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Iziduh S, Abenoja A, Theodorlis M, Ahluwalia V, Battistella M, Borkhoff CM, Hazlewood GS, Lofters A, MacKay C, Marshall DA, Gagliardi AR. Priority strategies to reduce socio-gendered inequities in access to person-centred osteoarthritis care: Delphi survey. BMJ Open 2024; 14:e080301. [PMID: 38373862 PMCID: PMC10897840 DOI: 10.1136/bmjopen-2023-080301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/11/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Osteoarthritis (OA) prevalence, severity and related comorbid conditions are greater among women compared with men, but women, particularly racialised women, are less likely than men to access OA care. We aimed to prioritise strategies needed to reduce inequities in OA management. DESIGN Delphi survey of 28 strategies derived from primary research retained if at least 80% of respondents rated 6 or 7 on a 7-point Likert scale. SETTING Online. PARTICIPANTS 35 women of diverse ethno-cultural groups and 29 healthcare professionals of various specialties from across Canada. RESULTS Of the 28 initial and 3 newly suggested strategies, 27 achieved consensus to retain: 20 in round 1 and 7 in round 2. Respondents retained 7 patient-level, 7 clinician-level and 13 system-level strategies. Women and professionals agreed on all but one patient-level strategy (eg, consider patients' cultural needs and economic circumstances) and all clinician-level strategies (eg, inquire about OA management needs and preferences). Some discrepancies emerged for system-level strategies that were more highly rated by women (eg, implement OA-specific clinics). Comments revealed general support among professionals for system-level strategies provided that additional funding or expanded scope of practice was targeted to only formally trained professionals and did not reduce funding for professionals who already managed OA. CONCLUSIONS We identified multilevel strategies that could be implemented by healthcare professionals, organisations or systems to mitigate inequities and improve OA care for diverse women.
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Affiliation(s)
- Sharon Iziduh
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Angela Abenoja
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Madeline Theodorlis
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Vandana Ahluwalia
- William Osler Health System - Brampton Civic Hospital, Brampton, Ontario, Canada
| | - Marisa Battistella
- University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Deborah A Marshall
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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202
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Dixon SL, Salerno Valdez E, Chan J, Weil M, Fisher T, Simoun A, Egan J, Beatriz E, Gubrium A. Stacked Up Against Us: Using Photovoice and Participatory Methods to Explore Structural Racism's Impact on Adolescent Sexual and Reproductive Health Inequities. Health Promot Pract 2024:15248399241229641. [PMID: 38374717 DOI: 10.1177/15248399241229641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
While structural racism has profound impacts on adolescent health, little is known about how youth synthesize racialized experiences and work to dismantle systems of oppression. This article provides an overview of a Youth Participatory Action Research study that used Photovoice and community mapping to explore how structural violence, like racism, impacts the sexual and reproductive health of historically excluded youth as they navigate unjust socio-political landscapes. Youth participants used photography and community maps to identify how the experience of bias, profiling, and tokenism impacted their ability to navigate complex social systems. With youth voices prioritized, participants explored ways to address structural racism in their lives. The importance of co-creating opportunities with and for youth in critical reflection of their lived experience is emphasized. Through an Arts and Cultural in Public Health framework, we provide an analysis of the ways structural racism functions as a gendered racial project and fundamental cause of adolescent sexual and reproductive health inequities, while identifying pathways toward liberation in pursuit of health and well-being.
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Affiliation(s)
| | | | - Jazmine Chan
- University of Massachusetts Amherst, Amherst, MA, USA
| | - Mira Weil
- University of Massachusetts Amherst, Amherst, MA, USA
| | - Tiarra Fisher
- University of Massachusetts Amherst, Amherst, MA, USA
| | - Alya Simoun
- University of Massachusetts Amherst, Amherst, MA, USA
| | - Justine Egan
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Aline Gubrium
- University of Massachusetts Amherst, Amherst, MA, USA
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203
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Nelson TJ, Butcher BDC, Delgado A, McLemore MR. Perspectives of Certified Nurse-Midwives and Physicians on the Structural and Institutional Barriers that Contribute to the Reproductive Inequities of Black Birthing People in the San Francisco Bay Area. J Midwifery Womens Health 2024. [PMID: 38369871 DOI: 10.1111/jmwh.13614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/31/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Black birthing people in the United States disproportionately endure inequitable experiences and outcomes during pregnancy and childbirth via structural, interpersonal, and obstetric racism. In this study, the researchers explore provider perspectives of how racism is perpetuated in institutional perinatal and reproductive health care. METHODS Critical Race Theory, Reproductive Justice, and midwifery theory were operationalized through secondary thematic analysis of existing qualitative data from the Community Racial Equity and Training Interventions and Evaluation of Current and Future Healthcare Clinicians Study. Twenty-four perinatal providers (certified nurse-midwives [n = 7] and physicians [n = 17]) voluntarily participated in interviews. A comparative approach was used to determine how professional identity and model of care influence physicians' and certified nurse-midwives' perceptions of equity. RESULTS Thematic analysis produced 5 themes: racism as a comorbidity, health care systems' inability to address the needs of Black birthing people, health care systems prioritizing providers over patients are failed systems, patients are the experts in the optimal health care model, and benefits of interprofessional teams grounded in Reproductive Justice. Additionally, both physicians and midwives expressed a need for a new care model. DISCUSSION With these findings, our team proposes a modification of the midwifery model for application by all provider types that could radically shift the experience and outcomes of perinatal and reproductive health care and reduce mortality. Using a human rights approach to care, a Reproductive Justice-Public Health Critical Race praxis-informed midwifery model may be operationalized by all perinatal and reproductive health care providers. This novel model reflects an iterative process that may offer institutions and providers methods to build on past research supporting midwifery-centered care for improving outcomes for all patients by specifically focusing on improving care of Black birthing people. The implications of this work offer broad application in current clinical practice, quality improvement, research, technology, and patient resources.
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Affiliation(s)
- Tamara J Nelson
- Department of Family Health Care Nursing School of Nursing, University of California San Francisco, San Francisco, California
| | - Brittany D Chambers Butcher
- Department of Human Ecology, Human Development and Family Studies, University of California Davis, Davis, California
| | - Ana Delgado
- Department of Family Health Care Nursing School of Nursing, University of California San Francisco, San Francisco, California
| | - Monica R McLemore
- Department of Family Health Care Nursing School of Nursing, University of California San Francisco, San Francisco, California
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204
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Safary E, Beran D, Vetter B, Lepeska M, Abdraimova A, Dunganova A, Besançon S, Lazo-Porras M, Portocarrero Mazanett J, Pérez-León S, Maixenchs M, Nchimbi H, Ramaiya K, Munishi C, Martínez-Pérez GZ. User requirements for non-invasive and minimally invasive glucose self-monitoring devices in low-income and middle-income countries: a qualitative study in Kyrgyzstan, Mali, Peru and Tanzania. BMJ Open 2024; 14:e076685. [PMID: 38367964 PMCID: PMC10875487 DOI: 10.1136/bmjopen-2023-076685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/30/2024] [Indexed: 02/19/2024] Open
Abstract
AIMS Development of non-invasive and minimally invasive glucose monitoring devices (NI-MI-GMDs) generally takes place in high-income countries (HICs), with HIC's attributes guiding product characteristics. However, people living with diabetes (PLWD) in low-income and middle-income countries (LMICs) encounter different challenges to those in HICs. This study aimed to define requirements for NI-MI-GMDs in LMICs to inform a target product profile to guide development and selection of suitable devices. METHODS This was a multiple-methods, exploratory, qualitative study conducted in Kyrgyzstan, Mali, Peru and Tanzania. Interviews and group discussions/activities were conducted with healthcare workers (HCWs), adults living with type 1 (PLWD1) or type 2 diabetes (PLWD2), adolescents living with diabetes and caregivers. RESULTS Among 383 informants (90 HCW, 100 PLWD1, 92 PLWD2, 24 adolescents, 77 caregivers), a range of differing user requirements were reported, including preferences for area of glucose measurement, device attachment, data display, alert type and temperature sensitivity. Willingness to pay varied across countries; common requirements included ease of use, a range of guiding functions, the possibility to attach to a body part of choice and a cost lower than or equal to current glucose self-monitoring. CONCLUSIONS Ease-of-use and affordability were consistently prioritised, with broad functionality required for alarms, measurements and attachment possibilities. Perspectives of PLWD are crucial in developing a target product profile to inform characteristics of NI-MI-GMDs in LMICs. Stakeholders must consider these requirements to guide development and selection of NI-MI-GMDs at country level, so that devices are fit for purpose and encourage frequent glucose monitoring among PLWD in these settings.
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Affiliation(s)
- Elvis Safary
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva, Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | - Beatrice Vetter
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Molly Lepeska
- Health Action International, Amsterdam, The Netherlands
| | | | | | | | - Maria Lazo-Porras
- Division of Tropical and Humanitarian Medicine, University of Geneva, Geneva, Switzerland
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Silvana Pérez-León
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Happy Nchimbi
- Tanzania NCD Alliance, Dar es Salaam, Tanzania, United Republic of
| | - Kaushik Ramaiya
- Tanzania NCD Alliance, Dar es Salaam, Tanzania, United Republic of
| | - Castory Munishi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
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205
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Heller JC, Givens ML, Johnson SP, Kindig DA. Keeping It Political and Powerful: Defining the Structural Determinants of Health. Milbank Q 2024. [PMID: 38363858 DOI: 10.1111/1468-0009.12695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/10/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024] Open
Abstract
Policy Points The structural determinants of health are 1) the written and unwritten rules that create, maintain, or eliminate durable and hierarchical patterns of advantage among socially constructed groups in the conditions that affect health, and 2) the manifestation of power relations in that people and groups with more power based on current social structures work-implicitly and explicitly-to maintain their advantage by reinforcing or modifying these rules. This theoretically grounded definition of structural determinants can support a shared analysis of the root causes of health inequities and an embrace of public health's role in shifting power relations and engaging politically, especially in its policy work. Shifting the balance of power relations between socially constructed groups differentiates interventions in the structural determinants of health from those in the social determinants of health.
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Affiliation(s)
- Jonathan C Heller
- These authors contributed equally to this work
- Population Health Institute, University of Wisconsin
- National Collaborating Centre for Determinants of Health, Saint Francis Xavier University
| | - Marjory L Givens
- These authors contributed equally to this work
- Population Health Institute, University of Wisconsin
| | | | - David A Kindig
- Population Health Sciences, Population Health Institute, School of Medicine and Public Health, University of Wisconsin-Madison
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206
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Barwise AK, Curtis S, Diedrich DA, Pickering BW. Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives. J Am Med Inform Assoc 2024; 31:611-621. [PMID: 38099504 PMCID: PMC10873784 DOI: 10.1093/jamia/ocad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/14/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES Inpatients with language barriers and complex medical needs suffer disparities in quality of care, safety, and health outcomes. Although in-person interpreters are particularly beneficial for these patients, they are underused. We plan to use machine learning predictive analytics to reliably identify patients with language barriers and complex medical needs to prioritize them for in-person interpreters. MATERIALS AND METHODS This qualitative study used stakeholder engagement through semi-structured interviews to understand the perceived risks and benefits of artificial intelligence (AI) in this domain. Stakeholders included clinicians, interpreters, and personnel involved in caring for these patients or for organizing interpreters. Data were coded and analyzed using NVIVO software. RESULTS We completed 49 interviews. Key perceived risks included concerns about transparency, accuracy, redundancy, privacy, perceived stigmatization among patients, alert fatigue, and supply-demand issues. Key perceived benefits included increased awareness of in-person interpreters, improved standard of care and prioritization for interpreter utilization; a streamlined process for accessing interpreters, empowered clinicians, and potential to overcome clinician bias. DISCUSSION This is the first study that elicits stakeholder perspectives on the use of AI with the goal of improved clinical care for patients with language barriers. Perceived benefits and risks related to the use of AI in this domain, overlapped with known hazards and values of AI but some benefits were unique for addressing challenges with providing interpreter services to patients with language barriers. CONCLUSION Artificial intelligence to identify and prioritize patients for interpreter services has the potential to improve standard of care and address healthcare disparities among patients with language barriers.
