Characteristics of a transgender and gender-diverse patient population in Utah: Use of electronic health records to advance clinical and health equity research

Transgender and gender-diverse (TGD) people, individuals whose gender identity differs from their sex assigned at birth, face unique challenges in accessing gender-affirming care and often experience disparities in a variety of health outcomes. Clinical research on TGD health is limited by a lack of standardization on how to best identify these individuals. The objective of this retrospective cohort analysis was to accurately identify and describe TGD adults and their use of gender-affirming care from 2003-2023 in a healthcare system in Utah, United States. International Classification of Disease (ICD)-9 and 10 codes and surgical procedure codes, along with sexual orientation and gender identity data were used to develop a dataset of 4,587 TGD adults. During this time frame, 2,985 adults received gender-affirming hormone therapy (GAHT) and/or gender-affirming surgery (GAS) within one healthcare system. There was no significant difference in race or ethnicity between TGD adults who received GAHT and/or GAS compared to TGD adults who did not receive such care. TGD adults who received GAHT and/or GAS were more likely to have commercial insurance coverage, and adults from rural communities were underrepresented. Patients seeking estradiol-based GAHT tended to be older than those seeking testosterone-based GAHT. The first GAS occurred in 2013, and uptake of GAS have doubled since 2018. This study provides a methodology to identify and examine TGD patients in other health systems and offers insights into emerging trends and access to gender-affirming care.

Conflicting HIV/AIDS Sex Education Policies and Mixed Messaging among Educators and Students in the Lower Manya Krobo Municipality, Ghana

While school-based comprehensive sex education (CSE) is effective in HIV prevention among young people ages 10-24 years, Ghana's national sexual and reproductive health education policy promotes abstinence. Meanwhile, the Ministry of Health's HIV prevention programs provide more comprehensive school-based education. This qualitative study evaluated the HIV/AIDS education program in the Lower Manya Krobo Municipality to assess the perspectives of students and educators in 10 schools on school-based sexual and reproductive health programs, including HIV/AIDS education and conflicting HIV/AIDS sex education policies. HIV prevalence in the Lower Manya Krobo Municipality of Ghana was more than twice the national average at 5.64% in 2018, and prevalence among youth in the municipality aged 15-24 was the highest in the nation at 0.8%. Educators have mixed feelings regarding abstinence-based and CSE approaches. However, students generally endorse abstinence and describe the limitations of condom use. Ambiguity in overarching policies is identified as a factor that could influence the orientation of school-based health educators, create disharmony in sex education interventions, introduce confusing sex education messages to young people, and create a potentially narrow curriculum that limits the gamut of HIV/AIDS sex education to exclude young people's risky sexual behaviours and diverse teaching and implementation strategies. Policies and the scope of sex education should be realigned to ensure the transparent implementation of HIV/AIDS sex education programs in Ghana.

Multi-method Examination of Elder Mistreatment in the Age of COVID-19

A multi-method study exposed COVID-19 influence on the pre-existing epidemic of elder mistreatment in Utah. We found changes in 1) abuse types, 2) service responses, 3) firearm access and 4) policy implications. Gun sales were tracked by news surveillance and FBI National Instant Criminal Background Check System (NICS) for pre-pandemic (2018/2019) and pandemic years (2020/2021). New requests for permits skyrocketed during the pandemic. The 2021 Utah State Legislature loosened restrictions on concealed permits. Domestic violence (DV) Fatality Tracker Data in pre-covid years were compared to 2020-2021. A figure illustrates the prevalence of DV fatalities, ages of victims by year and methods used. We conducted 15 in-depth interviews of stake holders who serve DV victims (shelters, police, etc.). DV shelters had a relative lack of children during the pandemic, but increased use by older persons 60+. Susceptibility to chronic respiratory distress syndrome, required social distance for older persons. DV shelters obtained CARES Act funds to adapt solutions, like placing victims in hotel rooms. Most victims stayed at home, confined with abuser(s), some without technology, so isolation decreased their safety. Evidence suggests some fatalities among elder adults. A case study during the pandemic described a 73-year-old mother’s suspicious bank account activity. Bank employees sent police to her home. She was missing, but her co-resident adult son was in possession of her bank cards. She was later found in a shallow grave. Utah households have increased risks of DV fatalities in the wake of the pandemic and for years to come.

What Protective Health Measures Are Americans Taking in Response to COVID-19? Results from the COVID Impact Survey

