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"Knight, Erin"
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Chemistry around the house
You do not need to be in a laboratory to see science in action. Just about everything you find in your home, the shampoo in the bathroom, the pizza in the oven, the gasoline in the car, depends on chemistry.
Book
Inequitable access to sport in juvenile justice across the USA: findings from a national survey
The USA incarcerates more young people than any other industrialized nation in the world, and black youth are much more likely to be incarcerated than white youth. Young people who interface with the criminal justice system are at higher risk for poor health upon release and the justice system is believed to be a contributor to racial health disparities. Sport participation during incarceration has the potential to improve health and health equity, but the evidence on the health benefits of youth sport participation has almost exclusively focused on school and community settings in the USA with little attention to non-traditional settings, such as the justice system. Given the poor health consequences of incarceration, the potential of sport to improve health, and the lack of research on this phenomenon in the USA, our objective was to describe the landscape of sport programming in juvenile correctional facilities and provide a baseline understanding upon which future research can build. Through a cross-sectional survey of all long-term secure juvenile correctional facilities in the USA (n = 211), we found 55.1% operate a sport program. Among facilities with programs, there was a range of sport program offerings. Gender disparities in access to various types of programs exist, with girls generally having less opportunity than boys. Most facilities reported a purpose of positive youth development in the operation of their programs. These findings have important implications for health promotion and the further integration of sport and juvenile justice as part of a public health agenda.
Journal Article
Steroids
Explores the dangers and side effects of steroid use, and discusses the warning signs of dependence and addiction.
Book
Delaware Contraceptive Access Now and Contraceptive Initiation Among Medicaid Enrollees, 2015‒2020
Delaware Contraceptive Access Now was a statewide contraceptive access program implemented in Delaware between 2015 and 2020. We evaluated the association of the program with contraceptive initiation in Delaware’s Medicaid program using a difference-in-differences design that compared changes in Delaware to changes in Maryland. Results suggest that program implementation was associated with increased initiation of long-acting reversible methods, particularly among adolescent patients aged 15 to 18 years. We found less-consistent evidence for changes to any contraceptive method. (Am J Public Health. 2022;112(S5):S537–S540. https://doi.org/10.2105/AJPH.2022.306938 )
Journal Article
Health-related quality of life profiles of adults with arthritis and/or fibromyalgia: a cross-sectional study
Purpose
Adults with arthritis experience poor health-related quality of life (HRQOL), though research often focuses on single HRQOL outcomes or summary scores. We aimed to identify HRQOL profiles in adults with different arthritis types and determine risk and protective factors.
Methods
Data including PROMIS-29 Profile v2.1 and PROMIS Short Form v2.0 – Emotional Support 4a were collected through a national foundation’s online survey of adults with arthritis in the U.S. We used latent profile analysis (LPA) to characterize the heterogeneity in arthritis patients by clustering them into HRQOL profiles, based on statistical model fit and clinical interpretability. We fit a multinomial logistic regression model with HRQOL profile assignment as the outcome to determine associations with protective and risk factors.
Results
We included 25,305 adults with arthritis. The LPA results favored a five-HRQOL profile solution (entropy = 0.83). While some profiles displayed better HRQOL in some domains, 93% of the sample displayed impacted pain and physical functioning. One profile (20%) displayed mean T-scores nearly 2 standard deviations below the population mean. Despite poor physical HRQOL outcomes, one profile (10%) displayed average mental health. All demographic and clinical factors contributed significantly to the model, including risk factors (arthritis types, work status) and protective factors (more emotional support, starting exercise).
Conclusion
We identified profiles with consistently impacted HRQOL in arthritis, though one displayed average mental health functioning despite poor physical functioning. These results highlight the value of considering the patient’s HRQOL experience alongside treatment options, and the potentially positive impact of non-pharmacological interventions.
Plain English Summary
Why is this study needed? Adults with arthritis often have a variety of symptoms or experiences that impact different parts of their lives. Research sometimes only focuses on a few of those things rather than all of them.
What is the key problem/issue/question this manuscript addresses? This study looks at several things that arthritis may affect, such as pain and ability to do physical activities, to understand the complexity of it and what situations in people’s lives may increase or decrease the effects.
