Moving home: Community transition supports for people with intellectual and developmental disabilities

BackgroundIn recognition of the important role housing plays in people's health and quality of life, Medicaid Home- and Community-Based Services (HCBS) programs are more frequently working to promote the housing security of Medicaid beneficiaries. One mechanism states use to promote housing security of people with intellectual and developmental disabilities (IDD) is to offer community transition services in their HCBS programs. Community transition services help with transition by assisting with securing housing and leases, obtaining basic furnishings, paying for utility setup, funding moving expenses, and making accessibility adaptations.ObjectiveThe aim of this study was to examine if and how states provided community transition services in their HCBS waiver programs for people with IDD.MethodsWe analyzed 107 fiscal year (FY) 2021 HCBS 1915(c) waivers for people with IDD from across the United States. We analyzed the service expenditures and utilization data for community transition services, including projected spending, projected number of users served, reimbursement rates, projected spending per participant, and annual service provision per participant.ResultsIn FY2021, 49 waivers (45.8%) from 28 states provided community transition services to people with IDD. A total of $7.21 million of spending was projected for community transition services for 2405 people with IDD, with an average spending per person of $2303.ConclusionsWhile community transition services can help promote the housing insecurity of people with IDD, there was wide variance in how these services were allocated to people with IDD in FY2021.     

Using decision trees to understand the influence of individual- and neighborhood-level factors on urban diabetes and asthma

ObjectiveTo determine the influence of individual and neighborhood factors that combined are associated with asthma and diabetes in a sample of urban Philadelphians using data mining, a novel technique in public health research.MethodsWe obtained secondary data collected between May 2011 and November 2014 on individual's health and perception of neighborhood characteristics (N = 450) and Philadelphia LandCare Program data that provided relevant environmental data for the analysis (N = 676). RapidMiner open access data mining software was used to perform decision tree analyses.ResultsIndividual- and neighborhood-level environmental factors were intricately related in the decision tree models, having varying influence on the outcomes of asthma and diabetes. The decision trees had high specificity (95–100) and classified factors that were associated with an absence of disease (diabetes/asthma).ConclusionImproved neighborhood-level conditions related to social and physical disorder were consistently found to be associated with an absence of both asthma and diabetes in this urban population.Policy implicationsThis study illustrates the potential utility of applying data mining techniques for understanding complex public health issues.     

Neighbourhood crime and major depression in Sweden: A national cohort study

BackgroundThe association between neighbourhood crime and major depression (MD) has been described before but previous studies may be limited by biases in self-reported data and the use of homogenous study populations. Our study aimed to examine the association between neighbourhood crime and clinically diagnosed MD among the immigrant and non-immigrant populations in Sweden.MethodsA retrospective cohort study was performed, which included non-immigrants and first- and second-generation immigrants residing in Sweden, who were born between 1960 and 1996. We used linked Swedish national registers, geospatial analysis and multilevel logistic regression models to examine the potential effect of neighbourhood crime on the odds of major depression between January 1, 2012, and December 31, 2015.ResultsOverall, individuals living in neighbourhoods with high levels of neighbourhood crime had higher odds of MD than those who did not. There was a significant interaction by immigrant status; the odds of MD among those with non-immigrant backgrounds were more strongly associated with increases in neighbourhood crime, after adjusting for potential confounders. Male and female immigrants born outside Sweden did not seem to be affected by increases in neighbourhood crime.ConclusionThe apparent effect of increases in neighbourhood crime on the odds of MD seemed to differ between those of different immigrant statuses. Future research should aim to explore the possible mechanisms behind the differences in the rates of MD among the non-immigrant and immigrant populations in neighbourhoods with high crime.     