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Affiliation(s)
- Amelia K Barwise
- Biomedical Ethics Research Program, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Susan Curtis
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55902, United States
| | - Daniel A Diedrich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55902, United States
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207
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Economou-Zavlanos NJ, Bessias S, Cary MP, Bedoya AD, Goldstein BA, Jelovsek JE, O’Brien CL, Walden N, Elmore M, Parrish AB, Elengold S, Lytle KS, Balu S, Lipkin ME, Shariff AI, Gao M, Leverenz D, Henao R, Ming DY, Gallagher DM, Pencina MJ, Poon EG. Translating ethical and quality principles for the effective, safe and fair development, deployment and use of artificial intelligence technologies in healthcare. J Am Med Inform Assoc 2024; 31:705-713. [PMID: 38031481 PMCID: PMC10873841 DOI: 10.1093/jamia/ocad221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/06/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE The complexity and rapid pace of development of algorithmic technologies pose challenges for their regulation and oversight in healthcare settings. We sought to improve our institution's approach to evaluation and governance of algorithmic technologies used in clinical care and operations by creating an Implementation Guide that standardizes evaluation criteria so that local oversight is performed in an objective fashion. MATERIALS AND METHODS Building on a framework that applies key ethical and quality principles (clinical value and safety, fairness and equity, usability and adoption, transparency and accountability, and regulatory compliance), we created concrete guidelines for evaluating algorithmic technologies at our institution. RESULTS An Implementation Guide articulates evaluation criteria used during review of algorithmic technologies and details what evidence supports the implementation of ethical and quality principles for trustworthy health AI. Application of the processes described in the Implementation Guide can lead to algorithms that are safer as well as more effective, fair, and equitable upon implementation, as illustrated through 4 examples of technologies at different phases of the algorithmic lifecycle that underwent evaluation at our academic medical center. DISCUSSION By providing clear descriptions/definitions of evaluation criteria and embedding them within standardized processes, we streamlined oversight processes and educated communities using and developing algorithmic technologies within our institution. CONCLUSIONS We developed a scalable, adaptable framework for translating principles into evaluation criteria and specific requirements that support trustworthy implementation of algorithmic technologies in patient care and healthcare operations.
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Affiliation(s)
| | - Sophia Bessias
- Duke AI Health, Duke University School of Medicine, Durham, NC 27705, United States
| | - Michael P Cary
- Duke AI Health, Duke University School of Medicine, Durham, NC 27705, United States
- Duke University School of Nursing, Durham, NC 27710, United States
| | - Armando D Bedoya
- Duke Health Technology Solutions, Duke University Health System, Durham, NC 27705, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States
| | - Benjamin A Goldstein
- Duke AI Health, Duke University School of Medicine, Durham, NC 27705, United States
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27705, United States
| | - John E Jelovsek
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC 27710, United States
| | - Cara L O’Brien
- Duke Health Technology Solutions, Duke University Health System, Durham, NC 27705, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States
| | - Nancy Walden
- Duke AI Health, Duke University School of Medicine, Durham, NC 27705, United States
| | - Matthew Elmore
- Duke AI Health, Duke University School of Medicine, Durham, NC 27705, United States
| | - Amanda B Parrish
- Office of Regulatory Affairs and Quality, Duke University School of Medicine, Durham, NC 27705, United States
| | - Scott Elengold
- Office of Counsel, Duke University, Durham, NC 27701, United States
| | - Kay S Lytle
- Duke University School of Nursing, Durham, NC 27710, United States
- Duke Health Technology Solutions, Duke University Health System, Durham, NC 27705, United States
| | - Suresh Balu
- Duke Institute for Health Innovation, Duke University, Durham, NC 27701, United States
| | - Michael E Lipkin
- Department of Urology, Duke University School of Medicine, Durham, NC 27710, United States
| | - Afreen Idris Shariff
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States
- Duke Endocrine-Oncology Program, Duke University Health System, Durham, NC 27710, United States
| | - Michael Gao
- Duke Institute for Health Innovation, Duke University, Durham, NC 27701, United States
| | - David Leverenz
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States
| | - Ricardo Henao
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27705, United States
- Department of Bioengineering, King Abdullah University of Science and Technology, Thuwal 23955, Saudi Arabia
| | - David Y Ming
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States
- Duke Department of Pediatrics, Duke University Health System, Durham, NC 27705, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, United States
| | - David M Gallagher
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States
| | - Michael J Pencina
- Duke AI Health, Duke University School of Medicine, Durham, NC 27705, United States
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27705, United States
| | - Eric G Poon
- Duke Health Technology Solutions, Duke University Health System, Durham, NC 27705, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27705, United States
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208
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Berninger TJ, Rajagopalan RM, Bloss CS. Compassion and equity-focused clinical genomics training for health professional learners. J Genet Couns 2024. [PMID: 38363012 DOI: 10.1002/jgc4.1874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/05/2024] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
There remains an urgent need for expanded genomics training in undergraduate medical education, especially as genetic and genomic assessments become increasingly important in primary care and routine clinical practice across specialties. Physician trainees continue to report feeling poorly prepared to provide effective consultation or interpretation of genomic test results. Here we report on the development, pilot implementation, and evaluation of an elective offering for pre-clinical medical students called the Sanford Precision Health Scholars Immersive Learning Experience (PHS), which was designed leveraging genetic counseling expertise as one means to address this need. This 9-week course, piloted in Fall 2021 at UC San Diego, afforded students the opportunity to build technical skills and competencies in clinical genomics while identifying, addressing, and engaging with pervasive health disparities in genomics. Interactive exercises focused students' learning on strategies for empathic and compassionate patient interactions while supporting the application of concepts and knowledge to future practice. Upon completion of the course, participants reported increases in confidence related to skills required for clinical genomics practice. Drawing on learnings from this pilot implementation, recommendations for refining the program include deepening pedagogical engagement with ethical issues, expanding the offering to trainees across health professions, including pharmacy students, and incorporating an optional experiential learning component. Educational offerings, like PHS, that are designed with the input of genetic counseling expertise may ease pressures on the genetic counseling profession by building a more genomic-literate healthcare workforce that can better support efforts to expand access for patients.
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Affiliation(s)
- Taylor J Berninger
- Center for Empathy and Technology, T. Denny Sanford Institute for Empathy and Compassion, UC San Diego, La Jolla, California, USA
- Augustana-Sanford Genetic Counseling Graduate Program, Augustana University, Sioux Falls, South Dakota, USA
- UC San Diego Health, La Jolla, California, USA
| | - Ramya M Rajagopalan
- Center for Empathy and Technology, T. Denny Sanford Institute for Empathy and Compassion, UC San Diego, La Jolla, California, USA
- Herbert Wertheim School of Public Health and Longevity Science, UC San Diego, La Jolla, California, USA
| | - Cinnamon S Bloss
- Center for Empathy and Technology, T. Denny Sanford Institute for Empathy and Compassion, UC San Diego, La Jolla, California, USA
- Herbert Wertheim School of Public Health and Longevity Science, UC San Diego, La Jolla, California, USA
- Department of Psychiatry, School of Medicine, UC San Diego, La Jolla, California, USA
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209
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Qin X, Mirabelli MC, Flanders WD, Hsu J. Medicaid Expansion and Health Care Use Among Adults With Asthma and Low Incomes: The Adult Asthma Call-Back Survey. Public Health Rep 2024:333549241228501. [PMID: 38357871 DOI: 10.1177/00333549241228501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVES Asthma disproportionately affects Black people and people with low incomes, but Medicaid expansion (hereinafter, expansion) data on these populations are limited. We investigated health care use among adults with asthma, before and after expansion, and examined whether asthma-related health care use after expansion varied by demographic characteristics. METHODS We analyzed data from the 2011-2013 and 2015-2019 Behavioral Risk Factor Surveillance System Adult Asthma Call-Back Survey on participants aged 18-64 years with current asthma and low incomes in 23 US states. We assessed 5 asthma-related outcomes, including medical visits (routine and emergency) and medication use, for expansion and nonexpansion groups. We used t tests to compare weighted percentages and 95% CIs, then performed adjusted difference-in-differences analyses. Secondary analyses stratified data by race, ethnicity, and sex. RESULTS Primary analyses (N = 10 796) found no significant associations between expansion and any outcome. Analyses stratified by race and ethnicity found no significant changes (eg, asthma controller medication use among non-Hispanic Black participants in the expansion group was 24.1% [95% CI, 14.4%-37.5%] in 2011-2013 and 35.5% [95% CI, 27.0%-45.1%] in 2015-2019; P = .13). Use of asthma controller medication increased significantly among non-Hispanic Other participants in the nonexpansion group (2011-2013: 16.0% [95% CI, 9.5%-25.5%]; 2015-2019: 40.2% [95% CI, 25.5%-56.8%]; P = .01). Asthma-related hospitalizations decreased significantly among women in the expansion group: 2011-2013 (7.8%; 95% CI, 5.3%-11.3%) and 2015-2019 (3.5%; 95% CI, 2.5%-4.9%) (P = .009). CONCLUSIONS Investigating factors other than health insurance (eg, social determinants of health) that influence the use of asthma-related health care could advance knowledge of potential strategies to advance health equity for adults with asthma and lower incomes.
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Affiliation(s)
- Xiaoting Qin
- Asthma and Air Quality Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria C Mirabelli
- Asthma and Air Quality Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Dana Flanders
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joy Hsu
- Asthma and Air Quality Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Harper CR, Tan-Schriner C, Royster J, Morgan KL, Burnett V, Treves-Kagan S, Bradford J, Ettman L, Espinosa O, Marziale E. Increasing support for the prevention of adverse childhood experiences and substance use: Implementation of narrative change strategies in local health departments. Am J Community Psychol 2024. [PMID: 38356403 DOI: 10.1002/ajcp.12741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/06/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024]
Abstract
Adverse childhood experiences (ACEs) are potentially traumatic but preventable experiences that occur before the ages of 18, including child abuse, witnessing violence, and parental substance use. ACEs have been linked with increased risk for substance use, along with a variety of other negative health outcomes. However, there is limited evidence of community-level strategies that link ACEs and substance to increase awareness of prevention efforts. This article reports on a $2.9 million program to promote health equity and inform narratives for the prevention of ACEs and substance use within three Midwestern communities. Program partners sought to create new transformational narratives that linked ACEs and substance use, while underscoring the importance of addressing social determinants of health (SDOH) that lead to disparities in ACEs and substance use. A mixed-methods evaluation design included document review, in-depth interviews with program staff (N = 8) and community liaisons (N = 2), and site reports from program staff (N = 8) and their community partners (N = 17). Analyses showed that successful implementation efforts had early leadership buy-in and support, set clear and manageable expectations at the outset of implementation, and developed strong relationships with organizations that engage in health equity work. Training and technical assistance were critical to helping community partners build trust, recognize each other's perspectives, broaden and reframe their world view, and better understand narrative efforts for the primary prevention of ACEs and substance use.
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Affiliation(s)
- Christopher R Harper
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Division of Violence Prevention, Atlanta, Georgia, USA
| | | | | | | | | | - Sarah Treves-Kagan
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Division of Violence Prevention, Atlanta, Georgia, USA
| | - Joivita Bradford
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Division of Violence Prevention, Atlanta, Georgia, USA
| | - Leah Ettman
- National Network of Public Health Institutes, Washington DC, USA
| | - Oscar Espinosa
- National Network of Public Health Institutes, Washington DC, USA
| | - Erin Marziale
- National Network of Public Health Institutes, Washington DC, USA
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Moyal-Smith R, Marsteller JA, Barnett DJ, Kent P, Purnell T, Yuan CT. Centering Health Equity in the Implementation of the Hospital Incident Command System: A Qualitative Case Comparison Study. Disaster Med Public Health Prep 2024; 18:e44. [PMID: 38351637 DOI: 10.1017/dmp.2024.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Disasters exacerbate inequities in health care. Health systems use the Hospital Incident Command System (HICS) to plan and coordinate their disaster response. This study examines how 2 health systems prioritized equity in implementing the Hospital Incident Command System (HICS) during the coronavirus disease 2019 (COVID-19) pandemic and identifies factors that influenced implementation. METHODS This is a qualitative case comparison study, involving semi-structured interviews with 29 individuals from 2 US academic health systems. Strategies for promoting health equity were categorized by social determinants of health. The Consolidated Framework for Implementation Research (CFIR) guided analysis using a hybrid inductive-deductive approach. RESULTS The health systems used various strategies to incorporate health equity throughout implementation, addressing all 5 social determinants of health domains. Facilitators included HICS principles, external partnerships, community relationships, senior leadership, health equity experts and networks, champions, equity-stratified data, teaming, and a culture of health equity. Barriers encompassed clarity of the equity representative role, role ambiguity for equity representatives, tokenism, competing priorities, insufficient resource allocation, and lack of preparedness. CONCLUSIONS These findings elucidate how health systems centered equity during HICS implementation. Health systems and regulatory bodies can use these findings as a foundation to revise the HICS and move toward a more equitable disaster response.