With the emergence of the novel SARS-CoV-2 and the disease it causes; COVID-19, compliance with/adherence to protective measures is needed. Information is needed on which measures are, or are not, being undertaken. Data collected from the COVID Impact Survey, conducted by the non-partisan and objective research organization NORC at the University of Chicago on April, May, and June of 2020, were analyzed through weighted Quasi-Poisson regression modeling to determine the association of demographics, socioeconomics, and health conditions with protective health measures taken at the individual level in response to COVID-19. The three surveys included data from 18 regional areas including 10 states (CA, CO, FL, LA, MN, MO, MT, NY, OR, and TX) and 8 Metropolitan Statistical Areas (Atlanta, GA; Baltimore, MD; Birmingham, AL; Chicago, IL; Cleveland and Columbus, OH; Phoenix, AZ; and Pittsburgh, PA). Individuals with higher incomes, insurance, higher education levels, large household size, age 60+, females, minorities, those who have asthma, have hypertension, overweight or obese, and those who suffer from mental health issues during the pandemic were significantly more likely to report taking precautionary protective measures relative to their counterparts. Protective measures for the three subgroups with a known relationship to COVID-19 (positive for COVID-19, knowing an individual with COVID-19, and knowing someone who had died from COVID-19) were strongly associated with the protective health measures of washing hands, avoiding public places, and canceling social engagements. This study provides first baseline data on the response to the national COVID-19 pandemic at the individual level in the US. The found heterogeneity in the response to this pandemic by different variables can inform future research and interventions to reduce exposure to the novel SARS-CoV-2 virus.

Assessment of clinical outcome and health insurance coverage among patients with breast cancer

Breast cancer is a global health concern in terms of morbidity and mortality. Risksharing mechanisms such as health insurance provide resources and promote access to healthcare. The aim of the study was to assess the relationship between health insurance coverage and clinical outcome of breast cancer patients. The study employed retrospective design involving the use of secondary data from the patients diagnosed with breast cancer. Between the period of 2015 to 2019, 250 patients' records were reviewed from a sample size of 300 patients over 5 year patients' follow-up period. A descriptive and Kaplan Meier survival analysis was performed to determine the patients' survival rate. Seventy-two percent of the patients had health insurance cover at the time of diagnosis. Insurance status was found to be significantly associated with survival (p-values= 0.036). Insurance cover had 1.42 hazard ratio (p=0.036, 95% CI: 1.023-1.980). Patients with health insurance coverage at the time of diagnosis had a higher survival rate. No significant association was found among the demographic characteristics and the patients' clinical outcomes.

Risk factors for loss to follow-up in human immunodeficiency virus care in the Greater Accra Regional Hospital in Ghana: a retrospective cohort study

BACKGROUND

Loss of human immunodeficiency virus (HIV)-positive patients to follow-up increases HIV-related morbidity and mortality. This study identified the factors associated with loss to follow-up (LTFU) in an urban health facility in Ghana.

METHODS

A 12-y retrospective study was conducted using routinely collected data from the National Acquired Immune Deficiency Syndrome (AIDS) Control Programme (NACP) on persons living with HIV/AIDS (PLWHA) who initiated antiretroviral therapy (ART) from 2006 to 2017 at the Greater Accra Regional Hospital. Convenience sampling was used to select the study area. All gathered data were exported to Stata 14 statistical software for analysis.

RESULTS

A total of 4330 PLWHA initiated ART between January 2006 and December 2017. Of these, 1166 (26.9%) were lost to follow-up over the 12-y period. The factors associated with LTFU included being a Muslim (adjusted hazard ratio [aHR] 1.31 [95% confidence interval {CI} 1.05 to 1.65]), having CD4 <250 cells/ml (aHR 1.45 [95% CI 1.21 to 1.76]) and completing adherence counselling (aHR 1.58 [95% CI 1.31 to 1.92]). Having other sources of health care funding and disclosure of one's disease status were found to be protective (aHR 0.74 [95% CI 0.58 to 0.94] and 0.80 [95% CI 0.65 to 0.98], respectively).

CONCLUSIONS

Some of the determinants of LTFU in the hospital are comparable to those found in other parts of Africa and could be addressed using existing interventions.

Sexual and reproductive health of adolescents in schools for people with disabilities

Introduction

Persons with disabilities have the same sexual and reproductive health (SRH) needs as the abled people but they often face barriers to SRH information and services which are necessary for healthy and safe relationships, protection from HIV and other sexually transmitted infections (STIs). This study sought to access the SRH services among adolescents with disabilities in four Special Needs Schools in Ghana.

Methods

The study adopted a cross-sectional study design with a quantitative approach to data collection between the months of January to March, 2018. A structured and pretested questionnaire was used to collect data from adolescents with disabilities from selected schools in Ghana. Both descriptive and inferential statistics were performed using chi-square test and multivariate logistic regression.

Results

Majority of participants had hearing disability (52.1%). The average age at menarche among females was 13 years whiles the age at which puberty was attained among boys was 14 years. School teachers were the major source of information on SRH for the respondents (63.7%) followed by parents (12.2%). A majority (67.1%) of respondents had good knowledge of SRH. Factors which were significantly associated with knowledge level were age (p=0.026), religion (p=0.034), sources of information (p<0.001), guardians (p=0.049).

Conclusion

The majority of participants had good knowledge of SRH, although their knowledge of contraceptive and access were poor. Only condoms were mostly known. There is the need for increased awareness on the availability of other contraceptives methods and the removal of barriers to contraceptive methods.

Physician preparedness for bioterrorism recognition and response: a Utah-based needs assessment

The medical community accepts that they have a need to be prepared to recognize and respond to bioterrorism events. A needs assessment conducted among physicians throughout the state of Utah provided insights into their perceived training needs and preferred methods of learning. Physicians have many competing demands on their time and tailored educational offering can increase the intended audience's acceptance and learning.