Washington State Department of Health

To examine the risk of hospital readmission after an index hospitalization for TBI in older adults. Using data from the Atherosclerosis Risk in Communities (ARIC) study, we used propensity score matching of individuals with an index TBI-related hospitalization to individuals with (1) non-TBI hospitalizations (primary analysis) and (2) orthopedic injury hospitalizations (secondary analysis). The rate of all-cause hospital readmission was estimated using adjusted Fine-Gray proportional hazards regression models within strata defined by time since hospitalization. Follow-up extended from the date of index hospitalization after study enrollment (1987-1989) through December 31, 2019. Six hundred sixty-seven participants with an index TBI-related hospitalization were matched using propensity scores with replacement with a ratio of 1:4-2668 participants with non-TBI-related hospitalizations and 1:3 with 2001 participants with orthopedic injury-related hospitalizations. Median age was 68 years (IQR = 46-95) at index hospitalization. Compared to participants with an index non-TBI-related hospitalization, readmission rates were lower among participants with an index TBI-related hospitalization (HR = 0.80, 95% CI = 0.74, 0.87) over a median follow-up of 2.7 years, although similar readmission rates were observed within the first year of follow-up (HR = 1.03, 95% CI = 0.88, 1.21). Rates of hospital readmission among persons with an index TBI-related hospitalization were similarly decreased compared with persons with an orthopedic injury-related hospitalization (HR = 0.78, 95% CI = 0.72, 0.85) over a median follow-up of 3.1 years. Among community-dwelling older adults with a TBI-related hospitalization, rates of hospital readmission were similar to individuals hospitalized for a non-TBI cause in the first year, but lower subsequently. Targeted interventions in the first year post-hospitalization may be most beneficial for reducing readmissions among individuals with TBI.

A patient-centered HIV care model (PCHCM) can improve antiretroviral treatment adherence and viral suppression outcomes. No studies have evaluated viral suppression among people with HIV (PWH) in carceral settings under this model. This study compares HIV virologic suppression among PWH in Washington state prisons under a PCHCM to all PWH in Washington between 2008 and 2019. We conducted three analyses of a retrospective cohort of 403 PWH in prison. Prison-wide annual viral suppression proportions among total HIV population and the HIV population tested each year were compared with Washington public health surveillance data. Average changes in viral suppression proportions at intake and release were summarized and tested for statistically significant differences. Prison-wide HIV viral suppression increased from 61.4% in 2008 to 86.0% in 2019, surpassing most annual statewide proportions. Viral suppression proportions among those with at least one yearly viral load test were even higher. Between 2015 and 2019, > 95% of incarcerated PWH achieved viral suppression. Average viral suppression proportions increased during incarceration from 59.1% at intake to 92.4% at release between 2008 and 2019 (p < 0.05). Prison populations can reach near universal viral suppression under a PCHCM, suggesting a higher threshold from which to judge the effectiveness of HIV carceral care.

Forced migrants (i.e., asylum seekers and refugees) experience greater mental health disparities and inequities in care. Mental health services and systems lack clear policy on integrated mental healthcare. Understanding the causal mechanisms of integrated mental health for migrants can promote a resilient and adaptive health and social care system. However, to achieve a functional mental health service integration, there is a need to understand how and why mental health system integration works and under what health systems conditions. The purpose of this realist review protocol will be to outline a process for refining an initial programme theory (IPT), developed through deliberative dialogues with key interest groups in British Columbia, Canada, and to test the IPT against the global evidence base. A realist review is an interpretive methodological approach to synthesising the literature based on the realist philosophy of science. Realist reviews are pragmatic approaches to theory development because they involve the participation of real-world actors or people who work within complex systems. Realist reviews are particularly useful for synthesising complex knowledge. We plan to conduct a seven-step review process, with iteration between each step. Steps 1-3 have already been completed in our previous work and included the development of an IPT, which will be refined systematically by exploring the global literature and consulting with an international advisory group. These will be used iteratively to identify, test and refine the programme theory. The quality of included literature will be appraised using the relevance, richness and rigour criteria and the realist quality appraisal tool, TAPUPASM (transparency, accessibility, propriety, utility, purposiveness, accuracy, specificity and modified objectivity). Steps 4-7 will include data extraction and realist analysis through retroductive theorising using the ICAMO (intervention, context, actor, mechanism and outcome) heuristic to help distinguish actors and resources from contexts, mechanisms and outcomes. Ethics approval for the deliberative dialogue interviews that inform this realist review and IPT were obtained by the University of British Columbia (ref: REB Number: H22-03195). Study recruitment occurred between 21 November 2023 and 16 January 2024. All participants provided informed consent to take part in deliberative dialogues and to have their interviews audio recorded and transcribed for the purpose of this research. We will disseminate results of the review through academic papers, conference presentations and through iterative interest group workshops and discussions. CRD42024580083.