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Affiliation(s)
- Rachel Moyal-Smith
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
| | - Jill A Marsteller
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
| | - Daniel J Barnett
- Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health and Engineering, Baltimore, MD, USA
| | - Paula Kent
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
| | - Tanjala Purnell
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Christina T Yuan
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
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Koh LM, Iradukunda F, Martínez AD, Caetano Schulz KC, Bielitz I, Walker RK. A remotely accessible plant-based culinary intervention for Latina/o/x adults at risk for diabetes: lessons learned. Front Nutr 2024; 11:1298755. [PMID: 38414490 PMCID: PMC10896850 DOI: 10.3389/fnut.2024.1298755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/25/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction Little research has examined how community-engaged and -participatory dietary interventions adapted to remotely-accessible settings during the COVID-19 pandemic. Objectives To identify lessons learned in design, implementation, and evaluation of a remotely-accessible, community-based, nurse-led approach of a culturally-tailored whole food plant-based culinary intervention for Latina/o/x adults to reduce type 2 diabetes risk, delivered during a pandemic. Methods A mixed methods quasi-experimental design consisting of a pre-post evaluation comprised of questionnaires, culinary classes, biometrics, and focus groups. Lessons learned Community partnerships are essential for successful recruitment/retention. To optimally deliver a remotely-accessible intervention, community leadership and study volunteers should be included in every decision (e.g., timeframes, goals). Recommendations include managing recruitment and supply chain disruption of intervention supplies. Conclusion Future research should focus on increasing accessibility and engagement in minoritized and/or underserved communities, supply chain including quality assurance and delivery of services/goods, study design for sustainable, remotely-accessible interventions, and health promotion.
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Affiliation(s)
- Linda M Koh
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Palo Alto, CA, United States
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States
| | - Favorite Iradukunda
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States
| | - Airín D Martínez
- School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | | | - Irene Bielitz
- Independent Researcher, Loma Linda, CA, United States
| | - Rae K Walker
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States
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213
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Roy M, Lee RS, Furfari K. Centering equity in a longitudinal health systems science curricula. Med Teach 2024:1-4. [PMID: 38350437 DOI: 10.1080/0142159x.2024.2313575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
What was the educational challenge?Health inequity impedes care at every level of the health care system. Despite this, health equity is not the foundation for most health systems science (HSS) curricula.What was the solution?We reframed our HSS curricula to focus on health equity.How was the solution implemented?We integrated equity concepts into all HSS content areas. First-year content emphasizes structural competency and is delivered through didactics, discussions, interprofessional education, panels, and service-learning requirements. Second-year content applies HSS principles in the clinical space through direct patient care and assignments. Third- and fourth-year content focuses on HSS advocacy and leadership.What lessons were learned that are relevant to a wider global audience?It is crucial to center health equity in medical curricula to improve patient outcomes. Proper faculty development, non-judgmental discussions, and integration with clinical and medical sciences are critical to successful implementation.What are the next steps?We will address feedback, emphasize relevance to patients and populations, and refine outcome measures.
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Affiliation(s)
- Micaela Roy
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Rita S Lee
- University of Colorado School of Medicine, Aurora, CO, USA
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214
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Forchuk C, Serrato J, Scott L. Perceptions of stigma among people with lived experience of methamphetamine use within the hospital setting: qualitative point-in-time interviews and thematic analyses of experiences. Front Public Health 2024; 12:1279477. [PMID: 38414902 PMCID: PMC10896942 DOI: 10.3389/fpubh.2024.1279477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/25/2024] [Indexed: 02/29/2024] Open
Abstract
Objectives As part of a larger mixed-methods study into harm reduction in the hospital setting and people with lived experience of methamphetamine use, stigma was found to be a prominent issue. The aim of this secondary analysis was to investigate the issue of stigma. Design Participants completed a one-time qualitative interview component to assess their experiences in the hospital setting. Setting The study setting included secondary and tertiary care in Southwestern Ontario, Canada. Participants who had received care from these settings were also recruited from an overdose prevention site, a primary healthcare center, a national mental health organization, an affordable housing agency, and six homeless-serving agencies between October 2020 and April 2021. Participants A total of 104 individuals completed the qualitative component of a mixed-methods interview. Sixty-seven participants identified as male, thirty-six identified as female, and one identified as non-binary. Inclusion criteria included past or current use of methamphetamine, having received services from a hospital, and being able to communicate in English. Methods Open-ended questions regarding experiences in the hospital setting were asked in relation to the lived experience of methamphetamine. A secondary analysis was conducted post-hoc using a thematic ethnographic approach due to prominent perceptions of stigma. Results Three themes were identified. The first theme identified that substance use was perceived as a moral and personal choice; the second theme pertained to social stigmas such as income, housing and substance use, and consequences such as being shunned or feeling less worthy than the general patient population; and the third theme highlighted health consequences such as inadequate treatment or pain management. Conclusion This study revealed that stigma can have consequences that extend beyond the therapeutic relationship and into the healthcare of the individual. Additional training and education for healthcare providers represents a key intervention to ensure care is non-stigmatizing and patient-centered, as well as changing hospital culture.
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Affiliation(s)
- Cheryl Forchuk
- Lawson Health Research Institute, London, ON, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | | | - Leanne Scott
- Lawson Health Research Institute, London, ON, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
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215
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Dibba Y, Kachimanga C, Gassimu J, Kulinkina AV, Bukhman G, Gilbert HN, Adler AJ, Mukherjee JS. Non-communicable disease care in Sierra Leone: a mixed-methods study of the drivers and barriers to retention in care for hypertension. BMJ Open 2024; 14:e077326. [PMID: 38346892 PMCID: PMC10862328 DOI: 10.1136/bmjopen-2023-077326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE To retrospectively analyse routinely collected data on the drivers and barriers to retention in chronic care for patients with hypertension in the Kono District of Sierra Leone. DESIGN Convergent mixed-methods study. SETTING Koidu Government Hospital, a secondary-level hospital in Kono District. PARTICIPANTS We conducted a descriptive analysis of key variables for 1628 patients with hypertension attending the non-communicable disease (NCD) clinic between February 2018 and August 2019 and qualitative interviews with 21 patients and 7 staff to assess factors shaping patients' retention in care at the clinic. OUTCOMES Three mutually exclusive outcomes were defined for the study period: adherence to the treatment protocol (attending >80% of scheduled visits); loss-to-follow-up (LTFU) (consecutive 6 months of missed appointments) and engaged in (but not fully adherent) with treatment (<80% attendance). RESULTS 57% of patients were adherent, 20% were engaged in treatment and 22% were LTFU. At enrolment, in the unadjusted variables, patients with higher systolic and diastolic blood pressures had better adherence than those with lower blood pressures (OR 1.005, 95% CI 1.002 to 1.009, p=0.004 and OR 1.008, 95% CI 1.004 to 1.012, p<0.001, respectively). After adjustment, there were 14% lower odds of adherence to appointments associated with a 1 month increase in duration in care (OR 0.862, 95% CI 0.801 to 0.927, p<0.001). Qualitative findings highlighted the following drivers for retention in care: high-quality education sessions, free medications and good interpersonal interactions. Challenges to seeking care included long wait times, transport costs and misunderstanding of the long-term requirement for hypertension care. CONCLUSION Free medications, high-quality services and health education may be effective ways of helping NCD patients stay engaged in care. Facility and socioeconomic factors can pose challenges to retention in care.
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Affiliation(s)
- Yusupha Dibba
- Clinical, Partners In Health, Freetown, Kono, Sierra Leone
- Harvard Medical School Blavatnik Institute, Boston, Massachusetts, USA
| | | | - Joseph Gassimu
- Clinical, Partners In Health, Freetown, Kono, Sierra Leone
| | - Alexandra V Kulinkina
- Clinical, Partners In Health, Freetown, Kono, Sierra Leone
- Swiss Tropical and Public Health Institute, Allschwil Switzerland, Basel, Switzerland
| | - Gene Bukhman
- Harvard Medical School Blavatnik Institute, Boston, Massachusetts, USA
- Center for Integration Science, Brigham and Women's Hospital, Boston, MA, USA
| | - Hannah N Gilbert
- Harvard Medical School Blavatnik Institute, Boston, Massachusetts, USA
| | - Alma J Adler
- Harvard Medical School Blavatnik Institute, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joia S Mukherjee
- Harvard Medical School Blavatnik Institute, Boston, Massachusetts, USA
- Clinical, Partners In Health, Boston, Massachusetts, USA
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216
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Taylor WL, Cheng R, Weinblatt AI, Bergstein V, Long WJ. An Artificial Intelligence Chatbot is an Accurate and Useful Online Patient Resource Prior to Total Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00104-9. [PMID: 38350517 DOI: 10.1016/j.arth.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/05/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Online information is a useful resource for patients seeking advice on their orthopaedic care. While traditional websites provide responses to specific frequently asked questions (FAQs), sophisticated artificial intelligence tools may be able to provide the same information to patients in a more accessible manner. Chat Generative Pretrained Transformer (ChatGPT) is a powerful artificial intelligence chatbot that has been shown to effectively draw on its large reserves of information in a conversational context with a user. The purpose of this study was to assess the accuracy and reliability of ChatGPT-generated responses to FAQs regarding total knee arthroplasty. METHODS We distributed a survey that challenged arthroplasty surgeons to identify which of the 2 responses to FAQs on our institution's website was human-written and which was generated by ChatGPT. All questions were total knee arthroplasty-related. The second portion of the survey investigated the potential to further leverage ChatGPT to assist with translation and accessibility as a means to better meet the needs of our diverse patient population. RESULTS Surgeons correctly identified the ChatGPT-generated responses 4 out of 10 times on average (range: 0 to 7). No consensus was reached on any of the responses to the FAQs. Additionally, over 90% of our surgeons strongly encouraged the use of ChatGPT to more effectively accommodate the diverse patient populations that seek information from our hospital's online resources. CONCLUSIONS ChatGPT provided accurate, reliable answers to our website's FAQs. Surgeons also agreed that ChatGPT's ability to provide targeted, language-specific responses to FAQs would be of benefit to our diverse patient population.
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Affiliation(s)
- Walter L Taylor
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Ryan Cheng
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Aaron I Weinblatt
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Victoria Bergstein
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - William J Long
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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217
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Weir S, May C, Wills A, Van Zanten E, Nesbit K, Ngalande A, Kanjirawaya R. Building Local Capacity in a Low-Resource Setting to Increase Access to Health Care: An Evaluation of Blood Pressure Monitoring Training. Health Promot Pract 2024:15248399231225444. [PMID: 38339998 DOI: 10.1177/15248399231225444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Cardiovascular risk factors such as hypertension are common and largely uncontrolled in Malawi. In this low-resource setting, Community Health Workers (CHWs) can increase access to home-based blood pressure (BP) monitoring. The purpose of this study is to evaluate the effectiveness of a CHW training focused on BP monitoring and referral criteria, as well as the accuracy of referral decision-making and documentation. The participants were a purposive sample of all active home-based palliative care CHWs at St. Gabriel's Hospital (n = 60) located in Namitete, Malawi, serving over 250,000 people within a 50 km radius. This was a retrospective cross-sectional study conducted in December 2020 using both quantitative (descriptive, paired t-test) and qualitative (thematic) analysis. Participants showed significantly greater knowledge on the post-test (M = 8.98, SD = 1.213) compared to the pretest (M = 7.96, SD = 1.231), t (54)-5.0557.475, p < .001. All participants who attended both days of training demonstrated competency on a skills checklist in 100% of the rehabilitation and BP monitoring skills taught. Through document analysis of record books, referral decisions for patients with hypertension were 87.57% accurate and 81.07% of entries (n = 713) were complete. Participants reported the lack of both transportation and equipment as barriers to their work. They reported trainings, supplies, and support from the hospital as facilitators to their work. This study shows that BP can be monitored in remote villages, accurate referrals can be made, and stroke prevention education can be provided. These interventions increase the chances of more equitable care for this vulnerable population in a resource-limited setting.