Influenza vaccination and respiratory virus interference among Department of Defense personnel during the 2017–2018 influenza season

PurposeReceiving influenza vaccination may increase the risk of other respiratory viruses, a phenomenon known as virus interference. Test-negative study designs are often utilized to calculate influenza vaccine effectiveness. The virus interference phenomenon goes against the basic assumption of the test-negative vaccine effectiveness study that vaccination does not change the risk of infection with other respiratory illness, thus potentially biasing vaccine effectiveness results in the positive direction. This study aimed to investigate virus interference by comparing respiratory virus status among Department of Defense personnel based on their influenza vaccination status. Furthermore, individual respiratory viruses and their association with influenza vaccination were examined.ResultsWe compared vaccination status of 2880 people with non-influenza respiratory viruses to 3240 people with pan-negative results. Comparing vaccinated to non-vaccinated patients, the adjusted odds ratio for non-flu viruses was 0.97 (95% confidence interval (CI): 0.86, 1.09; p = 0.60). Additionally, the vaccination status of 3349 cases of influenza were compared to three different control groups: all controls (N = 6120), non-influenza positive controls (N = 2880), and pan-negative controls (N = 3240). The adjusted ORs for the comparisons among the three control groups did not vary much (range: 0.46–0.51).ConclusionsReceipt of influenza vaccination was not associated with virus interference among our population. Examining virus interference by specific respiratory viruses showed mixed results. Vaccine derived virus interference was significantly associated with coronavirus and human metapneumovirus; however, significant protection with vaccination was associated not only with most influenza viruses, but also parainfluenza, RSV, and non-influenza virus coinfections.     

Physical activity resources and programming for substance use treatment in U.S. residential treatment programs

IntroductionRegular physical activity (PA) provides many physical and mental health benefits for people with substance use disorders (SUDs); however, multiple barriers exist integrating it into their treatment. This study examined the level of PA programming for adults in substance use residential treatment programs (RTPs) in the United States.MethodsUsing the Substance Abuse and Mental Health Services Administration's treatment locator, RTPs were identified and categorized by facility type (short-, long-term, or combined). In each state, 25% of RTPs from each facility type were randomly selected. A representative from each RTP was interviewed to identify equipment, time, space, and staff available for PA programming.ResultsOf the 193 RTPs interviewed, nearly all valued PA (89.1%) and believed their clients desired its inclusion in their treatment (89.6%). Most RTPs reported having space for PA programming (90.7%), had aerobic (52.9%) and strength training (54.9%) equipment, and included mandatory (57.0%) or optional (87.6%) time in the schedule for PA. Fewer RTPs reported having full- (24.3%) or part-time (56.8%) staff trained to lead PA programming. The most common organizational barriers were a lack of funding/resources (63.7%), space (31.6%), and staffing (11.9%). The most commonly perceived client barriers included a poor mindset/lack of motivation (55.4%), poor physical health (26.4%), client withdrawal/detoxification (14.5%), and general health issues (10.9%).ConclusionsRTPs valued PA and found unique ways to provide space, equipment, and time to offer PA programming. Future research should focus on strategies to overcome client barriers and increase staff qualified to lead PA programming.     

Association of functional disability and treatment modalities with perceived effectiveness of treatment among adults with depression: a cross-sectional study

BackgroundApproximately 17.3 million US adults had at least one major depressive episode (MDE) in 2017. Of those, about two-thirds received mental health services from health professionals. Persons with disabilities (PWD) have higher risks of depression and may face more challenges in seeking treatment.ObjectiveExamined whether the presence of disabilities affected the perceived effectiveness of treatment for people with MDE who received outpatient mental health care.MethodsWe obtained MDE status, functional disability, modality of treatment (i.e., medication only, counseling only, medication plus counseling), self-reported effectiveness of treatment, and covariates from a nationally representative sample of US adults aged ≥18 years in the 2015–2019 National Survey on Drug Use and Health. We used multivariable logistic regression models with recommended survey weighting to examine associations between disability and perceived effectiveness of treatment.ResultsThe study population comprised 9992 respondents, representing 9.53 million US adults who had MDE and received outpatient mental health care in the past year. Overall, 58.9% had at least one functional limitation. A higher proportion of PWDs received medication plus counseling treatment compared to persons without disabilities (79.2% vs. 67.9%, P < .001). PWDs were significantly less likely to rate treatment as effective (OR = 0.77; 95% CI: 0.66–0.91). Odds ratios decreased as the number of limitations increased, and this association was moderated by treatment modality.ConclusionPWDs have poorer perceived outcomes of outpatient mental health care for depression, especially for treatment modalities involving counseling. These findings call for focused attention to depression treatment efforts for PWD that accommodate their needs.     

