Intersectional Analysis of Social Risk and Need Among a Large Representative Sample of Adults From an Integrated Health System in the U.S.

Introduction: Social health is increasingly a focus of healthcare systems. Representative and intersectional analyses of individuals' social risks such as food, housing, transportation, and financial insecurity and their interest in receiving assistance from the healthcare system (social needs) can provide healthcare organizations with more nuanced estimates that can lead to more effective interventions.

Methods: The authors conducted cross-sectional survey of a representative sample of 43,936 Kaiser Permanente members in December 2019-September 2020.

Differentiating between romantic and mature love: Revisiting the three caskets.

Freud's paper on the three caskets is revisited. His view that the lead casket represented death is supported by extracts from The Merchant of Venice, in particular the song, "Tell Me Where is Fancy Bred". It is argued that the acceptance of death is a necessary step in the transformation of romantic love to mature love.

Improving Antibiotic Prescribing for Children with Community-acquired Pneumonia in Outpatient Settings.

Objective: To assess whether a two-phase intervention was associated with improvements in antibiotic prescribing among nonhospitalized children with community-acquired pneumonia.

Study Design: In a large health care organization, a first intervention phase was implemented in September 2020 directed at antibiotic choice and duration for children 2 months through 17 years of age with pneumonia. Activities included clinician education and implementation of a pneumonia-specific order set in the electronic health record.

A Kleinian appreciation of the Ego and the Id (1923-2023).

I divide this paper into three parts. First, I discuss Freud's ideas about repression and the unconscious sense of guilt in order to compare them with Klein's view that we disown uncomfortable facts through a process of splitting and projection, leading to a paranoid defence against guilt. Second, I describe Klein's struggle to understand the origin and the severity of the primitive super-ego which was so prominent in her child patients.

Mourning in Hamlet: Turning ancestral ghosts into ancestors.

Extracts from Shakespeare's are used to show how obstacles to mourning may arise from the persistent demands of melancholic internal objects demanding repair and revenge. It is only with the development of symbolic function as a result of separateness between self and object that reparation becomes possible and ghosts are turned into ancestors.

Mussel mass mortality in the Clinch River, USA: metabolomics detects affected pathways and biomarkers of stress.

Biologists monitoring freshwater mussel (order Unionida) populations rely on behavioral, often subjective, signs to identify moribund ("sick") or stressed mussels, such as gaping valves and slow response to probing, and they lack clinical indicators to support a diagnosis. As part of a multi-year study to investigate causes of reoccurring mortality of pheasantshell ( synonym ) in the Clinch River, Virginia and Tennessee, USA, we analyzed the hemolymph metabolome of a subset of mussels from the 2018 sampling period. Mussels at the mortality sites were diagnosed in the field as affected (case) or unaffected (control) based on behavioral and physical signs.

Associations between Missed Colonoscopy Appointments and Multiple Prior Adherence Behaviors in an Integrated Healthcare System: An Observational Study.

Background: Missed colonoscopy appointments delay screening and treatment for gastrointestinal disorders. Prior nonadherence with other care components may be associated with missed colonoscopy appointments.

Objective: To assess variability in prior adherence behaviors and their association with missed colonoscopy appointments.

Assessment of a Peer Support Group Intervention for Undocumented Latinx Immigrants With Kidney Failure.

Importance: Most undocumented immigrants with kidney failure rely on emergency dialysis (defined as dialysis after a patient presents as critically ill) and experience significant depression and anxiety and high mortality. Culturally and language-concordant peer support group interventions may be associated with reduced depression and anxiety and may provide emotional support.

Objective: To investigate the feasibility and acceptability of a single-group peer support group intervention.

Patient Pill Organization Strategies and Adherence Measured in a Cross-Sectional Study of Hypertension.

Background: The strategies patients use to organize medications (eg, pill dispenser) may be reflected in adherence measured at follow-up. We studied whether medication organization strategies patients use at home are associated with adherence measured using pharmacy-fills, self-report, and pill counts.

Design: Secondary analysis of data from a prospective randomized clinical trial.

Comparing two durations of medically tailored meals posthospitalization: A randomized clinical trial.

Background: Medically tailored meals (MTM) may be beneficial to patients after hospital discharge.

Objective: To determine if 2 versus 4 weeks of MTM posthospitalization will improve patient outcomes.

Design: Randomized unblinded trial.

Participant perspectives on the impact of receiving medically tailored meals on post-hospitalization.

Objective: The objective of this program evaluation was to measure the impact of a medically tailored meals (MTM) intervention on participants' self-reported recovery and satisfaction while recovering from a recent hospitalization.

Design: A qualitative design was employed using a brief survey among all participants at the end of the intervention and phone interviews with a subset of participants.

Sample: Participants in this study were recently discharged from the hospital and were members of (redacted for review) who had received 2-4 weeks of MTM.

Health Behavior Theory and Hypertension Management: Comparisons Among Black, White, and American Indian and Alaska Native Patients.

In the United States, hypertension is more common among individuals from racial and ethnic minority groups. Hypertension control rates are also lower for minority group members compared with White Americans. However, little research has employed well-established theoretical perspectives on health behavior, such as the Theory of Planned Behavior (TPB) and the Model of Goal-Directed Behavior (MGB), to better understand racial differences in rates of hypertension control.

Early Peanut Introduction in Primary Care: Evaluation of a Multicomponent Intervention.

Objective: To determine whether a multicomponent intervention focused on early peanut introduction was associated with a lower peanut allergy incidence in young children.

Methods: The study cohort comprised all children born January 1, 2013 through December 31, 2018 receiving care at a large health care organization. Intervention activities occurred over 16 months and included provider educational programs, electronic health record tools, and new patient instructions.

Sources of Clinician Burnout in Providing Care for Underserved Patients in a Safety-Net Healthcare System.

Background: Burnout among clinicians is common and can undermine quality of care, patient outcomes, and workforce preservation, but sources of burnout or protective factors unique to clinicians working in safety-net settings are less well understood. Understanding these clinician experiences may inform interventions to reduce burnout.

Objective: To describe clinician perspectives on sources of burnout in a safety-net healthcare system.

Perspectives of Latinx Individuals Who Were Unvaccinated And Hospitalized for COVID-19: A Qualitative Study.

Importance: Latinx individuals in the United States have lower COVID-19 vaccination rates and higher rates of COVID-19 infections, hospitalizations, and deaths than non-Latinx White individuals. Little is known about the perspectives of Latinx adults who had not received the COVID-19 vaccination and were hospitalized for COVID-19.

Objective: To describe the perspectives of Latinx individuals who were unvaccinated and subsequently hospitalized for COVID-19.

Racial and Ethnic Equity in Care for Hypertension and Diabetes in an Urban Indian Health Organization.

Approximately 70% of American Indian/Alaska Native (AI/AN) individuals reside in urban areas. Urban Indian Health Organizations (UIHOs) provide culturally engaged primary care for AI/AN patients and members of other racial and ethnic groups who have experienced disparities in diabetes and hypertension care, and are commonly affected by social and economic barriers to care. We assessed whether disparities were present between the racial and ethnic groups served by the largest UIHO in the USA.