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Affiliation(s)
- Sarah Weir
- California Children's Services, Alameda County, CA, USA
| | | | - Alexa Wills
- Renew Physical Therapy, San Francisco, CA, USA
| | | | - Kathryn Nesbit
- University of California San Francisco/San Francisco State Graduate Program in Physical Therapy, San Francisco, CA, USA
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218
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Milionis C, Ilias I, Milioni SO, Venaki E, Koukkou E. Caring for the Older Transgender Adults: Social, Nursing, and Medical Challenges. Clin Nurs Res 2024:10547738241231054. [PMID: 38339880 DOI: 10.1177/10547738241231054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Aging is a challenging process for people with gender nonconformity. Indeed, the older transgender population faces several disparities in accessing and using health care and social support services. Furthermore, the clinical management of gender transition in later life is empirical since clear research evidence is lacking. This paper aimed to present the problems encountered by older transgender adults in their access to social support and health care and to propose insightful solutions to address them both from a social and medical/nursing perspective. Trans elders face profound disparities in health and social care due to factors associated with limited accessibility to health services, social restrictions, administrative failures, and physical vulnerabilities. The medical treatment of older transgender adults also needs a careful approach to achieve satisfying gender affirmation without clinically significant risks. The potential induction of hormone-sensitive malignancies and the provocation of major adverse vascular events are the main concerns. Gender transition in older adults without a prior history of following gender-affirming therapy is challenging due to biological factors related to advanced age. Caring for elderly trans people unfolds at multiple levels. International organizations and governmental bodies should address the underprivileged status of elderly transgender people by creating and implementing inclusive policies. Safe and respectful clinical and residential environments and the formation of clearer medical guidelines could meet the unique needs of older trans adults. Care providers must advocate for their patients and be equipped to provide safe and effective services.
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219
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Kodyee S, Moonpanane K, Trakooltorwong P, Thepsaw J, Wuttipan N, Maneekunwong K. Feasibility and Acceptability of an ABCD Program for Child Development Among Skipped Families in Rural Thailand: A Pilot Study. J Multidiscip Healthc 2024; 17:629-639. [PMID: 38352862 PMCID: PMC10863458 DOI: 10.2147/jmdh.s446315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction The study aimed to develop and examine the aesthetic, bedtime story, connecting with nature, and drawing (ABCD), community based, program for grandparents to help them promote their grandchildren's development. Methods The action research was conducted in two phases. In the first phase, semi-structured interviews and focus group discussions were utilized to gather information from healthcare providers, teachers, and community leaders to develop the ABCD program. This was followed by a critical evaluation of the program's activities, materials, and contents. The second phase was to examine the program's effectiveness. A one-group pretest-posttest design was used to study the effectiveness of the program among 20 dyads of grandparents and grandchildren. Results All grandparents attended and completed the program. The grandparents' knowledge increased significantly (p = 0.024), and satisfaction with the program was high (X = 9, SD = 0.93) while children's development was not statistically different (p = 0.317). Conclusion The ABCD program was found to be feasible and acceptable to grandparents of skipped families to promote their grandchildren's development. The importance of healthcare providers, teachers, and community leaders in providing ABCD programs must also be recognized.
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Affiliation(s)
- Salisa Kodyee
- School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand
| | - Katemanee Moonpanane
- School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand
- Nursing Innovation Research and Resource Unit, School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand
| | | | - Jintana Thepsaw
- School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand
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220
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Babaita AO, Jahan Y, Nakamura R, Moriyama M. Identifying key factors for successful formulation and implementation of healthcare policies on non-communicable diseases: a multinational analysis. Front Public Health 2024; 12:1292176. [PMID: 38389939 PMCID: PMC10881649 DOI: 10.3389/fpubh.2024.1292176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Objectives Non-communicable diseases (NCDs) are a major public health concern that accounts for 74% of global deaths each year. The increasing burden of NCDs exhausts public health resources and threatens the achievement of the 2030 agenda for sustainable development. The purpose of this study is to thematically analyze the contributory factors in the health policy process and reforms to strengthen the prevention of NCDs across borders, as well as the milestones achieved through the process of policy-making, change, and implementation. Method This study informs and draws on the findings of contributory factors in the health policy process for preventing NCDs across borders: United States, England, Sweden, Bangladesh, Singapore, South Korea, and Thailand. Ten experts from the seven countries were recruited purposively for a semi-structured interview (e-Interview) on the NCD policy-making process in their countries, either through health ministries or the authors' network. This descriptive qualitative study design is guided by the "Three I's" framework of public policy (institutions, ideas, and interests). In addition to the information obtained from the interviewee, data were also sourced from relevant documents and homepages suggested by the interviewee, as well as health homepages of the countries. Result The following themes were generated: (1) environmental policies and social determinants, (2) multistakeholder involvement, (3) interministerial collaboration, (4) independent evidence and review institution, (5) integrated health data, and (6) primary care system. There was a shift from individual-targeted policies to environmental policies and social determinants. Notably, national campaigns were developed through non-governmental organizations (NGOs) for the primary prevention of NCDs. Conclusion The shift from behavioral modification and treatment to social determinants is important. NCDs are broad and require a multisector and multilevel approach. Establishing an organization or hierarchical body to overlook NCDs could result in increased awareness, focus, and surveillance and enhance the policy process.
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Affiliation(s)
| | - Yasmin Jahan
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryota Nakamura
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Kunitachi, Japan
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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221
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McKinley CE. "We have to … work for wholeness no matter what": Family and culture promoting wellness, resilience, and transcendence. Transcult Psychiatry 2024:13634615241227690. [PMID: 38327166 DOI: 10.1177/13634615241227690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Sociocultural, mental, behavioral, and physical factors are interrelated associates of chronic health conditions-such as diabetes, obesity, and cardiovascular disease-all of which are disproportionally high and drive much of the mortality and morbidity for Indigenous peoples. Indigenous worldviews conceptualize health holistically, with inseparability across social, spiritual, cultural, familial, mental, behavioral, physical, and social dimensions of wellness. Food, family, and culture are fundamental to Indigenous wellness. The purpose of this article is to use the Framework of Historical Oppression, Resilience, and Transcendence (FHORT) conceptualization of relational wellness to honor urban and rural U.S. Indigenous perspectives that highlight the intersections of family, culture, physical health, spiritual, and mental health to promote resilience and wellness. This research focused on interconnections between wellness, culture, health, and family. Thirty-one critical ethnographic interviews used a life-history approach with methodology following an Indigenous toolkit for ethical and culturally sensitive research strategies, such as building upon cultural strengths, engaging in long-term, relational commitments with communities, incorporating storytelling and oral history traditions, centering Indigenous methodologies and preferences, working with cultural insiders, and prioritizing the perspectives of Indigenous peoples. Emergent themes included: (a) roots of Indigenous wellness: cultural values promoting balance and connection; (b) practicing resilience: family transmission of health information; and (c) wholistic mental wellness and resilience, with the subtheme culture and wellness. Interventions can be developed in collaboration with tribes for optimum efficacy and cultural relevancy and can approach wellness holistically in culturally relevant ways that center foodways, culture, family, and spirituality.
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Fridman MR, Thompson SG, Tyson A, Barber PA, Davis A, Wu T, Fink J, Heppell D, Punter MNM, Ranta A. Sex differences in stroke reperfusion therapy in Aotearoa (New Zealand). Intern Med J 2024. [PMID: 38327096 DOI: 10.1111/imj.16318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 12/09/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND AIMS Stroke is a leading cause of death in Aotearoa (New Zealand), and stroke reperfusion therapy is a key intervention. Sex differences in stroke care have previously been asserted internationally. This study assessed potential differences in stroke reperfusion rates and quality metrics by sex in Aotearoa (New Zealand). METHODS This study used data from three overlapping sources. The National Stroke Reperfusion Register provided 4-year reperfusion data from 2018 to 2021 on all patients treated with reperfusion therapy (intravenous thrombolysis and thrombectomy), including time delays, treatment rates, mortality and complications. Linkage to Ministry of Health administrative and REGIONS Care study data provided an opportunity to control for confounders and explore potential mechanisms. T-test and Wilcoxon rank-sum analyses were used for continuous variables, while the chi-squared test and logistic regression were used for comparing dichotomous variables. RESULTS Fewer women presented with ischaemic stroke (12 186 vs 13 120) and were 4.2 years older than men (median (interquartile range (IQR)) 79 (68-86) vs 73 (63-82) years). Women were overall less likely to receive reperfusion therapy (13.9% (1704) vs 15.8% (2084), P < 0.001) with an adjusted odds ratio of 0.83 (0.77-0.90), P < 0.001. The adjusted odds ratio for thrombolysis was lower for women (0.82 (0.76-0.89), P < 0.001), but lower rates of thrombectomy fell just short of statistical significance ((0.89 (0.79-1.00), P = 0.05). There were no significant differences in complications, delays or documented reasons for non-thrombolysis. CONCLUSIONS Women were less likely to receive thrombolysis, even after adjusting for age and stroke severity. We found no definitive explanation for this disparity.
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Affiliation(s)
- Michal R Fridman
- Department of Medicine, University of Otago-Wellington, Wellington, New Zealand
| | - Stephanie G Thompson
- Older Adults, Rehabilitation and Allied Health Service, Capital, Coast, and Hutt Valley District, Te Whatu Ora - Health NZ, Wellington, New Zealand
| | - Alicia Tyson
- Department of Neurology, Capital, Coast, and Hutt Valley District, Te Whatu Ora - Health NZ, Wellington, New Zealand
| | - P A Barber
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Alan Davis
- Medical and Elder Services, Te Tai Tokerau District, Te Whatu Ora - Health NZ, Whangārei, New Zealand
| | - Teddy Wu
- Department of Neurology, Canterbury District, Te Whatu Ora - Health NZ, Christchurch, New Zealand
| | - John Fink
- Department of Neurology, Canterbury District, Te Whatu Ora - Health NZ, Christchurch, New Zealand
| | - Darren Heppell
- Information, Communication, and Technology, Capital, Coast, Hutt Valley District, and Wairarapa Districts, Te Whatu Ora - Health NZ, Wellington, New Zealand
| | - Martin N M Punter
- Department of Medicine, University of Otago-Wellington, Wellington, New Zealand
- Department of Neurology, Capital, Coast, and Hutt Valley District, Te Whatu Ora - Health NZ, Wellington, New Zealand
| | - Anna Ranta
- Department of Medicine, University of Otago-Wellington, Wellington, New Zealand
- Department of Neurology, Capital, Coast, and Hutt Valley District, Te Whatu Ora - Health NZ, Wellington, New Zealand
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Bess C, Ferdinand D, Underwood P, Ivy D, Albert MA, Onwuanyi A, McCullough C, Brewer LC. Promoting Cardiovascular Health Equity: Association of Black Cardiologists Practical Model for Community-Engaged Partnerships. J Am Coll Cardiol 2024; 83:632-636. [PMID: 38296407 DOI: 10.1016/j.jacc.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 02/08/2024]
Affiliation(s)
- Courtney Bess
- Division of Cardiology, University of Texas Southwestern, Dallas, Texas, USA
| | - Daphne Ferdinand
- Healthy Heart Community Prevention Project, Inc, New Orleans, Louisiana, USA
| | | | - Donnell Ivy
- Association of Black Cardiologists, Inc, Washington, DC, USA
| | - Michelle A Albert
- Center for the Study of Adversity and Cardiovascular Disease (NURTURE Center), Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Anekwe Onwuanyi
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | | | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA; Center for Health Equity and Community Engagement Research, Rochester, Minnesota, USA.
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Li C, Mowery DL, Ma X, Yang R, Vurgun U, Hwang S, Donnelly HK, Bandhey H, Akhtar Z, Senathirajah Y, Sadhu EM, Getzen E, Freda PJ, Long Q, Becich MJ. Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions. medRxiv 2024:2024.02.04.24302242. [PMID: 38370703 PMCID: PMC10871446 DOI: 10.1101/2024.02.04.24302242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background Social determinants of health (SDoH) like socioeconomics and neighborhoods strongly influence outcomes, yet standardized SDoH data is lacking in electronic health records (EHR), limiting research and care quality. Methods We searched PubMed using keywords "SDOH" and "EHR", underwent title/abstract and full-text screening. Included records were analyzed under five domains: 1) SDoH screening and assessment approaches, 2) SDoH data collection and documentation, 3) Use of natural language processing (NLP) for extracting SDoH, 4) SDoH data and health outcomes, and 5) SDoH-driven interventions. Results We identified 685 articles, of which 324 underwent full review. Key findings include tailored screening instruments implemented across settings, census and claims data linkage providing contextual SDoH profiles, rule-based and neural network systems extracting SDoH from notes using NLP, connections found between SDoH data and healthcare utilization/chronic disease control, and integrated care management programs executed. However, considerable variability persists across data sources, tools, and outcomes. Discussion Despite progress identifying patient social needs, further development of standards, predictive models, and coordinated interventions is critical to fulfill the potential of SDoH-EHR integration. Additional database searches could strengthen this scoping review. Ultimately widespread capture, analysis, and translation of multidimensional SDoH data into clinical care is essential for promoting health equity.
