1
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Hamed S, Bradby H, Thapar-Björkert S, Ahlberg BM. Healthcare staff's racialized talk: The perpetuation of racism in healthcare. Soc Sci Med 2024; 355:117085. [PMID: 39032198 DOI: 10.1016/j.socscimed.2024.117085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/11/2024] [Accepted: 06/28/2024] [Indexed: 07/22/2024]
Abstract
Research points to the existence of racial bias and beliefs among healthcare staff but does not explicate accounts of racialization in healthcare and the day-to-day utterances that have racializing effects excluding minoritized users' right to care. This study understands racism as structural and embedded in societies and institutions, including healthcare, as well as in interactions and talk. Through excavating accounts of healthcare staff's talk that devalues minoritized users, this study posits talk as reflective and constitutive of the dominant structure of racism within which it is situated. Drawing on qualitative interviews with 58 staff in Sweden, the study delineates three categories through which racialized talk differentiates between minoritized and majoritized users. These are: Characterizing minoritized users as 'bad' users, Characterizing minoritized users' health complaints as unworthy and finally, Devaluing minoritized users as justification for suboptimal and differential care. Healthcare staff accounts show that continuous racialization of minoritized users maintains existing power-relations representing Western users as civilized and non-Western users as uncivilized and problematic. Through reiteration, these practices of exclusion become invisible, normalized, and assume the status quo. It is imperative to address racialization as it has implications for the core ethics of healthcare.
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Affiliation(s)
- Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden; Department of Ethnology, History of Religion and Gender Studies, Stockholm University, Stockholm, Sweden.
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | | | - Beth Maina Ahlberg
- Department of Sociology, Uppsala University, Uppsala, Sweden; Skaraborg Institute for Research and Development, Skövde, Sweden
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2
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Tice-Brown D, Kelly P, Heyman JC, Phipps C, White-Ryan L, Davis HJ. Older adults' perceptions of ageism, discrimination, and racism. SOCIAL WORK IN HEALTH CARE 2024:1-18. [PMID: 38899560 DOI: 10.1080/00981389.2024.2365136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/03/2024] [Indexed: 06/21/2024]
Abstract
Older adults often experience different forms of discrimination, whether it be on the basis of their age, gender, race, or ethnicity (Rochon et al. 2021). Many older adults have stated they have experienced the health care system differently because of their race or ethnicity . Understanding older adults' experiences and their perceptions of ageism and racism can guide future work. This observational cross-sectional study captured community-dwelling older adults' perceptions about their experiences with ageism and racism. A few opened-ended questions were included in the cross-sectional survey. While results did not yield differences with respect to perceptions of ageism by race; there were statistically significant results in regard to perceived racism, with higher scores on the racism scales for individuals who self-identified as Black. Discussion and implications for practice, policy and research are explored.
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Affiliation(s)
- Derek Tice-Brown
- Graduate School of Social Service, Fordham University, New York, USA
| | - Peggy Kelly
- Graduate School of Social Service, Fordham University, New York, USA
| | - Janna C Heyman
- Graduate School of Social Service, Fordham University, New York, USA
| | - Colette Phipps
- Program Development, Westchester County Department of Senior Programs and Services, Mount Vernon, USA
| | - Linda White-Ryan
- Graduate School of Social Service, Fordham University, New York, USA
| | - Henry J Davis
- Programs, Research, and Evaluation, Graduate School of Social Service, New York, USA
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3
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Plamondon KM, Shahram SZ. Defining equity, its determinants, and the foundations of equity science. Soc Sci Med 2024; 351:116940. [PMID: 38761454 DOI: 10.1016/j.socscimed.2024.116940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/23/2024] [Accepted: 05/01/2024] [Indexed: 05/20/2024]
Abstract
Advancing equity as a priority is increasingly declared in response to decades of evidence showing the association between poorer health outcomes and the unfair distribution of resources, power, and wealth across all levels of society. Quandries present, however, through incongruence, vagueness and disparate interpretations of the meaning of equity dilute and fragment efforts across research, policy and practice. Progress on reducing health inequities is, in this context, unsurprisingly irresolute. In this article, we make a case for equity science that reimagines the ways in which we (as researchers, as systems leaders, as teachers and mentors, and as citizens in society) engage in this work. We offer a definition of equity, its determinants, and the paradigmatic foundations of equity science, including the assumptions, values, and processes., and methods of this science. We argue for an equity science that can more meaningfully promote coherent alignment between intention, knowledge and action within and beyond the health sciences to spark a more equitable future.
