Go‐Along Interview Assessment of Community Health Priorities for Neighborhood Renewal

Healthcare systems are increasingly investing in approaches to address social determinants of health and health disparities. Such initiatives dovetail with certain approaches to neighborhood development, such as the EcoDistrict standard for community development, that prioritize both ecologically and socially sustainable neighborhoods. However, healthcare system and community development initiatives can be untethered from the preferences and lived realities of residents in the very neighborhoods upon which they focus. Utilizing the go-along approach to collecting qualitative data in situ, we interviewed 19 adults to delineate residents\u27 community health perspectives and priorities. Findings reveal health priorities distinct from clinical outcomes, with residents emphasizing social connectedness, competing intra- and interneighborhood perceptions that potentially thwart social connectedness, and a neighborhood emplacement of agency, dignity, and self-worth. Priorities of healthcare systems and community members alike must be accounted for to optimize efforts that promote health and social well-being by being valid and meaningful to the community of focus

Beyond the Treatment: the Role of Race, Sex, and Education in Health Trajectories Between Cancer Survivors and Noncancer Older Adults

Introduction: The number of older, long-term cancer survivors is increasing. However, little is known about how cancer and aging affect the health trajectories of older adults differently. In addition, the impact of race, sex, and education on the processes of aging and the cancer experience needs further investigation. The current study aims to address this knowledge gap by combining two National Cancer Institute (NIC)-funded longitudinal studies conducted in Cleveland from 1998 to 2010. Materials and Methods: The unique cross-sequential design facilitates a comparison between the health changes in long-term (five years +) older cancer survivors (breast, prostate, and colorectal cancer) and demographically matched older adults without a history of cancer in the same geographic area within the same period. The study also captured comprehensive information on how socioeconomic status interacts with cancer and aging over time. General linear models were employed in the data analysis. Results: The findings showed that early cancer experience did not affect long-term cancer survivors\u27 health status in later life. Conversely, comorbidities, being an African American, being female, and having education less than a college degree significantly decreased the health trajectory in later life for all older adults. Moreover, compared to other groups, older African American cancer survivors reported a dramatic decrease in self-reported health after controlling for other conditions. Discussion: Study findings can inform public policy and social services to offer comprehensive treatment plans and help individuals overcome their diseases and lead longer and healthier lives

Clinical and Sociodemographic Characteristics as Predictors for Quality of Life in Transmasculine and Transfeminine Individuals Receiving Gender-Affirming Hormone Therapy

Healthcare systems and providers have increasingly acknowledged the role and impact of social determinants in overall health. However, gender-diverse individuals face persistent health disparities due to their identities. There is limited research on the impact of clinical and sociodemographic characteristics on mood and quality of life (QoL) for transgender (TG) individuals. Our study aims to understand and better elucidate social and clinical characteristics of transmasculine (TM) and transfeminine (TF) individuals and their impact on quality of life and depressive symptoms. In this cross-sectional study, 298 TF and TM individuals on gender-affirming hormone therapy (GAHT) were surveyed about their demographic characteristics (age, gender identity, body mass index (BMI), and education), social needs, mood, and quality of life. Multivariable regression modelling was performed to assess the effect of each variable listed above on three domains of QoL (psychological, environmental, and physical) as well as depressive symptoms. We find that QoL scores are similar between TM and TF individuals, with scores in the psychological domain particularly low in both cohorts. TM individuals report higher rates of stress and restroom avoidance than TF individuals. In particular, psychological well-being (measured by the psychological domain of QoL and depressive symptoms) is significantly associated with increased BMI, financial instability, and stress in TM individuals while for TF individuals, psychological well-being is associated with stress and social integration. These data suggest that social circumstances are key drivers of QoL and psychological well-being among gender-diverse individuals receiving GAHT with specific differences between TF and TM individuals. This information may be utilized by healthcare providers and policymakers to address and improve clinical care and social policies to improve health equity for gender-diverse individuals

Self-reported Determinants of COVID-19 Vaccine Acceptance Among Persons with and without Autoimmune Disease

