Preventive medicine
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Preventive medicine · Feb 2021
ReviewUniversal school-based mental health programmes in low- and middle-income countries: A systematic review and narrative synthesis.
Depression and anxiety pose a significant burden during adolescence, which may have consequences for adulthood and future generations. The mental health needs of children and adolescents in low- and middle-income countries are not adequately addressed due to a lack of availability and access to services, and limited intervention research in these contexts. Universal school-based interventions provide a unique and potentially scalable opportunity to prevent and address mental health concerns amongst children and adolescents in low- and middle-income countries. ⋯ Of the 12,478 articles identified, 12 studies met our inclusion criteria and were included in this review. The included studies report on a variety of interventions differing in approach, format and content. Given the small number of studies and concerns with study quality, we are unable to conclude that universal school-based interventions may reduce symptoms of anxiety and depression in children in low- and middle-income countries.
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Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) has the potential to improve reproductive health by allowing low-income women access to healthcare before and early in pregnancy. The aim of this study was to examine the effects of Oregon's Medicaid expansion on timely and adequate prenatal care. We included live births in Oregon from 2012 to 2015 and used individually-linked birth certificate and Medicaid eligibility data. ⋯ Pre-pregnancy Medicaid enrollment increased following Medicaid expansion (β = 0.55, p < 0.001) and was associated with both timely (β = 0.48, p < 0.001) and adequate receipt of prenatal care (β = 0.14, p < 0.001). Using two years of post-ACA data we found that Medicaid expansion had significant positive associations with Medicaid enrollment prior to pregnancy, which subsequently increased receipt of timely and adequate prenatal care. Our study provides evidence that expanding Medicaid has positive effects on women's use of healthcare.
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Preventive medicine · Feb 2021
Comparative StudyImpact of COVID-19 lockdown policy on homicide, suicide, and motor vehicle deaths in Peru.
Although lockdown measures to stop COVID-19 have direct effects on disease transmission, their impact on violent and accidental deaths remains unknown. Our study aims to assess the early impact of COVID-19 lockdown on violent and accidental deaths in Peru. Based on data from the Peruvian National Death Information System, an interrupted time series analysis was performed to assess the immediate impact and change in the trend of COVID-19 lockdown on external causes of death including homicide, suicide, and traffic accidents. ⋯ The slope in homicide in men during the lock-down period increased by 6.66 deaths per million men per year (95% CI:3.18, 10.15). External deaths presented a sudden drop after the lockdown was implemented and an increase in homicide in men was observed. Falls in mobility have a natural impact on traffic accidents, however, the patterns for suicide and homicide are less intuitive and reveal important characteristics of these events, although we expect all of these changes to be transient.
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Preventive medicine · Feb 2021
Core functions, knowledge bases and essential services: A proposed prescription for the evolution of the preventive medicine specialty.
The pandemonium from the 2020 pandemic calls for a greater emphasis on prevention, public health and population health. Yet the role of preventive medicine specialists, ideally qualified to lead this charge, remains difficult to situate within the houses of medicine and public health. To overcome this challenge to its identity and evolve to better tackle novel and on-going public health and population health problems, the authors propose that the specialty of preventive medicine should assert 3 core functions within preventive care; expand and modernize its knowledge base; and enhance its residency training accordingly. The authors also propose 10 essential services, not otherwise systematically provided by other specialties, that the preventive medicine specialty can optimally fulfill as its unique contributions within medicine and public health.
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Preventive medicine · Feb 2021
Comparative StudyA longitudinal study of psychological distress in the United States before and during the COVID-19 pandemic.
The COVID-19 pandemic has caused financial stress and disrupted daily life more quickly than any prior economic downturn and on a scale beyond any prior natural disaster. This study aimed to assess the impact of the pandemic on psychological distress and identify vulnerable groups using longitudinal data to account for pre-pandemic mental health status. Clinically significant psychological distress was assessed with the Kessler-6 in a national probability sample of adults in the United States at two time points, February 2019 (T1) and May 2020 (T2). ⋯ Increase in psychological distress above T1 was associated with gender, age, household income, and census region. Equal numbers of people experienced serious psychological distress in 30-days during the pandemic as did over an entire year prior to the pandemic. Mental health services and research efforts should be targeted to those with a history of mental health conditions and groups identified as at high risk for increases in distress above pre-pandemic levels.