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Affiliation(s)
- Katrina M Plamondon
- Equity Science Lab, Faculty of Health & Social Development, School of Nursing, University of British Columbia, ART360, 1147 Research Road, Kelowna, BC, Canada.
| | - Sana Z Shahram
- Equity Science Lab, Faculty of Health & Social Development, School of Nursing, University of British Columbia, ART360, 1147 Research Road, Kelowna, BC, Canada.
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4
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Rockhold MN, Gimbel BA, Richardson AA, Kautz-Turnbull C, Speybroeck EL, de Water E, Myers J, Hargrove E, May M, Abdi SS, Petrenko CLM. Racial and ethnic disparities in psychological care for individuals with FASD: a dis/ability studies and critical race theory perspective toward improving prevention, assessment/diagnosis, and intervention. Front Public Health 2024; 12:1355802. [PMID: 38544727 PMCID: PMC10965703 DOI: 10.3389/fpubh.2024.1355802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/16/2024] [Indexed: 05/14/2024] Open
Abstract
Fetal alcohol spectrum disorders (FASD) are among the most common neurodevelopmental disorders and substantially impact public health. FASD can affect people of all races and ethnicities; however, there are important racial and ethnic disparities in alcohol-exposed pregnancy prevention, assessment and diagnosis of FASD, and interventions to support individuals with FASD and their families. In this article we use the Dis/Ability Studies and Critical Race Theory (Dis/Crit) framework to structure the exploration of disparities and possible solutions within these three areas (prevention, diagnosis, intervention). Dis/Crit provides a guide to understanding the intersection of dis/ability and race, while framing both as social constructs. Following the Dis/Crit framework, the systemic, historical, and contemporary racism and ableism present in psychological care is further discussed. We aim to elucidate these racial and ethnic disparities within the fields of psychology and neuropsychology through the Dis/Crit framework and provide potential points of action to reduce these disparities.
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Affiliation(s)
| | - Blake A. Gimbel
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | | | | | - Emily L. Speybroeck
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States
| | - Erik de Water
- Great Lakes Neurobehavioral Center, Edina, MN, United States
| | - Julianne Myers
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States
| | - Emily Hargrove
- International Adult Leadership Collaborative of FASD Changemakers
| | - Maggie May
- International Adult Leadership Collaborative of FASD Changemakers
| | - Samia S. Abdi
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, United States
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5
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Vereen RJ, Wolf MF. Physician Workforce Diversity Is Still Necessary and Achievable if It Is Intentionally Prioritized. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01953-x. [PMID: 38466513 DOI: 10.1007/s40615-024-01953-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/13/2024]
Abstract
The 2023 Supreme Court Decision from Students for Fair Admissions v. Harvard and Students for Fair Admissions v. University of North Carolina threatens the current progress in achieving diversity within undergraduate and graduate medical education. This is necessary to achieve a diverse healthcare workforce, which is a key to healing historical healthcare trauma, eliminating health disparities, and providing equitable healthcare access for all communities. Although the Supreme Court decision seems obstructionist, viable opportunities exist to enhance recruitment further and solidify diversity efforts in undergraduate and graduate medical education to achieve these goals.
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Affiliation(s)
- Rasheda J Vereen
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Uniformed Services University, Carl R. Darnall Army Medical Center, Fort Cavazos, TX, USA.
| | - Mattie F Wolf
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Emory University School of Medicine & Children's Healthcare of Atlanta, Atlanta, GA, USA
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6
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Mays EJ, Diggs S, Vesoulis ZA, Warner B. The Effects of Health Disparities on Neonatal Outcomes. Crit Care Nurs Clin North Am 2024; 36:11-22. [PMID: 38296368 DOI: 10.1016/j.cnc.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The history of racism in the United States was established with slavery, and the carry-over effect continues to impact health care through structural and institutional racism. Racial segregation and redlining have impacted access to quality health care, thereby impacting prematurity and infant mortality rates. Health disparities also impact neonatal morbidities such as intraventricular hemorrhage and necrotizing enterocolitis and the family care experience including the establishment of breastfeeding and health care provider interactions.