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Affiliation(s)
- Chenyu Li
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Danielle L. Mowery
- University of Pennsylvania, Institute for Biomedical Informatics
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Xiaomeng Ma
- University of Toronto, Institute of Health Policy Management and Evaluations
| | - Rui Yang
- Duke-NUS Medical School, Centre for Quantitative Medicine
| | - Ugurcan Vurgun
- University of Pennsylvania, Institute for Biomedical Informatics
| | - Sy Hwang
- University of Pennsylvania, Institute for Biomedical Informatics
| | | | - Harsh Bandhey
- Cedars-Sinai Medical Center, Department of Computational Biomedicine
| | - Zohaib Akhtar
- Northwestern University, Kellogg School of Management
| | - Yalini Senathirajah
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Eugene Mathew Sadhu
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Emily Getzen
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Philip J Freda
- Cedars-Sinai Medical Center, Department of Computational Biomedicine
| | - Qi Long
- University of Pennsylvania, Institute for Biomedical Informatics
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Michael J. Becich
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
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225
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Osuide JO, Parsa AD, Mahmud I, Kabir R. The effect of limited access to antenatal care on pregnancy experiences and outcomes among undocumented migrant women in Europe: a systematic review. Front Glob Womens Health 2024; 5:1289784. [PMID: 38379839 PMCID: PMC10876992 DOI: 10.3389/fgwh.2024.1289784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
Women who are undocumented migrants in Europe encounter a variety of challenges while trying to access health services, including restricted access to antenatal care (ANC) despite the importance of ANC to the well-being of mothers and their infants. This study's aim was to examine the effect that limited access to antenatal care has on the pregnancy experiences and outcomes of undocumented migrant (UM) women in Europe. Systematic searches were done on PubMed, Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, and BioMed Central. From the search results, only primary research articles that reported on the pregnancy outcomes and experiences of undocumented migrants were selected. A meta-analysis was not possible because this review included information from both qualitative and quantitative studies. The data that was taken from the included publications was organised, analysed, using the Microsoft Excel programme, and then meta-synthesised. Twelve papers from seven different European nations-Belgium, France, Sweden, Denmark, Norway, Finland, and England-were included in this systematic review. Eight of the studies aimed to explore the access to and utilization of ANC by undocumented migrant women and the related pregnancy outcomes. Two of the included studies examined the pregnancy experiences of UMs and two examined the perinatal risks associated with living as a migrant with no legal status. Although heterogeneous in their specific findings most of the studies showed undocumented immigrants are more likely to experience unfavourable pregnancy outcomes and experience greater anxiety and worries due to a variety of factors than documented migrants and registered citizens. This review's conclusions demonstrate the pressing need for policy modifications and healthcare reforms in Europe to address the problems associated with undocumented migrants' restricted access to antenatal care. It also highlights the urgent need for structural changes that will give this vulnerable population's health and well-being a higher priority. It is not just an issue of health equality but also a humanitarian obligation to address the many obstacles and difficulties undocumented migrant women endure during pregnancy.
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Affiliation(s)
- Jennifer Okhianosen Osuide
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Essex, Chelmsford, United Kingdom
| | - Ali Davod Parsa
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Essex, Chelmsford, United Kingdom
| | - Ilias Mahmud
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- School of Health, University of New England, Armidale, NSW, Australia
| | - Russell Kabir
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Essex, Chelmsford, United Kingdom
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226
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Adams S, Komene E, Wensley C, Davis J, Carryer J. Integrating nurse practitioners into primary healthcare to advance health equity through a social justice lens: An integrative review. J Adv Nurs 2024. [PMID: 38318982 DOI: 10.1111/jan.16093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/17/2023] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
AIM To develop a framework to guide the successful integration of nurse practitioners (NPs) into practice settings and, working from a social justice lens, deliver comprehensive primary healthcare which advances health equity. DESIGN Integrative review. METHODS The integrative review was informed by the Whittemore and Knafl's framework and followed the Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines. Quality was assessed using the Johns Hopkins Research Evidence Appraisal Tool. Findings were extracted and thematically analysed using NVivo. A social justice lens informed all phases. DATA SOURCES Databases, including CINAHL, PubMed, Scopus and Web of Science, were searched for peer-reviewed literature published in English between 2005 and April 2022. RESULTS Twenty-eight articles were included. Six themes were identified at the individual (micro), local health provider (meso), and national systems and structures (macro) levels of the health sector: (1) autonomy and agency; (2) awareness and visibility; (3) shared vision; (4) leadership; (5) funding and infrastructure; and (6) intentional support and self-care. The evidence-based framework is explicitly focused on the components required to successfully integrate NPs into primary healthcare to advance health equity. CONCLUSION Integrating NPs into primary healthcare is complex and requires a multilevel approach at macro, meso and micro levels. NPs offer the potential to transform primary healthcare delivery to meet the health needs of local communities. Health workforce and integration policies and strategies are essential if the contribution of NPs is to be realized. The proposed framework offers an opportunity for further research to inform NP integration. IMPACT STATEMENT Nurse practitioners (NPs) offer the potential to transform primary healthcare services to meet local community health needs and advance health equity. Globally, there is a lack of guidance and health policy to support the integration of the NP workforce. The developed framework provides guidance to successfully integrate NPs to deliver comprehensive primary healthcare grounded in social justice. Integrating NPs into PHC is complex and requires a multilevel approach at macro, meso and micro levels. The framework offers an opportunity for further research to inform NP integration, education and policy. SUMMARY STATEMENT What problem did the study address: The challenges of integrating nurse practitioners (NPs) into primary healthcare (PHC) are internationally recognized. Attempts to establish NP roles in New Zealand have been ad hoc with limited research, evidence-informed frameworks or policy to guide integration initiatives. Our review builds on existing international literature to understand how NPs are successfully integrated into PHC to advance health equity and provide a guiding framework. What were the main findings: Six themes were identified across individual (micro), local health provider (meso) and national systems and structures (macro) levels as fundamental to NP integration: autonomy and agency; awareness and visibility of the NP and their role; a shared vision for the direction of primary healthcare utilizing NP scope of practice; leadership in all spaces; necessary funding and infrastructure; and intentional support and self-care. Where and on whom will the research have an impact: Given extant health workforce challenges together with persisting health inequities, NPs provide a solution to delivering comprehensive primary healthcare from a social justice lens to promote healthcare access and health equity. The proposed evidence-informed framework provides guidance for successful integration across the health sector, training providers, as well as the NP profession, and is a platform for future research. REPORTING METHOD This integrative review adhered to the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Sue Adams
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Ebony Komene
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Cynthia Wensley
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Josephine Davis
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jenny Carryer
- School of Nursing, University of Auckland, Auckland, New Zealand
- School of Nursing, Massey University, Palmerston North, New Zealand
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227
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Crowley AP, Neville S, Sun C, Huang QE, Cousins D, Shirk T, Zhu J, Kilaru A, Liao JM, Navathe AS. Differential Hospital Participation in Bundled Payments in Communities with Higher Shares of Marginalized Populations. J Gen Intern Med 2024:10.1007/s11606-024-08655-4. [PMID: 38319498 DOI: 10.1007/s11606-024-08655-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Medicare's voluntary bundled payment programs have demonstrated generally favorable results. However, it remains unknown whether uneven hospital participation in these programs in communities with greater shares of minorities and patients of low socioeconomic status results in disparate access to practice redesign innovations. OBJECTIVE Examine whether communities with higher proportions of marginalized individuals were less likely to be served by a hospital participating in Bundled Payments for Care Improvement Advanced (BPCI-Advanced). DESIGN Cross-sectional study using ordinary least squares regression controlling for patient and community factors. PARTICIPANTS Medicare fee-for-service patients enrolled from 2015-2017 (pre-BPCI-Advanced) and residing in 2,058 local communities nationwide defined by Hospital Service Areas (HSAs). Each community's share of marginalized patients was calculated separately for each of the share of beneficiaries of Black race, Hispanic ethnicity, or dual eligibility for Medicare and Medicaid. MAIN MEASURES Dichotomous variable indicating whether a given community had at least one hospital that ever participated in BPCI-Advanced from 2018-2022. KEY RESULTS Communities with higher shares of dual-eligible individuals were less likely to be served by a hospital participating in BPCI-Advanced than communities with the lowest quartile of dual-eligible individuals (Q4: -15.1 percentage points [pp] lower than Q1, 95% CI: -21.0 to -9.1, p < 0.001). There was no consistent significant relationship between community proportion of Black beneficiaries and likelihood of having a hospital participating in BPCI-Advanced. Communities with higher shares of Hispanic beneficiaries were more likely to have a hospital participating in BPCI-Advanced than those in the lowest quartile (Q4: 19.2 pp higher than Q1, 95% CI: 13.4 to 24.9, p < 0.001). CONCLUSIONS Communities with greater shares of dual-eligible beneficiaries, but not racial or ethnic minorities, were less likely to be served by a hospital participating in BPCI-Advanced Policymakers should consider approaches to incentivize more socioeconomically uniform participation in voluntary bundled payments.
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Affiliation(s)
- Aidan P Crowley
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Sarah Neville
- The Commonwealth Fund, New York, NY, USA
- Independent Health and Aged Care Pricing Authority, Sydney, Australia
| | - Chuxuan Sun
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Qian Erin Huang
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Deborah Cousins
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Torrey Shirk
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jingsan Zhu
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Austin Kilaru
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua M Liao
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, UT Southwestern Medical Center, Dallas, TX, USA
- Program on Policy Evaluation and Learning, UT Southwestern, Dallas, TX, USA
| | - Amol S Navathe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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228
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Suarez L, Armstrong S, Fleming R, Howard J, Cholera R. Families Benefit After Utilization of a Clinic-Based Food Pantry Irrespective of Food Insecurity Experiences in a Pediatric Obesity Treatment Program. Am J Health Promot 2024:8901171241229828. [PMID: 38321414 DOI: 10.1177/08901171241229828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE To evaluate the congruence between food insecurity screening outcome and clinic-based food pantry utilization and to examine caregiver reported comfort, motivation, and benefits of utilization. DESIGN Mixed-methods study. SETTING Academic pediatric obesity treatment clinic. SUBJECTS Convenience sample of caregivers. INTERVENTION Clinic-based food pantry offered irrespective of food insecurity screening outcome. MEASURES Food insecurity screening (Hunger Vital Sign) and severity, self-rated caregiver health, willingness to disclose food insecurity and receive food, and food-related stress. ANALYSIS Chi-square and t-tests were utilized to examine associations and descriptive analysis explored benefits. Rapid qualitative analysis was utilized to identify themes. RESULTS Caregivers of 120 children were included (child mean age 11.8; 56.7% female, 67.6% Non-Hispanic Black), with 47 of 59 eligible completing follow-up surveys and 14 completing in-depth interviews. Approximately half (N = 30/59, 50.8%) of families utilizing the food pantry screened negative for food insecurity. Families utilizing the food pantry were more likely to report severe food insecurity (N = 23/59; 38.9%) compared to those declining (N = 3/61; 4.9%, P < .001). Caregivers accepting food were able to meet a child health goal (N = 30/47, 63.8%). Caregivers reported feeling comfortable receiving food (N = 13/14) and felt utilizing the food pantry led to consumption of healthier foods (N = 7/14). CONCLUSIONS Families who screened both positive and negative for food insecurity utilized and benefited from a clinic-based food pantry. Clinics should consider strategies offering food resources to all families irrespective of screening outcome.