What is the main point of your study? There are five major groups of people with arthritis in terms of how it impacts their lives. Adults who are unable to work or who have multiple forms of arthritis are the most impacted by arthritis. However, some groups are doing as well as other adults without arthritis.
What are your main results and what do they mean? The impacts of arthritis are complex. Focusing on these broader impacts important to patients and things that contribute to it might help with treatment options and interventions that go beyond medication.
Journal Article
Barriers and facilitators to opioid agonist therapy in rural and remote communities in Canada: an integrative review
Background
People living in rural and remote communities in Canada are often disproportionately impacted by opioid use disorder. When compared to urban centres, rural and remote populations face additional barriers to treatment, including geographical distance as well as chronic shortages of health care professionals. This integrative review of the literature was conducted to explore the facilitators and barriers of OAT in rural and remote Canadian communities.
Methods
A search of the literature identified relevant studies published between 2001 and 2021.
Results
The search strategy yielded 26 scholarly peer-reviewed publications, which explored specific barriers and facilitators to rural and remote OAT in Canada, along with two reports and one fact sheet from the grey literature. Most of the scholarly articles were descriptive studies (
n
= 14) or commentaries (
n
= 9); there were only three intervention studies. Facilitators and barriers to OAT programs were organized into six themes: intrapersonal/patient factors, social/non-medical program factors, family/social context factors (including community factors), infrastructure/environmental factors, health care provider factors, and system/policy factors.
Conclusions
Although themes in the literature resembled the social-ecological framework, most of the studies focused on the patient-provider dyad. Two of the most compelling studies focused on community factors that positively impacted OAT success and highlighted a holistic approach to care, nested in a community-based holistic model. Further research is required to foster OAT programs in rural and remote communities.
Journal Article
LLIN Evaluation in Uganda Project (LLINEUP)–effects of a vector control trial on Plasmodium infection prevalence and genotypic markers of insecticide resistance in Anopheles vectors from 48 districts of Uganda
Pyrethroid bednets treated with the synergist piperonyl butoxide (PBO) offer the possibility of improved vector control in mosquito populations with metabolic resistance. In 2017–2019, we conducted a large-scale, cluster-randomised trial (LLINEUP) to evaluate long-lasting insecticidal nets (LLINs) treated with a pyrethroid insecticide plus PBO (PBO LLINs), as compared to conventional, pyrethroid-only LLINs across 104 health sub-districts (HSDs) in Uganda. In LLINEUP, and similar trials in Tanzania, PBO LLINs were found to provide greater protection against malaria than conventional LLINs, reducing parasitaemia and vector density. In the LLINEUP trial, we conducted cross-sectional household entomological surveys at baseline and then every 6 months for two years, which we use here to investigate longitudinal changes in mosquito infection rate and genetic markers of resistance. Overall, 5395 female
Anopheles
mosquitoes were collected from 5046 households. The proportion of mosquitoes infected (PCR-positive) with
Plasmodium falciparum
did not change significantly over time, while infection with non-
falciparum
malaria decreased in
An. gambiae
s.s., but not
An. funestus
. The frequency of genetic markers associated with pyrethroid resistance increased significantly over time, but the rate of change was not different between the two LLIN types. The knock-down resistance (
kdr
) mutation
Vgsc
-995S declined over time as
Vgsc
-995F, the alternative resistance mutation at this codon, increased.
Vgsc
-995F appears to be spreading into Uganda. Distribution of LLINs in Uganda was previously found to be associated with reductions in parasite prevalence and vector density, but here we show that the proportion of infective mosquitoes remained stable across both PBO and non-PBO LLINs, suggesting that the potential for transmission persisted. The increased frequency of markers of pyrethroid resistance indicates that LLIN distribution favoured the evolution of resistance within local vectors and highlights the potential benefits of resistance management strategies.
Trial registration
: This study is registered with ISRCTN, ISRCTN17516395. Registered 14 February 2017,
http://www.isrctn.com/ISRCTN17516395
.