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Affiliation(s)
- Erin J Mays
- St. Louis Children's Hospital NICU, 1 Childrens Place, St Louis, MO 63110, USA.
| | - Stephanie Diggs
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 1 Childrens Place, #8116-NWT 8, St Louis, MO 63110, USA
| | - Zachary A Vesoulis
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 1 Childrens Place, #8116-NWT 8, St Louis, MO 63110, USA
| | - Barbara Warner
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 1 Childrens Place, #8116-NWT 8, St Louis, MO 63110, USA
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Negrete M, Ademiluyi A, Karayeva E, Eskridge G, Huggins M, Eskridge CM, Price BD, Bendinskas KG, Watson KS, Kim SJ. Bridging the Gap: Engaging Black Men in Lung Cancer Research Through Barbershop Collaboration. Am J Mens Health 2024; 18:15579883241229417. [PMID: 38339791 PMCID: PMC10859066 DOI: 10.1177/15579883241229417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 02/12/2024] Open
Abstract
Health disparities persist among Black men, notably in the context of lung cancer and stress-related health outcomes. This study explores these disparities through a community-based participatory research (CBPR) approach, citizen science, and social network theory, leveraging the expertise and trust of Black barbers as community leaders. The purpose is to understand the nuanced connections between stress and lung cancer in this demographic. Engaging 161 Black men across four Chicago neighborhoods, the study successfully collected hair samples and survey data, emphasizing the importance of culturally sensitive recruitment strategies. Findings highlight the effectiveness of the collaboration, showcasing the role of barbershops as community hubs for research. The study concludes by advocating for sustained partnerships with community leaders, emphasizing transparency in research communication, and promoting culturally grounded approaches to address health disparities and enhance research participation among underrepresented populations.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Karriem S. Watson
- National Institutes of Health (NIH) All of Us Research Program, Bethesda, MD, USA
| | - Sage J. Kim
- University of Illinois Chicago, Chicago, IL, USA
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8
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Hong S. Trauma-Informed Cultural Humility Mental Health Practice: Centering History among African American Women. SOCIAL WORK 2023; 69:64-72. [PMID: 38016801 DOI: 10.1093/sw/swad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 07/07/2023] [Accepted: 07/17/2023] [Indexed: 11/30/2023]
Abstract
Social work has made significant strides in providing mental health services. However, advancement in mental health practices grounded in social work values, such as trauma-informed care and cultural humility mental health practice (CHMHP), is still lacking. One possible reason is that many strategies overlook clients' historical contexts, particularly the collective history held by the community to which the client belongs. By centering "history" in social work practices, clinical social workers can be more equipped to provide high-quality, client-centered services. This article advocates for adopting trauma-informed CHMHP as a critical strategy to elevate history in clinical social work practice and proposes that trauma-informed CHMHP can improve mental health service quality among clients of color who are profoundly disrupted by historical trauma. Specifically, this article proposes that using trauma-informed CHMHP to address historical trauma can enhance mental health treatment outcomes and experiences for African American women. Clinical social workers trained to address these interconnected issues can help reduce disparities in quality treatment access.
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9
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Hayba N, Cheek C, Austin E, Testa L, Richardson L, Safi M, Ransolin N, Carrigan A, Harrison R, Francis-Auton E, Clay-Williams R. Strategies to Improve Care in the Emergency Department for Culturally and Linguistically Diverse Adults: a Systematic Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01876-z. [PMID: 38117444 DOI: 10.1007/s40615-023-01876-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The emergency department (ED) is an important gateway into the health system for people from culturally and linguistically diverse (CALD) backgrounds; their experience in the ED is likely to impact the way they access care in the future. Our review aimed to describe interventions used to improve ED health care delivery for adults from a CALD background. METHODS An electronic search of four databases was conducted to identify empirical studies that reported interventions with a primary focus of improving ED care for CALD adults (aged ≥ 18 years), with measures relating to ED system performance, patient outcomes, patient experience, or staff experience. Studies published from inception to November 2022 were included. We excluded non-empirical studies, studies where an intervention was not provided in ED, papers where the full text was unavailable, or papers published in a language other than English. The intervention strategies were categorised thematically, and measures were tabulated. RESULTS Following the screening of 3654 abstracts, 89 articles underwent full text review; 16 articles met the inclusion criteria. Four clear strategies for targeting action tailored to the CALD population of interest were identified: improving self-management of health issues, improving communication between patients and providers, adhering to good clinical practice, and building health workforce capacity. CONCLUSIONS The four strategies identified provide a useful framework for targeted action tailored to the population and outcome of interest. These detailed examples show how intervention design must consider intersecting socio-economic barriers, so as not to perpetuate existing disparity. REGISTRATION PROSPERO registration number: CRD42022379584.
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Affiliation(s)
- Nematullah Hayba
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Colleen Cheek
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia.