Perceived impacts of COVID-19 on wellbeing among US working-age adults with ADL difficulty

BackgroundThe COVID-19 pandemic has disproportionately impacted people with disabilities. Working-age adults with ADL difficulty may face unique challenges and heightened health risks because of the pandemic. It is critical to better understand the impacts of COVID-19 on social, financial, physical, and mental wellbeing among people with disabilities to inform more inclusive pandemic response policies.ObjectiveThis study compares perceived COVID-19 physical and mental health, social, and financial impacts for US working-age adults with and without ADL difficulty.MethodsWe analyzed data from a national survey of US working-age adults (aged 18–64) conducted in February and March 2021 (N = 3697). We used logistic regression to compare perceived COVID-19-related impacts on physical and mental health, healthcare access, social relationships, and financial wellbeing among those with and without ADL difficulty.ResultsAdults with ADL difficulty were more likely to report negative COVID-19 impacts for many but not all outcomes. Net of covariates, adults with ADL difficulty had significantly greater odds of reporting COVID-19 infection (OR = 2.1) and hospitalization (OR = 6.7), negative physical health impacts (OR = 2.0), and negative impacts on family relationships (OR = 1.6). However, they had significantly lower odds of losing a friend or family member to COVID-19 (OR = 0.7). There were no significant differences in perceived impacts on mental health, ability to see a doctor, relationships with friends, or financial wellbeing.ConclusionsWorking-age adults with ADL difficulty experienced disproportionate health and social harm due to the COVID-19 pandemic. To address these disparities, public health response efforts and social policies supporting pandemic recovery must include disability perspectives.     

A broad assessment of covid-19 vaccine safety using tree-based data-mining in the vaccine safety datalink

BackgroundExcept for spontaneous reporting systems, vaccine safety monitoring generally involves pre-specifying health outcomes and post-vaccination risk windows of concern. Instead, we used tree-based data-mining to look more broadly for possible adverse events after Pfizer-BioNTech, Moderna, and Janssen COVID-19 vaccination.MethodsVaccine Safety Datalink enrollees receiving ≥1 dose of COVID-19 vaccine in 2020–2021 were followed for 70 days after Pfizer-BioNTech or Moderna and 56 days after Janssen vaccination. Incident diagnoses in inpatient or emergency department settings were analyzed for clustering within both the hierarchical ICD-10-CM code structure and the post-vaccination follow-up period. We used the self-controlled tree-temporal scan statistic and TreeScan software. Monte Carlo simulation was used to estimate p-values; p = 0.01 was the pre-specified cut-off for statistical significance of a cluster.ResultsThere were 4.1, 2.6, and 0.4 million Pfizer-BioNTech, Moderna, and Janssen vaccinees, respectively. Clusters after Pfizer-BioNTech vaccination included: (1) unspecified adverse effects, (2) common vaccine reactions, such as fever, myalgia, and headache, (3) myocarditis/pericarditis, and (4) less specific cardiac or respiratory symptoms, all with the strongest clusters generally after Dose 2; and (5) COVID-19/viral pneumonia/sepsis/respiratory failure in the first 3 weeks after Dose 1. Moderna results were similar but without a significant myocarditis/pericarditis cluster. Further investigation suggested the fifth signal group was a manifestation of mRNA vaccine effectiveness after the first 3 weeks. Janssen vaccinees had clusters of unspecified or common vaccine reactions, gait/mobility abnormalities, and muscle weakness. The latter two were deemed to have arisen from confounding related to practices at one site.ConclusionsWe detected post-vaccination clusters of unspecified adverse effects, common vaccine reactions, and, for the mRNA vaccines, chest pain and palpitations, as well as myocarditis/pericarditis after Pfizer-BioNTech Dose 2. Unique advantages of this data mining are its untargeted nature and its inherent adjustment for the multiplicity of diagnoses and risk intervals scanned.     