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Affiliation(s)
- Lilianna Suarez
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Department of Medicine, School of Medicine, Duke University, Durham, NC, USA
| | - Sarah Armstrong
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA
| | - Rachel Fleming
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Janna Howard
- Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA
| | - Rushina Cholera
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Duke Margolis Center for Health Policy, Duke University, NC, USA
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Bogulski CA, Pro G, Acharya M, Ali MM, Brown CC, Hayes CJ, Eswaran H. The association between rurality, dual Medicare/Medicaid eligibility and chronic conditions with telehealth utilization: An analysis of 2019-2020 national Medicare claims. J Telemed Telecare 2024:1357633X241226741. [PMID: 38314738 DOI: 10.1177/1357633x241226741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Telehealth services have the potential to increase healthcare access among underserved populations, such as rural residents and racial/ethnic minority groups. The COVID-19 public health emergency led to unprecedented growth in telehealth utilization, but evidence suggests the growth has not been equitable across all patient populations. This study aimed to explore whether telehealth utilization and expansion changed equitably from 2019 to 2020 among sub-groups of Medicare beneficiaries. METHODS We conducted an analysis of telehealth utilization among a 20% random sample of 2019-2020 Medicare beneficiaries on a national level. We fit multivariable logistic regression models and calculated average marginal effects (AME) to assess the association between demographic and clinical characteristics on telehealth utilization. RESULTS We found telehealth utilization was less likely among non-Hispanic Black/African-American (2019: adjusted odds ratio [aOR] = 0.77, AME = -0.15; 2020: aOR = 0.85, AME = -3.50) and Hispanic (2019: aOR = 0.79, AME = -0.13; 2020: aOR = 0.87, AME = -2.89) beneficiaries, relative to non-Hispanic White beneficiaries in both 2019 and 2020, with larger disparities in 2020. Rural beneficiaries were more likely to utilize telehealth than urban beneficiaries in 2019 (aOR = 2.62, AME = 0.84), but less likely in 2020 (aOR = 0.57, AME = -14.47). In both years, dually eligible Medicare/Medicaid beneficiaries were more likely than non-dually eligible beneficiaries to utilize telehealth (2019: aOR = 4.75, AME = 0.84; 2020: aOR = 1.34, AME = 2.25). However, the effects of dual eligibility and rurality changed in both models as the number of chronic conditions increased. DISCUSSION We found evidence of increasing disparities in telehealth utilization among several Medicare beneficiary sub-groups in 2020 relative to 2019, including individuals of minority race/ethnicity, rural residents, and dually eligible beneficiaries, with disparities increasing among individuals with more chronic conditions. Although telehealth has the potential to address health inequities, our findings suggest that many of the patients in greatest need of healthcare are least likely to utilize telehealth services.
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Affiliation(s)
- Cari A Bogulski
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - George Pro
- Department of Health Behavior and Health Education, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mahip Acharya
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mir M Ali
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Clare C Brown
- Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey J Hayes
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Hari Eswaran
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Alvares LTDEA, Rangel AG, Campos LN, Viana SW, Kim AWS, Sampaio NZ, Ferreira R, Silva JB, Mooney DP, Camargo CP. Expanding Global Surgery Education in Brazil: Perspectives after the 35th Brazilian Surgical Congress. Rev Col Bras Cir 2024; 51:e20243667. [PMID: 38324886 PMCID: PMC10826473 DOI: 10.1590/0100-6991e-20243667-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/15/2023] [Indexed: 02/09/2024] Open
Abstract
The 35th Brazilian Congress of Surgery marked a turning point for surgical education in the country. For the first time, the Brazilian College of Surgeons included Global Surgery on the main congressional agenda, providing a unique opportunity to rethink how surgical skills are taught from a public health perspective. This discussion prompts us to consider why and how Global Surgery education should be expanded in Brazil. Although Brazilian researchers and institutions have contributed to the fields expansion since 2015, Global Surgery education initiatives are still incipient in our country. Relying on successful strategies can be a starting point to promote the area among national surgical practitioners. In this editorial, we discuss potential strategies to expand Global Surgery education opportunities and propose a series of recommendations at the national level.
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Affiliation(s)
| | - Ayla Gerk Rangel
- - Harvard Medical School, Program in Global Surgery and Social Change - Boston - Massachusetts - Estados Unidos
| | | | | | | | | | - Roseanne Ferreira
- - McMaster University, Department of Health Research Methods, Evidence and, Impact - Hamilton - Ontario - Canadá
| | | | - David P Mooney
- - Boston Children's Hospital - Boston - Massachusetts - Estados Unidos
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231
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Ritchie ND, Turk MT, Holtrop JS, Durfee MJ, Dickinson LM, Kaufmann PG. A virtual recruitment protocol promotes enrollment of underrepresented groups in a diabetes prevention trial. J Clin Transl Sci 2024; 8:e26. [PMID: 38384920 PMCID: PMC10879998 DOI: 10.1017/cts.2024.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 02/23/2024] Open
Abstract
Strategies are needed to ensure greater participation of underrepresented groups in diabetes research. We examined the impact of a remote study protocol on enrollment in diabetes research, specifically the Pre-NDPP clinical trial. Recruitment was conducted among 2807 diverse patients in a safety-net healthcare system. Results indicated three-fold greater odds of enrolling in remote versus in-person protocols (AOR 2.90; P < 0.001 [95% CI 2.29-3.67]). Priority populations with significantly higher enrollment included Latinx and Black individuals, Spanish speakers, and individuals who had Medicaid or were uninsured. A remote study design may promote overall recruitment into clinical trials, while effectively supporting enrollment of underrepresented groups.
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Affiliation(s)
- Natalie D. Ritchie
- Center for Health Systems Research, Denver Health and
Hospital Authority, Denver, CO,
USA
- Department of Psychiatry, University of Colorado School of
Medicine, Aurora, CO, USA
| | | | - Jodi Summers Holtrop
- Adult & Child Center for Outcomes Research & Delivery Science,
University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
- Department of Family Medicine, University of Colorado
Anschutz Medical Campus, Aurora, CO,
USA
| | - Michael Josh Durfee
- Center for Health Systems Research, Denver Health and
Hospital Authority, Denver, CO,
USA
| | - L. Miriam Dickinson
- Department of Family Medicine, University of Colorado
Anschutz Medical Campus, Aurora, CO,
USA
| | - Peter G. Kaufmann
- Integrated Health Sciences, University of Nevada Las
Vegas, Las Vegas, NV, USA
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232
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Essien UR, Kim N, Hausmann LRM, Washington DL, Mor MK, Gellad WF, Fine MJ. Facility-Level Variation in Racial Disparities in Anticoagulation for Atrial Fibrillation: The REACH-AF Study. J Gen Intern Med 2024:10.1007/s11606-024-08643-8. [PMID: 38308154 DOI: 10.1007/s11606-024-08643-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/17/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Oral anticoagulation reduces stroke risk for patients with atrial fibrillation (AF). Prior research demonstrates lower anticoagulant prescribing in Black than in White individuals but few studies have examined racial differences in facility-level anticoagulant prescribing for AF. OBJECTIVE To assess variation in anticoagulant initiation by race within Veterans Health Administration (VA) facilities. DESIGN Retrospective cohort study. PARTICIPANTS Black and White patients enrolled in the VA with incident AF from 2020 through 2021. MAIN MEASURES The primary outcome was rate of any anticoagulant initiation (i.e., warfarin or direct oral anticoagulant [DOAC]) or any DOAC therapy within 90 days of an AF diagnosis, overall and for Black and White patients at each facility. We also estimated the adjusted Black-White risk difference. KEY RESULTS In 82 VA facilities serving 26,832 Black and White patients, overall unadjusted rates of any anticoagulant therapy ranged from 56.8 to 87.1% across facilities; the corresponding ranges for Black and White patients were 47.6 to 91.3% and 58.2 to 87.1%, respectively. Overall unadjusted rates of DOAC therapy ranged from 55.1 to 85.5% by facility; ranges for Black and White patients were 42.8 to 86.9% and 56.4 to 85.5%, respectively. The adjusted risk difference between Black and White patients ranged from - 29.9 (95% CI, - 54.9 to - 4.8) to 14.2 (95% CI, - 9.1 to 25.0) across facilities for any anticoagulant therapy and from - 28.8 (95% CI, - 58.3 to 0.8) to 15.0 (95% CI, - 8.0 to 38.1) for DOAC therapy. For any anticoagulant therapy there were 3 facilities where prescribing was statistically higher in White than Black patients; for DOAC therapy there were 5 such facilities. CONCLUSIONS In a national cohort of patients with AF, we observed large facility-level variation and adjusted risk differences in any anticoagulant and DOAC initiation, overall and by race. These findings represent a target for local quality improvement in AF care.
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Affiliation(s)
- Utibe R Essien
- HSRD Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA.
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
| | - Nadejda Kim
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Donna L Washington
- HSRD Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Walid F Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael J Fine
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Jones SM, Anvari S, Coleman A, Pesek RD, Kloepfer KM, Perry TT, Jefferson AA, Doan D, Andres A, Doderer M, Hilbun A, Solomon R, Scurlock AM. Food insecurity and allergic diseases: A call to collective action. J Allergy Clin Immunol 2024; 153:359-367. [PMID: 37926122 DOI: 10.1016/j.jaci.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
Food security encompassess the concept of access by all people at all times to enough food for an active, healthy life. Conversely, food insecurity (FI) refers to household-level economic and social conditions of limited or uncertain access to adequate food. FI is a key social determinant of health that can negatively affect nutrition and health outcomes, as it is estimated that 10.2% of the US population meets criteria for FI. Recognizing the impact of FI on our patients and families is critical to promote health equity and optimize health outcomes. This review focuses on FI and allergic disease from the perspective of key multisector stakeholders within the field of allergy and immunology as well as from the larger health care arena, highlighting key resources and initiatives important to patients. Collectively, as specialists in allergy and immunology, and within the medical field more broadly, we must leverage our unique roles as we interface with patients and families and serve as committed advocates for change. Developing innovative strategies to promote health equity can provide a pathway forward for all children, adults, and families to gain access to healthy, nutritious food as part of their routine lifestyle. This is a call to action.
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Affiliation(s)
- Stacie M Jones
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark.
| | - Sara Anvari
- Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Amaziah Coleman
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Robert D Pesek
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Kirsten M Kloepfer
- Indiana University School of Medicine and Riley Children's Hospital at IU Health, Indianapolis, Ind
| | - Tamara T Perry
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Akilah A Jefferson
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Dieu Doan
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Aline Andres
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Nutrition Center, Little Rock, Ark
| | - Marcy Doderer
- Arkansas Children's Hospital, Little Rock, Ark; Arkansas Children's Health System, Little Rock, Ark
| | - Ashlie Hilbun
- Arkansas Children's Hospital, Little Rock, Ark; Arkansas Children's Health System, Little Rock, Ark
| | - Ryan Solomon
- Arkansas Children's Hospital, Little Rock, Ark; Arkansas Children's Health System, Little Rock, Ark
| | - Amy M Scurlock
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
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234
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Vrudhula A, Kwan AC, Ouyang D, Cheng S. Machine Learning and Bias in Medical Imaging: Opportunities and Challenges. Circ Cardiovasc Imaging 2024; 17:e015495. [PMID: 38377237 PMCID: PMC10883605 DOI: 10.1161/circimaging.123.015495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Bias in health care has been well documented and results in disparate and worsened outcomes for at-risk groups. Medical imaging plays a critical role in facilitating patient diagnoses but involves multiple sources of bias including factors related to access to imaging modalities, acquisition of images, and assessment (ie, interpretation) of imaging data. Machine learning (ML) applied to diagnostic imaging has demonstrated the potential to improve the quality of imaging-based diagnosis and the precision of measuring imaging-based traits. Algorithms can leverage subtle information not visible to the human eye to detect underdiagnosed conditions or derive new disease phenotypes by linking imaging features with clinical outcomes, all while mitigating cognitive bias in interpretation. Importantly, however, the application of ML to diagnostic imaging has the potential to either reduce or propagate bias. Understanding the potential gain as well as the potential risks requires an understanding of how and what ML models learn. Common risks of propagating bias can arise from unbalanced training, suboptimal architecture design or selection, and uneven application of models. Notwithstanding these risks, ML may yet be applied to improve gain from imaging across all 3A's (access, acquisition, and assessment) for all patients. In this review, we present a framework for understanding the balance of opportunities and challenges for minimizing bias in medical imaging, how ML may improve current approaches to imaging, and what specific design considerations should be made as part of efforts to maximize the quality of health care for all.
