Birmingham Repertory Theatre

Introduction Hereditary angioedema (HAE) is a rare disorder characterized by unpredictable swelling attacks. Social determinants of health may impact patient care. Methods US patients from Inovalon’s closed claims database with ≥2 medical claims (D84.1 complement system or T783XXX angioedema) and ≥1 prescription for HAE medication between 1/1/2017–9/30/2021 were screened (first claim defined as index date). Patients with evidence of ACE inhibitor use after HAE diagnosis were excluded. Eligible patients had 12 months continuous enrollment in a health-plan pre- and 24 months post-index. Race/ethnicity, income, and rurality were analyzed to understand differences in healthcare resource utilization across the population. Results In multivariable models, Black and Hispanic/Latino patients had a greater risk of ≥1 emergency department (ED) visit than White patients (risk ratio [RR; 95% CI]: 1.29 [1.19–1.40] and 1.22 [1.10–1.36], respectively). Black patients also had a greater risk of hospitalization than White patients (RR [95% CI]: 1.69 [1.28–2.24]). Low-income (<$50K) patients had a higher risk of having ≥1 ED visit or hospitalization than patients with higher incomes (≥$50K; RR [95% CI]: 1.31 [1.21–1.41] and 1.31 [1.03–1.67], respectively). However, rural patients had a lower risk of hospitalization than urban/suburban patients (RR [95% CI]: 0.63 [0.40–0.99]) with a higher mean number of prophylaxis medication fills than urban/suburban patients (RR [95% CI]: 2.0 [1.10–3.66]; no differences by race/ethnicity or income). Conclusion Differences in healthcare resource utilization occur among patients with HAE associated with race/ethnicity, income, and rurality. Strategies to improve equity in care are needed.

LGBTQ+ individuals experience disproportionately high rates of mental health challenges, driven largely by exposure to stigma, discrimination, and minority stress. In response, there is growing interest in creative, community-based interventions that support wellbeing. This study evaluates “LGBTQteehee!”, a 10-week stand-up comedy programme designed to promote mental wellbeing and resilience among LGBTQ+ individuals. N = 6 participants took part in post-intervention qualitative data collection via focus group and semi-structured interviews. Data were analysed using Reflexive Thematic Analysis. Two overarching themes were identified: “Standing up Together: A Queer Ensemble” and “Comedy as Catharsis”, each comprising two subthemes. The first theme captured the importance of community, highlighting “Where Comedy Meets Community” and “Where Safety Takes Centre Stage”, emphasising the role of belonging, diversity, and psychological safety. The second theme reflected the transformative potential of comedy, with “Performing (Queer) Resilience” and “Taking the Mic and Owning the Moment” illustrating how participants reframed lived experience into empowering narratives and reported increased confidence and self-expression. Findings suggest that the benefits of the intervention extend beyond humour alone, instead reflecting the interplay between social connection and identity-affirming narrative expression. Participants described how having a space to talk openly about their mental health and receive support from others contributed to their perceptions of both individual and collective resilience. These findings suggest that community-based comedy interventions may offer accessible and identity-affirming spaces through which LGBTQ+ individuals can explore wellbeing, belonging, and resilience. Whilst further evaluation is required, the findings contribute to growing discussions regarding the role of arts-based approaches in supporting LGBTQ+ mental health and wellbeing.

Introduction Left ventricular assist devices (LVADs) are routinely considered by patients with heart failure to prolong life and improve quality of life (QOL); however, this has been accompanied by increasing demands on family caregivers (FCGs). To address gaps in formalized training around LVAD caregiving, we developed the ENABLE-LVAD program to optimize the experience of LVAD clinicians and FCGs of patients with LVADs. Methods We performed a pilot randomized trial (intervention vs. control) designed to test the feasibility, acceptability, and preliminary effectiveness of ENABLE-LVAD. The intervention consists of 1) 4-hour online LVAD coordinator training, who then conduct 2) 4 one-on-one virtual FCG coaching sessions focused on coping, self-care, symptom management, and decision making. The Feasibility of Intervention Measure (FIM, range 4-20, higher scores=higher feasibility) and Acceptability of Intervention Measure (AIM, range 4-20, higher scores=higher feasibility) were administered to LVAD coordinators and FCGs in the intervention arm at 24-weeks. The Hospital Anxiety and Depression Scale (higher scores=higher anxiety and depression), Perceived Stress Scale (higher scores=higher stress), and EQ Visual Analog Scale (EQ-VAS, higher scores=higher QOL) were collected from FCGs at baseline and 24-weeks. Statistical analyses were conducted using Fisher’s exact test for categorical variables and Mann-Whitney U tests for numerical values. Results From 6/2023-3/2024, we enrolled 4 LVAD nurse coordinators and 35 caregivers (intervention=18, control=17). Sixteen FCGs completed all 4 coaching sessions. LVAD coordinators reported high feasibility and acceptability of ENABLE-LVAD (FIM=17.5(1.9), AIM=17.8(1.7)). Similarly, FCGs reported high feasibility and acceptability of ENABLE-LVAD (FIM=16.4(2.7), AIM=16.3(2.4)). Positive trends in FCG-reported outcomes were shown in several domains for the intervention group, although we were not powered to test significance. Anxiety and depression decreased more in the intervention group (anxiety: 6.5->5.4 vs 6.5->6.8; depression: 4.8->4.7 vs 4.4->5.7). Stress decreased more in the intervention group (14.4->12.7 vs 16.0->15.9) and QOL increased more in the intervention group (69.2->74.3 vs 74.4->69.7). Conclusions ENABLE-LVAD was feasible and acceptable to both LVAD coordinators and FCGs and demonstrated a signal of potential effectiveness for anxiety, depression, stress and QOL. The findings highlight the potential of a structured intervention enhancing clinician and FCG experiences caring for patients with an LVAD. A larger hybrid implementation and effectiveness trial is needed to confirm these results.

Background:Given increasing technology reliance, there is a need for a deeper understanding of individual and community-level comfort with technology as it pertains to basic and more complex healthcare-related skills. Methods:The objective of this quasi-experimental study was to engage participants in conversations about digital health literacy to facilitate awareness and to compare digital health literacy for community members, healthcare providers, non-clinical navigators, and community health advisors and county coordinators (henceforth referred to as CHAs) in the Deep South (AL, MS, FL). Interactive community conversations on digital health literacy were given in community (n = 16) and clinical (n = 5) settings. Participants completed pre- and post- surveys assessing personal comfort performing technological tasks on a 5-point scale. Mixed models estimated both within- and between-role changes in self-reported comfort. Results:Of 248 participants, 56% were community members, 18% healthcare providers, 17% CHAs, and 8% non-clinical navigators. Community members had the lowest personal comfort performing every task assessed (all p < .05). In the pre-test, the largest differences in reported personal comfort performing tasks were seen for basic skills including scanning QR codes (mean comfort score: community members 2.7 [SD 1.5] vs. non-clinical navigator 4.5 [1.0], p < .001) and sharing a website (mean comfort score: community members 2.9 [SD 1.6] vs. non-clinical navigator 4.5 [1.0], p < .001). Pre- vs. post-community conversation, community members experienced significant increases in their personal comfort scanning QR codes (β=0.8, 95% CI 0.5-1.0), creating an online account (general use) (β=0.4, 95% CI 0.2-0.6), and using a smartphone (β=0.3, 95% CI 0.1-0.5). Conclusions:As technological advances continue to be implemented, gaps in digital health literacy must be addressed. Non-clinical navigators may play a future role in teaching patients technology skills.