Unmet need for COVID-19 vaccination coverage in Kenya

COVID-19 has impacted the health and livelihoods of billions of people since it emerged in 2019. Vaccination for COVID-19 is a critical intervention that is being rolled out globally to end the pandemic. Understanding the spatial inequalities in vaccination coverage and access to vaccination centres is important for planning this intervention nationally. Here, COVID-19 vaccination data, representing the number of people given at least one dose of vaccine, a list of the approved vaccination sites, population data and ancillary GIS data were used to assess vaccination coverage, using Kenya as an example. Firstly, physical access was modelled using travel time to estimate the proportion of population within 1 hour of a vaccination site. Secondly, a Bayesian conditional autoregressive (CAR) model was used to estimate the COVID-19 vaccination coverage and the same framework used to forecast coverage rates for the first quarter of 2022. Nationally, the average travel time to a designated COVID-19 vaccination site (n = 622) was 75.5 min (Range: 62.9 – 94.5 min) and over 87% of the population >18 years reside within 1 hour to a vaccination site. The COVID-19 vaccination coverage in December 2021 was 16.70% (95% CI: 16.66 – 16.74) – 4.4 million people and was forecasted to be 30.75% (95% CI: 25.04 – 36.96) – 8.1 million people by the end of March 2022. Approximately 21 million adults were still unvaccinated in December 2021 and, in the absence of accelerated vaccine uptake, over 17.2 million adults may not be vaccinated by end March 2022 nationally. Our results highlight geographic inequalities at sub-national level and are important in targeting and improving vaccination coverage in hard-to-reach populations. Similar mapping efforts could help other countries identify and increase vaccination coverage for such populations.     

The burden of herpes zoster disease in Norway

BackgroundNo national vaccination program against herpes zoster (HZ) is currently in place in Norway. We aimed to quantify the burden of medically attended HZ to assess the need for a vaccination program.MethodsWe linked data from several health registries to identify medically attended HZ cases during 2008–2014 and HZ-associated deaths during1996–2012 in the entire population of Norway. We calculated HZ incidences for primary and hospital care by age, sex, type of health encounter, vaccination status, and co-morbidities among hospital patients. We also estimated HZ-associated mortality and case-fatality.ResultsThe study included 82,064 HZ patients, of whom none were reported as vaccinated against HZ. The crude annual incidence of HZ was 227.1 cases per 100,000 in primary healthcare and 24.8 cases per 100,000 in hospitals. Incidence rates were higher in adults aged ≥50 years (461 per 100,000 in primary care and 57 per 100,000 in hospitals), and women than in men both in primary healthcare (267 vs 188 per 100,000), and hospitals (28 vs 22 per 100,000). Among hospital patients, 47% had complicated zoster and 25% had comorbidities, according to the Charlson comorbidity index. The duration of hospital stay (median 4 days) increased with the severity of comorbidities. The estimated mortality rate was 0.18 per 100,000; and in-hospital case-fatality rate was 1.04%.ConclusionsMedically attended HZ poses a substantial burden in the Norwegian healthcare sector. The majority of the zoster cases occurred among adults aged ≥50 years – the group eligible for zoster vaccination – and increased use of zoster vaccination may be warranted, especially among persons with co-morbidities.     

Barriers to COVID-19 vaccination of migrant populations: A qualitative interview study of immunisation providers in Victoria,Australia

IntroductionThis study aimed to understand barriers and enablers, future strategies, communication approaches and resources needed for COVID-19 vaccination among migrant communities in Melbourne, Australia.Material and methodsWe interviewed 24 immunisation providers who deliver immunisation services to migrant populations in Melbourne. We used the WHO Behavioural and Social Drivers framework (underlined) to organise barriers and enablers to COVID-19 vaccination.ResultsParticipants believed migrants had concerns about vaccine safety and efficacy and saw vaccines as minimally beneficial in the ‘low COVID-19′ environment of Australia (what people think and feel). Healthcare providers with established relationships within migrant communities played key roles in vaccine advocacy (social processes). Migrants’ vaccine motivation was mediated by health literacy, institutional trust and previous experiences with health services. Practical issues included perceived lack of information on vaccine booking process and accessibility challenges.ConclusionsStrategies to increase migrant vaccine coverage should utilise immunisation providers with community links and trusted local vaccine ambassadors to engage and address community vaccine concerns.     

