A traditional focus of academic medicine and healthcare systems has been on tackling health inequities through measures designed to increase diversity within the medical workforce. In the case of this method
While a diverse workforce is desirable, health equity in its entirety, not just diversity, must be the core objective for all academic medical centers, interwoven with clinical care, education, research, and community connection.
NYU Langone Health (NYULH) has commenced a comprehensive restructuring process to become an equity-focused learning health system. One-way NYULH accomplishes this by initiating the formation of a
Within the context of our healthcare delivery system, an organizing framework supports our embedded pragmatic research to address and dismantle health inequities across our tripartite mission of patient care, medical education, and research.
This paper provides a detailed account of each of the six elements contained within NYULH.
The components of achieving health equity encompass: (1) the establishment of procedures for gathering detailed data on race, ethnicity, language, sexual orientation, gender identity, and disability; (2) the utilization of data analysis to pinpoint disparities in health outcomes; (3) the creation of performance metrics and targets to track progress in closing health equity gaps; (4) the investigation into the underlying causes of identified disparities; (5) the development and evaluation of evidence-based interventions to address and rectify the inequities; and (6) ongoing monitoring and feedback mechanisms for system enhancements.
A vital part of the procedure is the application of each element.
Academic medical centers can create a model for the embedding of a culture of health equity into their health systems, leveraging pragmatic research.
Implementing each component of the roadmap exemplifies a model for academic medical centers to cultivate a health equity culture within their systems using pragmatic research methodologies.
The research community has been unable to agree upon the precise factors that lead to suicide amongst former military personnel. Research findings, while concentrated in a select few countries, demonstrate a lack of consistency and present contradictory conclusions. Research on suicide, a significant health concern in the USA, has been prolific; however, the UK has relatively little research focused on veterans from the British Armed Forces.
In adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this systematic review was meticulously undertaken. PsychINFO, MEDLINE, and CINAHL were the databases used for the corresponding literature searches. For inclusion in the review, articles addressing suicide, suicidal ideation, its frequency, or the elements contributing to suicide risk among British Armed Forces veterans were considered. The analysis involved a selection of ten articles that aligned with the defined inclusion criteria.
UK general population suicide rates were found to be equivalent to veterans' suicide rates. Hanging and strangulation were frequently reported as the chosen method in cases of suicide. Hepatitis E Among suicide fatalities, firearms were identified in 2% of the reported incidents. The link between demographic factors and risk was often inconsistent in research, with certain studies associating risk with older veterans while others with younger veterans. Female veterans were shown to face a greater degree of risk in comparison to female civilians. infections: pneumonia Combat deployments were associated with a reduced risk of suicide among veterans, with research further suggesting a correlation between delayed mental health help-seeking and an increased incidence of suicidal ideation.
Peer-reviewed publications have disclosed UK veteran suicide prevalence to be broadly comparable to the general public, with variations evident among international military contingents. Veteran demographics, service history, difficulties in transitioning to civilian life, and mental health issues can all contribute to heightened suicide risks and suicidal thoughts. Research has identified elevated risk factors for female veterans in contrast to civilian women, potentially attributable to the predominantly male veteran cohort; consequently, further investigation is warranted. The existing research on suicide within the UK veteran population is insufficient; a more thorough investigation into prevalence and risk factors is therefore required.
Published research, vetted by peers, demonstrates a UK veteran suicide rate broadly similar to the civilian rate, while also emphasizing disparities among international armed forces. Potential risk factors for suicide and suicidal thoughts among veterans include demographic information, service history, the transition process, and mental health conditions. Research demonstrates a greater risk for female veterans in comparison to their civilian counterparts, a phenomenon possibly attributable to the preponderance of male veterans; further investigation is crucial to understanding this disparity. The existing research base concerning suicide among UK veterans demands further investigation into its prevalence and associated risk factors.
