Mobile health clinics (MHCs) effectively provide healthcare to underserved communities. However, their application during health emergencies is understudied. We described the implementation of an MHC program delivering vaccinations during the COVID-19 pandemic, examined the program's reach to medically underserved communities, and investigated characteristics of vaccination uptake in order to inform the utility of MHCs during health emergencies. The study observed COVID-19 MHC vaccination rates and factors associated with uptake between February 20th, 2021, and February 17th, 2022. Prisma Health deployed six MHCs to underserved communities. We described the characteristics of individuals who utilized the MHCs and evaluated census tract-level community factors associated with use of the MHCs through generalized linear mixed effects models. The MHCs conducted 260 visits at 149 unique sites in South Carolina, providing 12,102 vaccine doses to 8545 individuals: 2890 received a partial dose, 4355 received a primary series, and 1300 received a booster dose. Among individuals utilizing the MHC, the median age was 42 years (IQR: 22–58), 44.0 % were Black, 49.2 % were male, and 44.2 % were uninsured. Black, Hispanic, and uninsured individuals were significantly more likely to utilize MHC services for COVID-19 vaccination. During periods when vaccines were limited, MHC utilization was significantly greater in communities facing access barriers to healthcare. The high COVID-19 vaccination uptake at MHCs demonstrated that the MHC framework is an effective and acceptable intervention among medically underserved populations during health emergencies, especially when resources are scarce. The identified factors associated with vaccination uptake demonstrated that the MHCs had the greatest impact in higher-risk communities and can be used to inform allocation of such field-level interventions in future health emergencies.

The present study investigated immediate and long-lasting cognitive effects of chronic sleep restriction (CSR) in adolescent rats. After 10 days of CSR produced by gentle handling, both hippocampal-dependent and non-hippocampal-dependent long-term memory abilities were tested using the object location task and the object recognition task, respectively. Testing occurred in adolescence and after a 4-week delay during which rats slept freely and matured to adulthood. Rats exposed to CSR showed impaired memory on the object location task during adolescence that persisted into adulthood. However, there was no effect of CSR on memory for the object recognition task at either time point. These results demonstrate that CSR during adolescence produces an impairment in hippocampal-dependent memory but does not affect non-hippocampal-dependent memory. In addition, this impairment persists even after 4 weeks of undisturbed sleep. This study is the first rodent model to use a longitudinal approach to investigate adolescent CSR and provides practical implications for the health of adolescents.

Cognitive reserve (CR) is the ability to maintain cognitive performance despite brain pathology. CR is built through lifecourse experiences (e.g., education) and is a key construct in promoting healthy aging. However, the operationalization of CR and its estimated association with late-life cognition varies. The purpose of this study was to systematically examine the operationalization of CR and the relationship between its operationalization and late-life cognition. We performed a comprehensive review of experiences (proxies) used to operationalize CR. The review informed quantitative analyses using data from 1366 participants of the Memory and Aging Project to examine 1) relationships between proxies and 2) the relationship between operationalization and late-life cognition. We also conducted a factor analysis with all identified CR experiences to create a composite lifecourse CR score. Generalized linear mixed models examined the relationship between operationalizations and global cognition, with secondary outcomes of five domains of cognition to examine consistency. Based on a review of 753 articles, we found the majority (92.3%) of the 28 commonly used proxies have weak to no correlation between one another. There was substantial variability in the association between operationalizations and late-life global cognition (median effect size: 0.99, IQR: 0.34 to 1.39). There was not strong consistency in the association between CR operationalizations and the five cognitive domains (mean consistency: 56.1%). The average estimate for the 28 operationalizations was 0.91 (SE = 0.48), compared to 2.48 (SE = 0.40) for the lifecourse score and it was associated with all five domains of cognition. Inconsistent methodology is theorized as a major limitation of CR research and barrier to identification of impactful experiences for healthy cognitive aging. Based on the weak associations, it is not surprising that the relationship between CR and late-life cognition is dependent on the experience used to operationalize CR. Scores using multiple experiences across the lifecourse may help overcome such limitations. Adherence to a lifecourse approach and collaborative movement towards a consensus operationalization of CR are imperative shifts in the study of CR that can better inform research on risk factors related to cognitive decline and ultimately aid in the promotion of healthy aging.

Mobile health clinics (MHCs) are effective mechanisms for hepatitis C virus (HCV) screening and treatment in underserved populations. However, effective strategies for identifying and prioritizing high-risk communities are lacking. This study examined individual-level and community-level predictors of MHC utilization, HCV positivity rates, and HCV treatment initiation to assess the utility of these programs and improve MHC allocation. Clemson Rural Health (CRH), a health service delivery organization focused on rural and underserved communities, mobilizes MHCs for HCV screening and treatment initiation in the Upstate and Midlands regions of South Carolina. Participants for this study were individuals screened at CRH MHC sites between May 2021 and January 2024. Generalized linear mixed-effects models were used to examine the association between community-level predictors and number of individuals screened and community- and individual-level predictors and infection status and treatment initiation. The community-level analysis showed that individuals from census tracts with higher rates of poverty (relative risk; RR = 1.32, p = .012), higher rates of uninsurance (RR = 1.31, p = .003), and less rural areas (RR = 0.74, p = .029) were more likely to utilize the MHC for HCV screening. The individual-level analysis showed that an individual’s age of 30–44 (RR = 2.28, p = .020), non-White race (RR = 0.32, p < .001), history of injection drug use (RR = 10.16, p < .001), and lack of insurance (RR = 1.99, p < .001) were significantly associated with infection status. Lack of insurance (RR = 2.67, p = .012) was the only individual-level factor associated with treatment initiation. Community-level factors associated with treatment initiation were higher rates of poverty (RR = 1.72, p = .027) and uninsurance (RR = 1.74, p = .023), while a greater percent of individuals ages 30–44 was associated with less treatment initiation (RR = 0.47, p = .028). While programs and protocols for care for difficult-to-treat populations exist, understanding the effectiveness for uptake among target populations is necessary. The study demonstrated the utilization of MHC HCV services by the individuals and communities that would most benefit from this type of care. Screening services were utilized more by communities that tend to be medically underserved, and HCV infections were identified in groups that are known to be at high risk. Going forward, these findings can be used to direct allocation of MHC HCV resources for targeted intervention.

There is growing concern about the over-prescription of opioids and the risks of long-term use. This study examined the relationship between initial need (pre-operative, post-operative, and discharge pain) and dosage of opioids in the first prescription after surgery with continued opioid use through opioid refills over 12 months, while considering patient-level characteristics. A total of 9262 opioid-naïve patients underwent elective surgery, 7219 of whom were prescribed opioids following surgery. The results showed that 17% of patients received at least one opioid refill within one year post-surgery. Higher initial opioid doses, measured in morphine milligram equivalent (MME), were associated with a greater likelihood of continued use. Patients receiving a dose greater than 90 MME were 1.57 times more likely to receive a refill compared to those receiving less than 90 MME (95% confidence interval: 1.30–1.90, p < 0.001). Additionally, patients who experienced pain before or after surgery were more likely to receive opioid refills. Those experiencing moderate or severe pain were 1.66 times more likely to receive a refill (95% confidence interval: 1.45–1.91, p < 0.001). The findings highlight the need to consider surgery-related factors when prescribing opioids and the importance of developing strategies to balance the optimization of pain management with the risk of opioid-related harms.