Influenza vaccination coverage among adults with diabetes,United States, 2007–08 through 2017–18 seasons

BackgroundDiabetes is associated with higher risk of hospitalization, morbidity, and mortality from influenza. We assessed influenza vaccination coverage among adults aged ≥ 18 years with diabetes during the 2007–08 through 2017–18 influenza seasons and identified factors independently associated with vaccination during the 2017–18 season.MethodsWe analyzed data from the 2007–2018 National Health Interview Surveys, using Kaplan-Meier survival analysis to estimate season-specific influenza vaccination coverage. Multivariate logistic regression was conducted to examine whether diabetes was independently associated with self-reported influenza vaccination in the past 12 months and identify factors independently associated with vaccination among adults with diabetes using the 2017–18 data.ResultsDuring the 2007–08 through 2017–18 influenza seasons, influenza vaccination coverage among adults aged ≥ 18 years with diabetes ranged from 62.6% to 64.8%. In the 2017–18 influenza season, coverage was significantly higher among adults with diabetes (64.8%) compared with those without diabetes (43.9%). Having diabetes was independently associated with an increased prevalence of vaccination after controlling for other factors. Among adults with diabetes, living at or above poverty level, having more physician contacts, having usual place for health care, and being unemployed were independently associated with increased prevalence of vaccination; being 18–64 years and non-Hispanic black were independently associated with decreased prevalence of vaccination.ConclusionsDespite specific recommendations for influenza vaccination among people with diabetes, more than one-third of adults with diabetes are unvaccinated. Targeted efforts are needed to increase influenza vaccination coverage among adults with diabetes.     

Evaluation of mortality risk after COVID-19 vaccination,Utah 2021

IntroductionIn order to evaluate trends in death after COVID-19 vaccination we analyzed the timing of death relative to vaccination date and the causes of death in vaccinated Utahns in 2021.MethodsWe matched people in the Utah immunization registry with documented COVID-19 vaccinations between December 18, 2020 and December 31, 2021 to Utah’s 2021 vital statistics death records. Vaccinated people were categorized as having one, two, or ≥ three COVID-19 vaccine doses in a time-updated metric. We examined crude mortality rates by dosing groups in two-week intervals for all deaths, and by COVID-19 versus non-COVID-19 causes, within the 44 weeks following receipt of the most recent vaccine.ResultsWe identified 2,072,908 individuals who received at least one dose of COVID-19 vaccine of whom 10,997 died in 2021. Only 17.5 % of the total vaccinated population was age 65+, while 80.9 % of those who died were over 65. In the four weeks following the first or second vaccination, all-cause mortality was low and then stabilized for the remainder of the evaluation period at a bi-weekly average of 33.0 and 39.0 deaths/100,000 people for one and two doses, respectively. Typical seasonal variation in death was observed among those with two doses. Small sample size precluded analysis of those with ≥ three doses, but trends were similar.ConclusionsMortality rates in the 44 weeks following the COVID-19 vaccination did not show trends suggesting an increase in mortality related to COVID-19 vaccination, reinforcing the safety of COVID-19 vaccines. This represents an accessible approach for local evaluation.     

Association between health insurance coverage and uptake of seasonal influenza vaccine in Brazos County,Texas

BackgroundLack of health insurance may limit access to influenza vaccination, resulting in higher risk of infection.MethodsThe Brazos County Health Department obtained medical records summarizing vaccination and health insurance status of all influenza cases occurring in December 2017 (n = 417). The odds of influenza vaccination were estimated for those with public or private health insurance as compared to uninsured individuals using multivariate logistic regression analysis adjusted for age and race.ResultsHealth insurance coverage among Brazos County residents with influenza was 62.4%. Public and private health insurance was associated with higher odds of influenza vaccination compared to no insurance (aOR: 2.05; 95% CI: 1.00–4.21 and aOR: 1.77; 95% CI: 1.07–2.92, respectively), particularly among adults 18–64 years of age.ConclusionsInfluenza vaccination is strongly associated with health insurance. Expansion of programs that facilitate access to health services or provide free influenza vaccines may improve influenza prevention among the uninsured.     

