RESUMEN
This article examines organizational-level outcomes achieved during a technical assistance (TA) initiative designed to increase the capacity of local health departments (LHDs) to prevent youth violence (YV) via a multisectoral approach. This effort was designed to address the knowledge gap regarding how to provide effective TA to LHDs, specifically in YV. Twelve communities with high rates of YV were selected to participate using a multistage process. TA provided to LHD representatives (and other community partners) included monthly calls with TA specialists, group online learning events, community-of-practice calls, and access to an online portal offering additional resources. Data sources were used to determine the extent to which communities achieved the initiative's intended outcomes, including increased infrastructure to support youth violence prevention (YVP) at LHDs and the creation of community-wide violence prevention plans. Data sources included an online TA tracking system, annual semistructured group interviews, and point-of-contact surveys. While results indicated variation in TA uptake across sites, several target outcomes were achieved including increased representation and engagement of diverse perspectives in local YVP efforts and strengthened infrastructure and integration of YVP at LHDs. Findings highlight the importance of supporting LHDs to align YVP work with other priorities and funded activities, building a larger role for leadership in providing organizational support for YV, supporting the development of multisector coalitions or partnerships to decrease silos among different sectors focused on similar populations or communities. Implications from this initiative suggest that LHDs can be supported to convene local, multisector YVP efforts, which can be sustained if local YVP infrastructure is enhanced.
Asunto(s)
Gobierno Local , Violencia , Adolescente , Humanos , Liderazgo , Violencia/prevención & controlRESUMEN
Individuals receiving in-center maintenance hemodialysis bear a high burden of both physical and mood symptoms. More than half of patients on hemodialysis report sleep disturbance, muscle cramps, and fatigue. Patients describe symptoms as having a deleterious effect on their quality of life, suggesting that symptom alleviation may meaningfully improve patient-reported outcomes. Moreover, patients on hemodialysis have identified symptom management as a key area for research and innovation, prioritizing symptom alleviation over other health outcomes such as mortality and biochemical indices. Despite the importance of symptoms to patients, there has been little research explicitly geared toward improving patient symptoms, and therefore minimal innovation in symptom management. In general, the physiologic underpinnings of symptoms are poorly understood, hampering the development of targeted therapies. In fact, there have been few drugs or devices approved by the US Food and Drug Administration for the indication of improving any patient-reported outcomes for patients on hemodialysis. Recognizing this gap in innovation, the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology and US Food and Drug Administration, convened a workgroup to first prioritize symptoms for the development of therapeutic interventions, and then identify near-term actionable research goals for the prioritized physical symptoms of insomnia, muscle cramps, and fatigue. This paper summarizes the pathophysiology of the three prioritized symptoms, identifies key knowledge gaps, acknowledges factors that challenge development of new therapies, and offers the nephrology community actionable research goals for insomnia, muscle cramps, and fatigue.
Asunto(s)
Investigación Biomédica , Fatiga/terapia , Calambre Muscular/terapia , Diálisis Renal/efectos adversos , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Fatiga/etiología , Fatiga/fisiopatología , Objetivos , Humanos , Calambre Muscular/etiología , Calambre Muscular/fisiopatología , Calidad de Vida , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatologíaRESUMEN
BACKGROUND AND OBJECTIVES: Individuals receiving in-center hemodialysis experience a high symptom burden that detrimentally affects their quality of life. There are few evidence-based interventions for symptom relief in this population. To stimulate innovation in symptom management, data on patient symptom prioritization and treatment preferences are needed. We undertook this study to (1) identify patient-prioritized symptoms for the development of symptom relief therapies and (2) elicit preferences for treatments among individuals receiving hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a mixed methods study that included focus groups in Carrboro, North Carolina; Tucson, Arizona; and Seattle, Washington and a nationally distributed online survey. Focus group transcripts were analyzed for patterns, and the highest priority symptoms were determined on the basis of frequency and report severity. We used focus group findings to inform survey items. Focus group and survey results were crossvalidated and synthesized for final symptom prioritization. RESULTS: There were 32 participants across three focus groups and 87 survey respondents from 27 states in the United States. The physical symptoms of insomnia, fatigue, muscle cramping, and nausea/vomiting and the mood symptoms of anxiety and depressed mood were reported by participants in all focus groups. Among survey respondents, fatigue (94%), cramping (79%), and body aches (76%) were the most common physical symptoms, and feeling depressed (66%), worried (64%), and frustrated (63%) were the most common mood symptoms. The top-prioritized symptoms were consistent across focus group and survey participants and included the physical symptoms insomnia, fatigue, and cramping and the mood symptoms anxiety, depression, and frustration. Participants indicated that symptom frequency, duration, unpredictability, and social and financial effects factored most heavily into symptom prioritization. CONCLUSIONS: Patients prioritized the physical symptoms of insomnia, fatigue, and cramping and the mood symptoms of anxiety, depression, and frustration as the top symptoms for which to find new therapies.