Objective: Patients with autoimmune disease (AD) are at increased risk for complications from COVID-19 infection, so, optimizing vaccine utilization in this population is of particular importance. We compared COVID-19 vaccination perspectives among persons with and without AD. Methods: 471 patients in the MetroHealth System and Cleveland Veteran Affairs Medical Center completed a 38-item questionnaire between August 2021 and February 2022. This survey containing questions regarding COVID-19 vaccine perceptions and demographics was administered both to unvaccinated individuals and individuals who delayed vaccination for at least 2 months. Multivariable ordinary least squares regression models were created to assess factors associated with vaccination likelihood. Results: The number of reasons given for (p \u3c 0.001) and against receiving COVID-19 vaccination (p \u3c 0.001) were highly associated with increased and decreased vaccination likelihood respectively. Factors most closely associated with obtaining vaccine were: protecting family (p = 0.045) personal safety (p \u3c 0.001) and preventing serious infection (p \u3c 0.001). Reasons associated with decreased vaccination likelihood were: lack of concern of COVID-19 infection (p \u3c 0.001), vaccine safety (p \u3c 0.001) and beliefs that the vaccine was made too quickly (p = 0.024). AD patients were more likely to cite having a chronic condition (29.1 % vs 17.1 %, p = 0.003) and physician recommendation(s) (18.4 % vs 9.1 %, p = 0.005) as reasons for vaccination and were more concerned about potential medication interaction than non-AD respondents (22.4 % vs 3.3 %, p \u3c 0.001). Conclusion: The number of benefits of vaccination identified strongly related to vaccination likelihood. Affirmative provider recommendations correlated with increased vaccination likelihood in AD patients. Clinical conversations centered on the benefits of COVID-19 vaccination may help increase vaccine acceptance

Bringing community oriented primary care into an academic training setting: A qualitative study

Objectives: Identify patient-informed strategies through which an urban resident continuity clinic can implement the principles of community oriented primary care (COPC). Methods: As part of a larger sequential mixed methods study supporting implementation evaluation of a new urban academic medical center in Cleveland, Ohio, semi-structured telephone interviews using a descriptive phenomenological approach were conducted spring 2021 with patients to explore perspectives regarding community involvement by healthcare providers and what they want clinicians to know about their community. A constant comparative analysis of emerging themes was used to analyze the thematic contents of interviews. Results: Twenty-one participants completed interviews. Almost all thought clinicians’ community involvement is important. Thematic guidance from participants highlighted that clinicians should be: (1) knowledgeable about the Black experience, (2) seen in the community outside the clinic, and (3) aware that “knowing my community is knowing me.” Conclusions: Design with a target community in mind is a necessary but not sufficient step to implement COPC in practice. The visibility of clinicians in community settings is essential for COPC

Dynamic measurements on polymer chain dimensions below the θ-temperature

To observe the contraction of a flexible chain, quasi-elastic light scattering and viscosity experiments were performed below the θ-temperature. The systems used were monodisperse polystyrene (Mw = 1.71 x 10 5, Mw =4.11 × 105, Mw = 1.26 ×106) dissolved in cyclohexane. It is observed that : — Hydrodynamic and viscosity expansion factors, αH and α3 η, scale with the reduced variable (θ-T T)√M. — αH and α3η have a linear behaviour in a «θ domain» (0≤ |θ - T / T| √M ≤ 10) which is symmetric with respect to the θ-temperature. — There is no evidence of an asymptotic collapsed regime for (θ-T T)√M≤ 35.Des expériences de diffusion de lumière quasi-élastique et de viscosité sont réalisées en dessous de la température θ pour observer la contraction d'une chaine flexible. Les échantillons utilisés sont du polystyrène monodisperse dissous dans du cyclohexane (Mw = 1,71 x 105; Mw =4,11 × 105; Mw = 1,26 × 106 ). On observe que : — Les facteurs d'expansion hydrodynamique (αH et de viscosité (α3 η) s'échellent selon la variable reduite (θ - T / T)√ M. — αH et α3η ont un comportement linéaire dans un « domaine θ » (0 ≤|θ - T / T| √M ≤ 10) qui est symétrique. par rapport à θ. — Le « régime asymptotique collapsé» n'est pas observé pour (θ-T T)√M≤ 35