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Affiliation(s)
- Amey Vrudhula
- Icahn School of Medicine at Mount Sinai, New York
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center
| | - Alan C Kwan
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center
| | - David Ouyang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center
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235
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Pottorff A, Liu E, Du M, Catacora A, Rosen R, McSweeney M. Assessment of families' experience with care integration within an aerodigestive program. J Pediatr Gastroenterol Nutr 2024; 78:223-230. [PMID: 38374563 DOI: 10.1002/jpn3.12108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVES The objective of this study was to assess if enrollment in a pediatric multidisciplinary aerodigestive program significantly impacted families' experiences with care integration. METHODS A previously validated 48-question Pediatric Integrated Care Survey (PICS) was administered in a cross-sectional manner to both new (new-ADC) and established (est-ADC) patients presenting for an outpatient Aerodigestive Center visit at Boston Children's Hospital. Survey results were grouped into the following five care coordination domains: (1) access to care, (2) care goal creation/planning, (3) family impact, (4) communication with health care providers, and (5) team functioning. Families were asked to rate their care integration experiences in the prior 12 months using yes/no and Likert-based questions. Comparisons were analyzed using logistic regression. Factor analysis was also performed. RESULTS Ninety patient families were surveyed: 54 (60%) est-ADC patients and 36 (40%) new-ADC patients. Est-ADC patients reported higher levels of experience with team functioning, provider awareness of prior testing, provider communication, and access to alternative methods of communication. Self-identified non-White patients reported lower satisfaction in team functioning and provider understanding of their child's long-term care plan. No significant differences in care integration experiences before and after the onset of the coronavirus pandemic were seen. CONCLUSIONS Patients enrolled in aerodigestive centers experienced improved care integration, most significantly in provider communication and team functioning. Despite these improvements, self-identified non-White families reported a lower care integration experience.
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Affiliation(s)
- Alexandra Pottorff
- Division of Gastroenterology, Hepatology and Nutrition, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maritha Du
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Andrea Catacora
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rachel Rosen
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maireade McSweeney
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
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236
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Rao BR, Dickert NW, Morris AA. Ethical Complexity of Medical Treatment Affordability and Clinical Trial Diversity in Heart Failure. Circ Cardiovasc Qual Outcomes 2024; 17:e010227. [PMID: 38377226 DOI: 10.1161/circoutcomes.123.010227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Birju R Rao
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (B.R.R., N.W.D., A.A.M.)
| | - Neal W Dickert
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (B.R.R., N.W.D., A.A.M.)
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (N.W.D.)
| | - Alanna A Morris
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (B.R.R., N.W.D., A.A.M.)
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237
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Iyamu I, McKee G, Haag D, Gilbert M. Defining the role of digital public health in the evolving digital health landscape: policy and practice implications in Canada. Health Promot Chronic Dis Prev Can 2024; 44:66-69. [PMID: 38353941 PMCID: PMC11013030 DOI: 10.24095/hpcdp.44.2.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
In this article, we argue that current digital health strategies across Canada do not appropriately consider the implications of digital technologies (DTs) for public health functions because they adopt a primarily clinical focus. We highlight differences between clinical medicine and public health, suggesting that conceptualizing digital public health (DPH) as a field distinct from, but related to, digital health is essential for the development of DTs in public health. Focussing on DPH may allow for DTs that deeply consider fundamental public health principles of health equity, social justice and action on the social and ecological determinants of health. Moreover, the digital transformation of health services catalyzed by the COVID-19 pandemic and changing public expectations about the speed and convenience of public health services necessitate a specific DPH focus. This imperative is reinforced by the need to address the growing role of DTs as determinants of health that influence health behaviours and outcomes. Making the distinction between DPH and digital health will require more specific DPH strategies that are aligned with emergent digital strategies across Canada, development of intersectoral transdisciplinary partnerships and updated competencies of the public health workforce to ensure that DTs in public health can improve health outcomes for all Canadians.
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Affiliation(s)
- Ihoghosa Iyamu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Geoffrey McKee
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Devon Haag
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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238
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Johnson DN, Patel S, Howard ED, Bowley MR. Critical Changes in the Maternal Health Landscape: Community Care, Doulas, and Coverage. Nurs Womens Health 2024; 28:23-29. [PMID: 38206238 DOI: 10.1016/j.nwh.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/21/2023] [Accepted: 11/05/2023] [Indexed: 01/12/2024]
Abstract
In this commentary, we present an overview of the accelerating trend toward community-based models for pregnancy care. Doula services, as part of community care programs, are the major target for new coverage changes. Obstetric professionals who include community care providers in their treatment plans can benefit from these local resources in the prenatal, birthing, and postpartum stages of patient management. Including community care programs may help achieve goals of improving health outcomes and health equity.
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239
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Stadelman-Behar AM, Cahill ME, Newell K, Sievers M, Gehre M, Carter KK, Sosin DM, Torrone EA. Effects of Rurality on Distance and Time Traveled to Receive Vaccination Against Mpox-New Mexico and Idaho 2022-2023. Sex Transm Dis 2024; 51:102-104. [PMID: 37977191 PMCID: PMC10843776 DOI: 10.1097/olq.0000000000001904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
ABSTRACT We compared mpox vaccination access between urban and rural residents who received ≥1 JYNNEOS dose using immunization data in Idaho and New Mexico. Rural residents traveled 5 times farther and 3 times longer than urban residents to receive mpox vaccination. Increasing mpox vaccine availability to health care facilities might increase uptake.
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Affiliation(s)
- Anna M. Stadelman-Behar
- Epidemic Intelligence Service, Division of Workforce Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemiology Response Division, New Mexico Department of Health, Santa Fe, New Mexico, USA
| | - Megan E. Cahill
- Epidemic Intelligence Service, Division of Workforce Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of Public Health, Idaho Department of Health and Welfare, Boise, Idaho, USA
| | - Katherine Newell
- Epidemic Intelligence Service, Division of Workforce Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marla Sievers
- Epidemiology Response Division, New Mexico Department of Health, Santa Fe, New Mexico, USA
| | - Mika Gehre
- Epidemiology Response Division, New Mexico Department of Health, Santa Fe, New Mexico, USA
| | - Kris K. Carter
- Division of Public Health, Idaho Department of Health and Welfare, Boise, Idaho, USA
- Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel M. Sosin
- Epidemiology Response Division, New Mexico Department of Health, Santa Fe, New Mexico, USA
| | - Elizabeth A. Torrone
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD & TB Prevention, Atlanta, GA, USA
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240
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Lemon ED, Mera Nieto KS, Serrano Laguna LY, Flores YA, Niño-Suastegui M, Peraza Campos J, Fuentes V, Lozada K, Ling A, Woods-Jaeger B. "I Can Never Feel Safe": Latinx Youth Voices on Psychosocial Impacts of 287(g) in Georgia. Health Educ Behav 2024; 51:71-81. [PMID: 37675769 DOI: 10.1177/10901981231193695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Increasingly, immigration policies are understood as structural determinants, rooted in racism, nativism, and ethnocentrism, which raise serious public health concerns for Latinx adolescents' mental health. Our objective was to examine how immigration policy enforcement affects mental health of Latinx youth raised in a county with an aggressive interior immigration enforcement program. From 2009 to 2021, Gwinnett County, GA, led the nation in deportations under the 287(g) program as a "universal enforcement model," where local law enforcement were deputized to detain undocumented immigrants, primarily through traffic violations. From June to July 2022, we followed a participatory action research approach with two groups of Latinx youth who grew up in Gwinnett County. In total, 10 youth took photos related to the research question, and engaged in facilitated dialogue using photovoice guide SHOWED/VENCER for four, 2-hour sessions that were audio-recorded and transcribed. Transcripts were analyzed following grounded theory principles to arrive at a conceptual model codeveloped and validated by youth. Youth described how 287(g) led to policing and deportation in their communities, fueling stereotypes, and discrimination that criminalized Latinx immigrants. Youth linked immigration enforcement policies like 287(g) to exclusionary systems that contributed to fear, marginalization, and loss in their communities, bringing experiences of sadness, grief, isolation, hopelessness, and low self-worth. From youth-driven research, we identified mental health implications of the 287(g) program among Latinx youth. The cascading harms of immigration enforcement policies highlight the need to address these policies and identify immediate strategies to promote Latinx youth mental health.
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Abstract
OBJECTIVE To explore how Accountable Communities of/for Health (ACHs), a type of health-focused multisector collaborative, are developing strategies to address health equity with diverse partners. DATA SOURCES AND STUDY SETTING Interview and focus group participants were recruited from a purposive sample of 22 ACH participant organizations in Washington (n = 9 ACHs) and California (n = 13 ACH). STUDY DESIGN Interview and focus group data were thematized using constant comparison analysis. DATA COLLECTION Interviews were conducted to learn how each ACH's system context, collaboration processes, and goals influence its progress toward health equity. Focus groups were conducted to gain a deeper understanding of how local context and power dynamics influence an ACH's ability to make progress toward health equity. There were 22 focus group participants and 65 interview participants. PRINCIPAL FINDINGS Results indicate that ACHs advance health equity across the social-ecological spectrum of health with approaches targeting the individual, community, and societal levels. Specific approaches used by ACHs to collaboratively address health equity include providing equity education to participating organizations and community groups; including diverse community voices in collaborative decision-making; changing practices in their participant's daily operations; improving existing services and developing new services; and actively promoting a culture of keeping equity at the center of ACH efforts. CONCLUSIONS This study identifies strategies for advancing health equity in multisector collaboratives. ACHs in Washington and California are devoting resources to ensure health equity is central to their work. The numerous approaches ACHs use to advance health equity are important to ensure everyone can reach their full health potential. While current literature argues that multisector health initiatives are integral for advancing health equity, there is a lack of research on how these initiatives advance equity in practice. Thus, this paper provides generalizable strategies that can be further investigated to optimize progress toward health equity.
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Affiliation(s)
- Stephanie Bultema
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
| | - Kendra Piper
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
| | - Esmeralda Salas
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
| | - Peter Forberg
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
| | - Sue Grinnell
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
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242
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Chou FL, Donovan DJ, Weller RJ, Fremed MA, Glickstein JS, Krishnan US. Disparities in resource utilisation by families of children with cardiac conditions. Cardiol Young 2024; 34:325-333. [PMID: 37415565 DOI: 10.1017/s1047951123001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
OBJECTIVES There are limited data documenting sources of medical information that families use to learn about paediatric cardiac conditions. Our study aims to characterise these resources and to identify any disparities in resource utilisation. We hypothesise there are significant variations in the resources utilised by families from different educational and socio-economic backgrounds. METHODS A survey evaluating what resources families use (websites, healthcare professionals, social media, etc.) to better understand paediatric cardiac conditions was administered to caretakers and paediatric patients at Morgan Stanley Children's Hospital. Patients with a prior diagnosis of CHD, cardiac arrhythmia, and/or heart failure were included. Caretakers' levels of education (fewer than 16 years vs. 16 years or more) and patients' medical insurance types (public vs. private) were compared with regard to the utilisation of resources. RESULTS Surveys completed by 137 (91%) caretakers and 27 (90%) patients were analysed. Websites were utilised by 72% of caretakers and 56% of patients. Both private insurance and higher education were associated with greater reported utilisation of websites, healthcare professionals, and personal networks (by insurance p = 0.009, p = 0.001, p = 0.006; by education p = 0.022, p < 0.001, p = 0.018). They were also more likely to report use of electronic devices (such as a computer) compared to those with public medical insurance and fewer than 16 years of education (p < 0.001, p < 0.001, respectively). CONCLUSION Both levels of education and insurance status are associated with the utilisation of informative resources and digital devices by families seeking to learn more about cardiac conditions in children.
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Affiliation(s)
- Francisca L Chou
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Denis J Donovan
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel J Weller
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael A Fremed
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Julie S Glickstein
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Usha S Krishnan
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
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Scanzera AC, Kravets S, Hallak JA, Musick H, Krishnan JA, Chan RP, Kim SJ. Evaluating the Relationship between Neighborhood-Level Social Vulnerability and Patient Adherence to Ophthalmology Appointments. Ophthalmic Epidemiol 2024; 31:11-20. [PMID: 36820490 PMCID: PMC10444903 DOI: 10.1080/09286586.2023.2180806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/28/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To examine the association between neighborhood-level social vulnerability and adherence to scheduled ophthalmology appointments. METHODS In this retrospective cohort study, records of all patients ≥18 years scheduled for an ophthalmology appointment between September 12, 2020, and February 8, 2021, were reviewed. Primary exposure is neighborhood-level Social Vulnerability Index (SVI) based on the patient's residential location. SVI is a rank score of 15 social factors into four themes (socioeconomic status, household composition/disability, minority status/language, and housing type/transportation), ranging from 0 to 1.0, with higher ranks indicating greater social vulnerability. The overall SVI score and each theme were analyzed separately as the primary exposure of interest in multivariable logistic regression models that controlled for age, sex, appointment status (new or established), race, and distance from clinic. The primary outcome, non-adherence, was defined as missing more than 25% of scheduled appointments. RESULTS Of 8,322 patients (41% non-Hispanic Black, 24% Hispanic, 22% non-Hispanic White) with scheduled appointments, 28% were non-adherent. Non-adherence was associated with greater social vulnerability (adjusted odds ratio [aOR] per 0.01 increase in overall SVI = 2.46 [95% confidence interval, 1.99, 3.06]) and each SVI theme (socioeconomic status: aOR = 2.38 [1.94, 2.91]; household composition/disability: aOR = = 1.51 [1.26, 1.81]; minority status/language: aOR = 2.03 [1.55, 2.68]; housing type/transportation: aOR = 1.41 [1.16, 1.73]). CONCLUSION Neighborhood-level social vulnerability is associated with greater risk of non-adherence to scheduled ophthalmology appointments, controlling for individual characteristics. Multi-level intervention strategies that incorporate neighborhood-level vulnerabilities are needed to reduce disparities in access to ophthalmology care.
