinics (MHCs) serve as an alternative HIV care delivery method for the HIV-burdened eThekwini district. This study aimed to describe and profile the HIV care services provided by the MHCs through process evaluation. A descriptive cross-sectional quantitative evaluation study was performed on 137 MHCs using total population sampling. An online data collection method using a validated 50-item researcher-developed instrument was administered to professional nurses who are MHC team leaders, following ethical approval from the local university and departments of health. Descriptive statistics were used to analyze the data. The results described that HIV care services are offered in open spaces (43%), community buildings (37%), solid built buildings called health posts (15%), vehicles (9%), and tents (2%) with no electricity (77%), water (55%), and sanitation (64%). Adults (97%) are the main recipients of HIV care in MHCs (90%) offering antiretroviral therapy (95%). Staff, monitoring, and retaining care challenges were noted, with good linkage (91%) and referral pathways (n = 123.90%). In conclusion, the standardization and prioritization of HIV care with specific contextual practice guidelines are vital. Full article

People released from prison experience high health needs and face barriers to health care in the community. During the COVID-19 pandemic, people released early from California state prisons to under-resourced communities. Historically, there has been minimal care coordination between prisons and community primary care. The Transitions Clinic Network (TCN), a community-based non-profit organization, supports a network of California primary care clinics in adopting an evidence-based model of care for returning community members. In 2020, TCN linked the California Department of Corrections and Rehabilitation (CDCR) and 21 TCN-affiliated clinics to create the Reentry Health Care Hub, supporting patient linkages to care post-release. From April 2020–August 2022, the Hub received 8420 referrals from CDCR to facilitate linkages to clinics offering medical, behavioral health, and substance use disorder services, as well as community health workers with histories of incarceration. This program description identifies care continuity components critical for reentry, including data sharing between carceral and community health systems, time and patient access for pre-release care planning, and investments in primary care resources. This collaboration is a model for other states, especially after the Medicaid Reentry Act and amid initiatives to improve care continuity for returning community members, like California‘s Medicaid waiver (CalAIM). Full article

The complexity and variety of gut microbiomes within and among individuals have been extensively studied in recent years in connection to human health and diseases. Our growing understanding of the bidirectional communication between metabolic diseases and the gut microbiome has also highlighted the significance of gut microbiome dysbiosis in the genesis and development of obesity-related cancers. Therefore, it is crucial to comprehend the possible role of the gut microbiota in the crosstalk between obesity and colorectal cancer (CRC). Through the induction of gut microbial dysbiosis, gut epithelial barrier impairment, metabolomic dysregulation, chronic inflammation, or dysregulation in energy harvesting, obesity may promote the development of colorectal tumors. It is well known that strategies for cancer prevention and treatment are most effective when combined with a healthy diet, physical activity, and active lifestyle choices. Recent studies also suggest that an improved understanding of the complex linkages between the gut microbiome and various cancers as well as metabolic diseases can potentially improve cancer treatments and overall outcomes. In this context, we herein review and summarize the clinical and experimental evidence supporting the functional role of the gut microbiome in the pathogenesis and progression of CRC concerning obesity and its metabolic correlates, which may pave the way for the development of novel prognostic tools for CRC prevention. Therapeutic approaches for restoring the microbiome homeostasis in conjunction with cancer treatments are also discussed herein. Full article