Journal Article
Selecting patient-reported outcome measures of health-related quality of life in adult rheumatology: quality and breadth of coverage
Patient-centered research should assess outcomes important to patients and include patient-reported outcome measures (PROMs) to assess health-related quality of life (HRQOL) domains. Using a well-known HRQOL framework (World Health Organization QOL, or WHOQOL), we reviewed established PROMs used with adults with different types of arthritis to evaluate their HRQOL domain coverage and psychometric evidence to help PROM users select measures and determine whether other measures should be validated and/or developed. Nineteen PROMs and 92 corresponding articles were reviewed to determine which HRQOL domains were assessed. To support a streamlined but rigorous review, we used a rating system based on criteria established in part through existing rubrics (e.g., OMERACT COSMIN). Psychometric properties were rated on a scale from 1 to 18, where 18 was strongest. We examined the intersection between level of domain coverage and extent of psychometric support. Measures most commonly assessed physical health and level of independence, while fewer assessed social relations, environment, and psychological health. No measures assessed spirituality and religion, which may be relevant depending on intended use. PROMs with higher psychometric evidence tended to assess a broader range of HRQOL domains. Rubric scores ranged from 3 to 16, with an average of 9.3. Prominent and psychometrically sound PROMs are available that cover many of the WHOQOL domains. While gaps exist in the domain of spirituality, future work should focus on refining optimal use of existing PROMs relevant for arthritis versus developing new measures. We provide guidance on selecting PROMs, to that end.
Journal Article
“Power of Mom”: A Mixed Methods Investigation of Mothers’ Influence on Women’s Contraceptive Attitudes and Behaviors
ObjectivesUnintended pregnancy is an individual and public health problem with significant social and economic consequences. The literature has established that parents, especially mothers, play an important role in shaping the contraceptive attitudes and behaviors of young women and could therefore affect the likelihood of their daughter experiencing an unintended pregnancy. However, research has yet to fully explore the nuances of how mothers influence their daughters with respect to contraception.MethodsWe conducted a mixed methods study to explore the impact of mothers on women’s contraceptive attitudes and behaviors. In-depth interviews were conducted with 86 women of reproductive age to identify potential patterns and explore the nature of mothers’ influences. We then analyzed medical and prescription claims for a cohort of 9813 pairs of women (mother–daughter proxies) enrolled in Medicaid, to determine if such patterns of contraceptive use held in a larger sample.ResultsIn-depth interviews reveal how and why mothers shape women’s contraceptive attitudes and behaviors, particularly highlighting the nuances of communication, knowledge, and relationships. The statistical claims data supported such findings on a broader scale. For instance, across several types of contraceptives, including oral, injectable, and long-acting reversible contraceptives (LARCs), young women were significantly more likely to use a particular method if an older woman in the household (mother proxy) also used that method (AOR (95% CI) 1.99 (1.67–2.37), 2.06 (1.58–2.68) and 2.83 (1.64–4.88) respectively).Conclusions for PracticeThis study fills a gap in the literature regarding the nuanced ways in which mothers influence women’s contraceptive behavior. In turn, it supports the importance of familial context—especially the influence of mothers—in contraception decision-making and suggests that interventions aimed at improving access to and uptake of effective methods of contraception consider this context in their design and implementation.
Journal Article
Shifting Public Health Practice to Advance Health Equity
While the evidence base regarding the social determinants of health and their relationship to health inequities grows, the field of public health is challenged to translate this knowledge into practice changes that advance health equity.
Drawing on the knowledge, beliefs, and experiences of public health experts and community leaders working to advance health equity, our objective was to develop and disseminate recommendations for changing public health practice to better address this problem.
We conducted semistructured, qualitative telephone interviews (n = 25) with key informants. Interviews were recorded and transcribed, and data were coded and analyzed using both inductive and deductive methods. Member checks were used to enhance quality.
A purposeful sample of key informants was selected from content experts and community leaders involved with the development of the Unnatural Causes public impact campaign. Participants represented state and local health departments, community-based organizations, national research/advocacy organizations, and academic institutions across the country.
Participants distinguished between social determinants of health and their structural precursors in social and political institutions. They believed that the field of public health has an obligation to address health inequities and shifts in practice are needed that focus more attention on societal factors that underlie such inequities. According to participants, specific practice changes are difficult to identify because actions should be community specific and community driven. Recommended approaches that may be adapted to community-based needs and assets include building nontraditional partnerships, engaging in political advocacy, promoting community leadership, collecting better data on social conditions and institutional factors, and enhancing communication for health equity.
Recommended shifts in practice may be facilitated by revisiting our understanding of the 3 core functions of public health-assessment, assurance, and policy development.
Journal Article