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Lieke Richardson
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Mariam Safi
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Internal Medicine Research Unit, Department of Regional Health Research, University Hospital of Southern Denmark, Aabenraa, University of Southern Denmark, Odense, Denmark
| | - Natália Ransolin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Robyn Clay-Williams
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
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10
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Jindal M, Chaiyachati KH, Fung V, Manson SM, Mortensen K. Eliminating health care inequities through strengthening access to care. Health Serv Res 2023; 58 Suppl 3:300-310. [PMID: 38015865 PMCID: PMC10684044 DOI: 10.1111/1475-6773.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To provide a research agenda and recommendations to address inequities in access to health care. DATA SOURCES AND STUDY SETTING The Agency for Healthcare Research and Quality (AHRQ) organized a Health Equity Summit in July 2022 to evaluate what equity in access to health care means in the context of AHRQ's mission and health care delivery implementation portfolio. The findings are a result of this Summit, and subsequent convenings of experts on access and equity from academia, industry, and the government. STUDY DESIGN Multi-stakeholder input from AHRQ's Health Equity Summit, author consensus on a framework and key knowledge gaps, and summary of evidence from the supporting literature in the context of the framework ensure comprehensive recommendations. DATA COLLECTION/EXTRACTION METHODS Through a stakeholder-engaged process, themes were developed to conceptualize access with a lens toward health equity. A working group researched the most appropriate framework for access to care to classify limitations identified during the Summit and develop recommendations supported by research in the context of the framework. This strategy was intentional, as the literature on inequities in access to care may itself be biased. PRINCIPAL FINDINGS The Levesque et al. framework, which incorporates multiple dimensions of access (approachability, acceptability, availability, accommodation, affordability, and appropriateness), is the backdrop for framing research priorities for AHRQ. However, addressing inequities in access cannot be done without considering the roles of racism and intersectionality. Recommendations include funding research that not only measures racism within health care but also tests burgeoning anti-racist practices (e.g., co-production, provider training, holistic review, discrimination reporting, etc.), acting as a convener and thought leader in synthesizing best practices to mitigate racism, and forging the path forward for research on equity and access. CONCLUSIONS AHRQ is well-positioned to develop an action plan, strategically fund it, and convene stakeholders across the health care spectrum to employ these recommendations.
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Affiliation(s)
- Monique Jindal
- Department of Academic Internal MedicineUniversity of Illinois ChicagoChicagoIllinoisUSA
| | - Krisda H. Chaiyachati
- Verily, Inc.South San FranciscoCaliforniaUSA
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Vicki Fung
- Department of Medicine, Harvard Medical School, Mongan InstituteMassachusetts General HospitalBostonMassachusettsUSA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Karoline Mortensen
- Department of Health Management and PolicyMiami Herbert Business SchoolCoral GablesFloridaUSA
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11
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Greenwald A, Kelly A, Thomas L. Trauma-informed care in the emergency department: concepts and recommendations for integrating practices into emergency medicine. MEDICAL EDUCATION ONLINE 2023; 28:2178366. [PMID: 36799730 PMCID: PMC9946309 DOI: 10.1080/10872981.2023.2178366] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/08/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
The experience of psychological trauma is common and has become even more prevalent during the COVID-19 pandemic for both health care workers and the general population [1-3]. Traumatic experiences can have varied and lasting physical and mental health effects on patients, beyond what we are privy to in the acute environment of the emergency department. The effects of these prior traumatic experiences can be exacerbated by interaction with the healthcare system, and yet emergency medicine physicians have no standardized methods for working with patients in a trauma-informed way. The systematic implementation of trauma-informed care (TIC) practice requires the cooperation of multiple domains within the health care system, including focus on the physical environment, direct care, and administrative practices. Here we provide recommendations specific to emergency medicine for the development and implementation of TIC in the regular patient-clinician interaction, situated within the context of the TIC framework as outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA) [4].
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Affiliation(s)
- Audria Greenwald
- Department of Medical Sciences, Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Amber Kelly
- Department of Medical Sciences, Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Listy Thomas
- Department of Social Work, Quinnipiac University School for Health Sciences, North Haven, CT, USA
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12
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Juarez PD. Economic Determinants of Health Disparities and the Role of the Primary Care Provider. Prim Care 2023; 50:561-577. [PMID: 37866831 DOI: 10.1016/j.pop.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
The economic determinants of adverse personal health outcomes and population level disparities pose a daunting challenge for primary care providers in promoting health for persons experiencing poverty and neighborhood deprivation. Until they are addressed, however, the health and economic well-being of persons experiencing neighborhood deprivation is not likely to be improved. There is growing evidence of effective interventions that primary care providers can adopt to address social and economic determinants of health. Primary care providers can participate in clinic and community-based approaches that target individual, neighborhood and social level drives of health and disparities.
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Affiliation(s)
- Paul D Juarez
- Department of Family & Community Medicine, Meharry Medical College, 1005 Dr. DB Todd Jr. Boulevard, Nashville, TN 37208, USA.