In recent years, advancements in hereditary angioedema (HAE) treatment for C1-inhibitor (C1-INH) deficiency have led to the inclusion of two subcutaneous (SC) options, a monoclonal antibody, lアナde lumab, and a plasma-derived C1-INH concentrate, SC-C1-INH. These therapies have been subject to limited reporting regarding their real-world performance. Describing new users of lanadelumab and SC-C1-INH, the study sought to analyze their demographics, healthcare resource utilization (HCRU), related costs, and treatment patterns, both preceding and subsequent to the commencement of therapy. This research utilized an administrative claims database as its data source for a retrospective cohort study. Two cohorts of new adult (18 years) lanadelumab or SC-C1-INH users, demonstrating 180 days of unbroken treatment, were independently identified. The 180-day period preceding the index date (when a new treatment was initiated) and the subsequent 365 days encompassed the analysis of HCRU, costs, and treatment patterns. HCRU and costs were ascertained by utilizing annualized rates. Among the studied patients, forty-seven used lanadelumab, while thirty-eight utilized SC-C1-INH. The predominant on-demand HAE treatments at the initial stage of both cohorts were the same, including bradykinin B antagonists (489% for lanadelumab, 526% for SC-C1-INH), and C1-INHs (404% for lanadelumab, 579% for SC-C1-INH). Following the initiation of treatment, over 33% of patients continued to refill their on-demand medication prescriptions. After treatment was initiated, annualized angioedema-related emergency department visits and hospitalizations declined significantly. Patients on lanadelumab showed a decrease from 18 to 6, while those receiving SC-C1-INH saw a reduction from 13 to 5. Annualized total healthcare expenditures post-treatment initiation, in the database, totaled $866,639 for the lanadelumab group and $734,460 for the SC-C1-INH group, respectively. Pharmacy costs comprised a percentage exceeding 95% of these total expenditures. Concluding that HCRU decreased after treatment commencement, the persistent need for angioedema-associated emergency department visits, hospitalizations, and on-demand treatment use remained. Utilizing modern HAE medications does not fully resolve the burden posed by ongoing disease and treatment.
A variety of public health methods, beyond the conventional, are essential for closing many substantial gaps in public health evidence. Public health researchers are to be introduced to a curated selection of systems science methods, which will serve to improve their understanding of intricate phenomena and lead to more impactful interventions. A case study of the present cost-of-living crisis reveals how disposable income, a key structural component, significantly impacts health.
We initially sketch out the possible applications of systems science methodologies in public health research generally, then delve into the complexities of the cost-of-living crisis as a concrete illustration. We outline a strategy for applying four systems science approaches—soft systems, microsimulation, agent-based modeling, and system dynamics—to gain a more nuanced perspective. The unique knowledge offered by each method is presented, along with several suggested research projects to inform policy and practice.
Due to its pivotal role in influencing health determinants, the cost-of-living crisis represents a complex public health predicament, aggravated by the limited resources for interventions at the population scale. Tackling complex systems, marked by non-linearity, feedback loops, and adaptation, systems methodologies empower a more in-depth comprehension and forecasting of the mutual interactions and ripple effects stemming from real-world policies and interventions.
Public health methodologies benefit from the robust methodological framework provided by systems science. Understanding the current cost-of-living crisis in its early stages can be significantly aided by this toolbox, enabling the development of solutions and the simulation of responses to improve the health of the population.
Traditional public health methodologies are enriched by the comprehensive methodological toolkit offered by systems science approaches. This toolbox can prove particularly valuable during the initial stages of the current cost-of-living crisis for elucidating the situation, crafting solutions, and simulating potential responses in order to improve population health.
The question of who to admit to critical care during a pandemic continues to lack a definitive answer. Epigenetics inhibitor Age, Clinical Frailty Score (CFS), 4C Mortality Score, and in-hospital death rates were contrasted during two separate COVID-19 surges, differentiated by the physician's escalation plan.
A review of all critical care referrals during the initial wave of COVID-19 (cohort 1, March/April 2020) and a subsequent surge (cohort 2, October/November 2021) was performed in a retrospective manner.