Tree-based data mining for safety assessment of first COVID-19 booster doses in the Vaccine Safety Datalink

BackgroundThe Centers for Disease Control and Prevention’s Vaccine Safety Datalink (VSD) has been performing safety surveillance for COVID-19 vaccines since their earliest authorization in the United States. Complementing its real-time surveillance for pre-specified health outcomes using pre-specified risk intervals, the VSD conducts tree-based data-mining to look for clustering of a broad range of health outcomes after COVID-19 vaccination. This study’s objective was to use this untargeted, hypothesis-generating approach to assess the safety of first booster doses of Pfizer-BioNTech (BNT162b2), Moderna (mRNA-1273), and Janssen (Ad26.COV2.S) COVID-19 vaccines.MethodsVSD enrollees receiving a first booster of COVID-19 vaccine through April 2, 2022 were followed for 56 days. Incident diagnoses in inpatient or emergency department settings were analyzed for clustering within both the hierarchical ICD-10-CM code structure and the follow-up period. The self-controlled tree-temporal scan statistic was used, conditioning on the total number of cases for each diagnosis. P-values were estimated by Monte Carlo simulation; p = 0.01 was pre-specified as the cut-off for statistical significance of clusters.ResultsMore than 2.4 and 1.8 million subjects received Pfizer-BioNTech and Moderna boosters after an mRNA primary series, respectively. Clusters of urticaria/allergy/rash were found during Days 10–15 after the Moderna booster (p = 0.0001). Other outcomes that clustered after mRNA boosters, mostly with p = 0.0001, included unspecified adverse effects, common vaccine-associated reactions like fever and myalgia, and COVID-19. COVID-19 clusters were in Days 1–10 after booster receipt, before boosters would have become effective. There were no noteworthy clusters after boosters following primary Janssen vaccination.ConclusionsIn this untargeted data-mining study of COVID-19 booster vaccination, a cluster of delayed-onset urticaria/allergy/rash was detected after the Moderna booster, as has been reported after Moderna vaccination previously. Other clusters after mRNA boosters were of unspecified or common adverse effects and COVID-19, the latter evidently reflecting immunity to COVID-19 after 10 days.     

COVID-19 vaccination hesitancy in people affected by diabetes and strategies to increase vaccine compliance: A systematic narrative review and meta-analysis

IntroductionPeople affected by diabetes are at higher risk for complications from certain vaccine-preventable diseases. Suboptimal vaccination coverages are reported in this population sub-group. The purpose of this study is to estimate the proportion of diabetic patients who express hesitation to the COVID-19 vaccine worldwide.MethodsSeven studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar and Scopus databases from 2020 to 2022. The following terms were used for the search strategy: (adherence OR hesitancy OR compliance OR attitude) AND (covid* OR SARS*) AND (vaccin* OR immun*) AND (diabet*).ResultsThe vaccine hesitation rate among persons with diabetes was 27.8 % (95 %CI = 15.6–41.9 %). In the comparison of vaccine hesitancy between sexes and educational status, the RRs were 0.90 (95 %CI = 0.71–1.15) and 0.88 (95 %CI = 0.76–1.02), respectively. The main reasons of unwillingness were lack of information, opinion that the vaccine was unsafe or not efficient, and fear of adverse events.ConclusionsIn order to achieve a high vaccination coverage, multifactorial approach is needed, which requires major social, scientific and health efforts. The success of the vaccination campaign in this population depends on the capillarity and consistency of the interventions implemented.     

COVID-19 vaccine safety inquiries to the Centers for Disease Control and Prevention Immunization Safety Office

BackgroundFollowing the authorization and recommendations for use of the U.S. COVID-19 vaccines, the Centers for Disease Control and Prevention (CDC)’s Immunization Safety Office (ISO) responded to inquiries and questions from public health officials, healthcare providers, and the general public on COVID-19 vaccine safety.MethodsWe describe COVID-19 vaccine safety inquiries, by topic, received and addressed by ISO from December 1, 2020–August 31, 2022.ResultsOf the 1978 COVID-19 vaccine-related inquiries received, 1655 specifically involved vaccine safety topics. The most frequently asked-about topics included deaths following vaccination, myocarditis, pregnancy, and reproductive health outcomes, understanding or interpreting data from the Vaccine Adverse Event Reporting System (VAERS), and thrombosis with thrombocytopenia syndrome.ConclusionsInquiries about vaccine safety generally reflect issues that receive media attention. ISO will continue to monitor vaccine safety inquiries and provide accurate and timely information to healthcare providers, public health officials, and the general public.