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Affiliation(s)
- Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, 1855 W. Taylor Street, Chicago, IL 60612, United States
| | - Sasha Kravets
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, 1855 W. Taylor Street, Chicago, IL 60612, United States
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, Chicago, IL 60612, United States
| | - Joelle A. Hallak
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, 1855 W. Taylor Street, Chicago, IL 60612, United States
| | - Hugh Musick
- Institute for Healthcare Delivery Design, Population Health Sciences Program, University of Illinois Chicago, 1220 S. Wood Street, Chicago, IL 60657, United States
| | - Jerry A. Krishnan
- Institute for Healthcare Delivery Design, Population Health Sciences Program, University of Illinois Chicago, 1220 S. Wood Street, Chicago, IL 60657, United States
| | - R.V. Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, 1855 W. Taylor Street, Chicago, IL 60612, United States
| | - Sage J. Kim
- Division of Health Policy & Administration, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, Chicago, IL 60612, United States
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244
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Jansen JP, Brewer IP, Chung S, Sullivan P, Espinosa OD, Grossman JP. The Health Inequality Impact of a New Cancer Therapy Given Treatment and Disease Characteristics. Value Health 2024; 27:143-152. [PMID: 37952840 DOI: 10.1016/j.jval.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 10/02/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES This study aimed to perform a simulation study to quantify the health inequality impact of a cancer therapy given cancer and treatment characteristics using the distributional cost-effectiveness framework. METHODS The following factors were varied in 10 000 simulations: lifetime risk of the disease, median overall survival (OS) with standard of care (SOC), difference in OS between non-Hispanic (NH)-Black and NH-White patients (prognostic effect), treatment effect of the new therapy relative to SOC, whether the treatment effect differs between NH-Black and NH-White patients (effect modification), health utility, drug costs, and preprogression and postprogression costs. Based on these characteristics, the incremental population net health benefits were calculated for the new therapy and applied to a US distribution of quality-adjusted life expectancy at birth. The health inequality impact was quantified as the difference in the degree of inequality in the "post-new therapy" versus "pre-new therapy" quality-adjusted life expectancy distributions. RESULTS For cancer types characterized by relatively large lifetime risk, large median OS with SOC, large treatment effect, and large effect modification, the direction of the impact of the new therapy on inequality is easy to predict. When effect modification is minor or absent, which is a realistic scenario, the direction of the inequality impact is difficult to predict. Larger incremental drug costs have a worsening effect on health inequality. CONCLUSIONS The findings provide a guide to help decision makers and other stakeholders make an initial assessment whether a new therapy with known treatment effects for a specific tumor type can have a positive or negative health inequality impact.
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Kalbaugh CA, Witrick B, Howard KA, Sivaraj LB, McGinigle KL, Robinson WP, Cykert S, Hicks CW, Lesko CR. Investigating the impact of suboptimal prescription of preoperative antiplatelets and statins on race and ethnicity-related disparities in major limb amputation. Vasc Med 2024; 29:17-25. [PMID: 37737127 PMCID: PMC10922837 DOI: 10.1177/1358863x231196139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Non-Hispanic Black and Hispanic patients with symptomatic PAD may receive different treatments than White patients with symptomatic PAD. The delivery of guideline-directed medical treatment may be a modifiable upstream driver of race and ethnicity-related disparities in outcomes such as limb amputation. The purpose of our study was to investigate the prescription of preoperative antiplatelets and statins in producing disparities in the risk of amputation following revascularization for symptomatic peripheral artery disease (PAD). METHODS We used data from the Vascular Quality Initiative, a vascular procedure-based registry in the United States (2011-2018). We estimated the probability of preoperative antiplatelet and statin prescriptions and 1-year incidence of amputation. We then estimated the amputation risk difference between race/ethnicity groups that could be eliminated under a hypothetical intervention. RESULTS Across 100,579 revascularizations, the 1-year amputation risk was 2.5% (2.4%, 2.6%) in White patients, 5.3% (4.9%, 5.6%) in Black patients, and 5.3% (4.7%, 5.9%) in Hispanic patients. Black (57.5%) and Hispanic patients (58.7%) were only slightly less likely than White patients (60.9%) to receive antiplatelet and statin therapy. However, the effect of antiplatelets and statins was greater in Black and Hispanic patients such that, had all patients received these medications, the estimated risk difference comparing Black to White patients would have reduced by 8.9% (-2.9%, 21.9%) and the risk difference comparing Hispanic to White patients would have been reduced by 17.6% (-0.7%, 38.6%). CONCLUSION Even though guideline-directed care appeared evenly distributed by race/ethnicity, increasing access to such care may decrease health care disparities in major limb amputation.
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Affiliation(s)
- Corey A Kalbaugh
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Brian Witrick
- West Virginia Clinical and Translational Sciences Institute, Morgantown, WV, USA
| | - Kerry A Howard
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
- Center for Public Health Modeling and Response, Clemson University, Clemson, SC, USA
| | | | - Katharine L McGinigle
- Department of Surgery, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William P Robinson
- Division of Vascular Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Samuel Cykert
- Division of General Medicine and Clinical Epidemiology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caitlin W Hicks
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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246
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Thompson HM, Wang TM, Talan AJ, Baker KE, Restar AJ. First They Came for Us All: Responding to Anti-Transgender Structural Violence With Collective, Community-Engaged, and Intersectional Health Equity Research and Advocacy. Health Educ Behav 2024; 51:5-9. [PMID: 37746726 DOI: 10.1177/10901981231201146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
This article is a call for collective action across health equity researchers and advocates to build a more just world. We attempt to make sense of senseless structural and interpersonal brutality in the context of the current political climate across the United States, whereby the spectrum of gender nonconformity has been and continues to be stigmatized. From drag performance to transgender identities to gender-affirming health care, extremists have instrumentalized primary levers of democracy-the courts, legislatures, and social media-to attempt to outlaw and eradicate gender expansiveness and those who provide forms of support and care, including gender-affirming medical care, to transgender, nonbinary, and gender-expansive (TNBGE) individuals.
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Affiliation(s)
| | | | - Ali J Talan
- Whitman-Walker Institute, Washington, DC, USA
| | | | - Arjee J Restar
- School of Public Health, University of Washington, Seattle, WA, USA
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247
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Matthias MS, Bolla AL, Bair SM, Adams J, Eliacin J, Burgess DJ, Hirsh AT. Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE): a Qualitative Analysis of a Tailored Coaching Program for Black Patients with Chronic Pain. J Gen Intern Med 2024; 39:222-228. [PMID: 37726645 PMCID: PMC10853119 DOI: 10.1007/s11606-023-08410-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Racial inequities in pain treatment are well-documented and persist despite national priorities focused on health equity. The COOPERATE (Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity) intervention was a patient-centered, tailored intervention aimed at improving health equity by targeting patient activation-the knowledge and confidence to manage one's health. COOPERATE led to significant and sustained increases in patient activation, significant short-term increases in communication self-efficacy (confidence to communicate with clinicians), and more intervention participants experienced clinically significant (≥ 30%) reductions in pain at 3 months than control group participants. OBJECTIVE To understand how participants experienced the intervention, including their perspectives on its effects on their health and healthcare experiences. DESIGN Semi-structured qualitative interviews. PARTICIPANTS Black veterans with chronic pain who participated in the COOPERATE intervention. KEY RESULTS Participants described acquiring new tools and cultivating skills to use in their clinic visits, including preparing for their visit (writing an agenda, listing questions); asking focused, effective questions; and expressing concerns and communicating goals, values, and preferences. Participants indicated that by putting these tools to use, they felt more confident and able to take ownership of their own pain care; for some, this led to better pain management and improved pain. Participants expressed mixed views of disparities in pain care, with some believing race and racism did not play a role in their care, while others valued being part of an intervention that helped equip them with tools to exercise autonomy over their healthcare. CONCLUSIONS Black patients with chronic pain described gaining greater confidence to self-manage and communicate with their clinicians after participating in the COOPERATE intervention. With its focus on empowering individuals, the COOPERATE intervention represents a promising approach to help advance equity in pain care.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, USA.
- Regenstrief Institute, Indianapolis, USA.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
| | - Arya L Bolla
- Regenstrief Institute, Indianapolis, USA
- Indiana University School of Medicine, Indianapolis, USA
| | | | - Jasma Adams
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, USA
| | - Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, USA
- Regenstrief Institute, Indianapolis, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, USA
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, USA
- Department of Medicine, University of Minnesota, Minneapolis, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University, Indianapolis, USA
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248
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Zaidi M, Fantasia HC, Penders R, Koren A, Enah C. Increasing U.S. Maternal Health Equity Among Immigrant Populations Through Community Engagement. Nurs Womens Health 2024; 28:11-22. [PMID: 38072010 DOI: 10.1016/j.nwh.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 01/09/2024]
Abstract
Immigrant women in the United States are at an elevated risk of poor maternal health outcomes due to cultural, linguistic, or socioeconomic barriers that may lead to critical delays in obtaining adequate health care. Ensuring access to high-quality, culturally appropriate perinatal health care is crucial to improve the health and well-being of immigrant mothers and their children. Various aspects of perinatal health care for immigrant women can be improved through community engagement strategies. Barriers can be addressed by involving community members in designing and delivering culturally appropriate maternal health services. Some strategies discussed in this commentary include working with community health workers, encouraging telehealth through community health workers, providing breastfeeding and mental health support within cultural norms, and involving community-based doulas and midwives.
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249
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Krissberg JR, Verghese PS. Kidney paired donation. Pediatr Transplant 2024; 28:e14667. [PMID: 38054539 DOI: 10.1111/petr.14667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Jill R Krissberg
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Division of Nephrology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Priya S Verghese
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Division of Nephrology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Aldabbour B, Abu Sidgh O, Haboush I, Jalhum E, Alsmary S, Irheem S, Elamassie S, Zimmo M, Asad MD. Factors limiting women's adherence to venous thromboembolism prophylaxis after cesarean section in the Gaza Strip: A cross-sectional study. Phlebology 2024; 39:29-36. [PMID: 37846865 DOI: 10.1177/02683555231207712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
OBJECTIVES We evaluate the rates and limitations of women's adherence to low molecular weight heparin (LMWH) after cesarean section (CS) in the Gaza Strip. METHODS Women who underwent CS were recruited consecutively. Communication offered to women, adherence to Venous thromboembolism (VTE), and its limiting factors were surveyed. RESULTS 281 women participated (mean age 27.9 years). 51.95% fully adhered to VTE prophylaxis. Causes of suboptimal adherence were: 51.1% did not feel VTE prophylaxis was important, 37.8% due to high drug cost, and 11.1% didn't receive a prescription for LMWH at discharge. Poor communication was evident as 48.8% of the sample did not receive any instructions about the technical method of LMWH injection, 45.6% did not receive any information about the clinical significance of heparin, and 74.7% were unaware of LMWH side effects. CONCLUSION There is inadequate adherence to VTE prophylaxis after CS among Gaza women, mostly due to a lack of appropriate communication but also due to drug costs.
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Affiliation(s)
- Belal Aldabbour
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Ola Abu Sidgh
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Israa Haboush
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Eman Jalhum
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Shimaa Alsmary
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Sara Irheem
- Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine
| | - Samah Elamassie
- Health Services, United Nations Relief and Works Agency (UNRWA), Gaza, State of Palestine
| | - Mohammad Zimmo
- Obstetrics Department, Al-Shifa Medical Complex, Gaza, State of Palestine
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