ABSTRACTObjectiveEmbedded research partnerships can advance the implementation of evidence‐based policies and practices, including those aligned with person‐centered care. Care delivery model transformations, such as the VA's person‐centered Whole Health System (WHS), can benefit from an ongoing cycle of program implementation and their evaluation to inform future evolution. This paper describes how embedded researchers partnered with policy makers leading VA's WHS transformation to support its development, implementation, and scaling to illustrate lessons learned for embedded research.Data Sources and Study SettingFifty‐eight embedded research projects were conducted from FY2013 to FY2024.Study DesignWe recorded each project's scope, methodology, results, products, and impact. Through a group reflection process, we identified common cross‐project lessons that fostered this successful embedded research partnership. Finally, we mapped projects to phases of Kilbourne's Knowledge to Action Framework (Pre‐Implementation, Implementation, and Sustainment) to demonstrate how embedded researchers defined evaluation questions, evaluated WHS transformation, and assessed outcomes to inform the implementation and sustainment of VA's WHS transformation.Data Collection/Extraction MethodsProjects used multiple qualitative, survey, and large database methods.Principal FindingsAcross 58 projects, 380 discrete products were used by our operational partner to refine the WHS model, improve implementation support, scale effective practices, inform new policy, and sustain transformation. Three practices cut across these projects to contribute to our successful embedded research partnership: agility, collaboration, and continuous learning and improvement. Additionally, the purpose, questions, and methods of embedded research projects varied as operational partner activities moved across pre‐implementation, implementation, and sustainment phases, iteratively impacting WHS transformation.ConclusionsEmbedded research can transform a healthcare system through the timely translation of data into practice, enabling evidence‐based policy and practice decisions. Our embedded research‐operations partnership, characterized by trust, respect, and strong communication, ensured that evaluations generated an evidence base to inform both implementation and impact.

Abstract Description This study investigated how human immunodeficiency virus (HIV) and associated immunosuppression influenced development of post-vaccination immunity to SARS-CoV-2. among. Twenty-two people living with HIV (PLWH) and 30 healthy donors (HDs) were recruited from the Greater New Orleans Area of Louisiana, with samples collected 21–378 days following mRNA SARS-CoV-2 vaccination (Pfizer or Moderna). We analyzed plasma and cellular samples using systems serology approaches together with T-cell (Tc) surface marker profiling for activation &amp; subset phenotyping following SARS-CoV-2 spike or HIV-1 gag peptide pool stimulation. Lentiviral pseudovirus neutralization assays were found to be compromised by antiretroviral therapy (ART) drugs in patients’ plasma. Isotype prevalence targeting spike and receptor-binding domain epitopes were altered post-vaccination in PLWH compared to HDs. While memory phenotypes were similar between PLWH and HDs, the durability &amp; quality of CD4 but not CD8 Tc responses were reduced in PLWH. Notably, altered spike-specific immune responses correlated with CD4 and CD8 Tc responses to HIV-1 gag peptide. In conclusion, primary SARS-CoV-2 vaccination in immunocompetent PLWH generates comparable CD8 T-cell memory and spike-specific antibodies relative to healthy controls. However, CD4 T-cell and antibody responses were altered in PLWH post-vaccination based on CD4 immunodeficiency, ART, and HIV-specific Tc activation Funding Sources Funding for this study was provided under NIH Project U54CA260581-01 Topic Categories Viral Immunology (VIR)

BackgroundThis narrative review examines the time to return to fertility after discontinuation of subcutaneous depot medroxyprogesterone acetate (DMPA SC) 104 mg among women of reproductive age.MethodsThe review was conducted using multiple data sources including PubMed, CINAHL, Web of Science, The Cochrane Library, Google Scholar, Ovid Medline, EMBASE, POPLINE, Global Health/EBSCO, Scopus, WHO Global Index Medicus, International Clinical Trials Registry Platform (ICTRP), Global Index Medicus – WHO, African Index Medicus (AIM), ScienceDirect, Public Library of Science (PLOS), BioMed Central, Dryad and JSTOR. Search terms included DMPA, SC-DMPA, depot medroxyprogesterone acetate, ovulation, pregnancy, Depo Provera, return to ovulation, fertility, return to fertility, subcutaneous and SubQ. We included studies that used the standard and not experimental dosing of DMPA SC.ResultsFour of the 31 articles met the inclusion criteria. The trials compared DMPA SC 104 mg with intramuscular DMPA (DMPA IM) at various dosages and routes. Follow-up varied from 7.5 to 18 months after the last injection. Median time to ovulation for DMPA SC was 212 days and was not statistically significantly different from DMPA IM 150 mg (183 days). There were no differences in time to ovulation by region, body mass index or age. No studies reported on time to pregnancy, effect of duration or frequency of dosing.ConclusionsMedian time to ovulation for DMPA SC 104 mg of 212 days was similar to that of DMPA IM 150 mg of 183 days, suggesting that choice of formulation (SC vs IM) does not impact the timeline for return to fertility.