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13
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Delafield R, Watkins-Victorino L, Quint JJ, Freitas SM, Kamaka M, Hostetter CJ, Matagi CE, Ku T, Kaholokula JK. No Kākou, Na Kākou - For Us, By Us: Native Hawaiians and Pacific Islanders Informing Race Data Collection Standards for Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:73-76. [PMID: 37901657 PMCID: PMC10612412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
This article describes recommendations for standardized race data collection developed by the Hawai'i Native Hawaiian and Pacific Islander COVID-19 Response, Recovery, and Resilience Team (NHPI 3R Team). These recommendations attempt to address the expressed desires of Native Hawaiians and the diverse Pacific Islander communities in Hawai'i who seek greater visibility in data and research. The Native Hawaiian and Pacific Islander (NHPI) racial category is 1 of the 5 racial categories listed in the 1997 Statistical Policy Directive #15 issued by the Office of Management and Budget (OMB). The OMB directive sets the minimum standard for collection of race data in federal surveys, administrative forms, records, and other data collection. The NHPI 3R Team's recommendation provides a standard for detailed data collection that could improve smaller communities' ability to identify, advocate for, and address their own needs. The article also describes lessons learned through the collaborative and iterative process that was led by members and leaders of NHPI communities impacted by data driven decisions and policies. The NHPI 3R Team focused on expanding and standardizing race data collection as part of their COVID-19 response efforts, but implementation of the recommendations could produce benefits well beyond the pandemic.
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Affiliation(s)
- Rebecca Delafield
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (RD, MK, JKK)
| | | | | | - Sharde Mersberg Freitas
- Native Hawaiian Pacific Islander COVID-19 Response, Recovery, and Resiliency Team - Data and Research Committee, Honolulu, HI (SMF)
| | - Martina Kamaka
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (RD, MK, JKK)
| | | | | | - Tercia Ku
- Papa Ola Lōkahi, Honolulu, HI (JJQ, CEM, TK)
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14
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Carlson MS, Romo ML, Kelvin EA. Impact of the First Year of the COVID-19 on Unmet Healthcare Need among New York City Adults: a Universal Healthcare Experiment. J Urban Health 2023; 100:962-971. [PMID: 37583004 PMCID: PMC10618138 DOI: 10.1007/s11524-023-00752-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 08/17/2023]
Abstract
We examined the impact of the first year of the COVID-19 pandemic on unmet healthcare need among New Yorkers and potential differences by race/ethnicity and health insurance. Data from the Community Health Survey, collected in 2018, 2019, and 2020, were merged to compare unmet healthcare need within the past 12 months during the pandemic versus the 2 years prior to 2020. Univariate and multivariable logistic regression models evaluated change in unmet healthcare need overall, and we assessed whether race/ethnicity or health insurance status modified the association. Overall, 12% of New Yorkers (N = 27,660) experienced unmet healthcare during the 3-year period. In univariate and multivariable models, the first year of the pandemic (2020) was not associated with change in unmet healthcare need compared with 2018-2019 (OR = 1.04, p = 0.548; OR = 1.03, p = 0.699, respectively). There was no statistically significant interaction between calendar year and race/ethnicity, but there was significant interaction with health insurance status (interaction p = 0.009). Stratifying on health insurance status, those uninsured had borderline significant lower odds of experiencing unmet healthcare need during 2020 compared to the 2 years prior (OR = 0.72, p = 0.051) while those with insurance had a slight increase that was not significant (OR = 1.12, p = 0.143). Unmet healthcare need among New Yorkers during the first year of the pandemic did not differ significantly from 2018-2019. Federal pandemic relief funding, which offered no-cost COVID-19 testing and care to all, irrespective of health insurance or legal status, may have helped equalized access to healthcare.
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Affiliation(s)
- Madelyn S Carlson
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.
| | - Matthew L Romo
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Elizabeth A Kelvin
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Occupational Health, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, NY, USA
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Pearson AL, Zhou Y, Buxton RT, Horton TH, Pfeiffer KA, Beyer KM. The effects of contemporary redlining on the mental health of Black residents. SSM Popul Health 2023; 23:101462. [PMID: 37456619 PMCID: PMC10339054 DOI: 10.1016/j.ssmph.2023.101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/29/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
Understanding how structural racism, including institutionalized practices such as redlining, influence persistent inequities in health and neighborhood conditions is still emerging in urban health research. Such research often focuses on historical practices, giving the impression that such practices are a thing of the past. However, mortgage lending bias can be readily detected in contemporary datasets and is an active form of structural racism with implications for health and wellbeing. The objective of the current study was to test for associations among multiple measures of mental health and a measure of contemporary redlining. We linked a redlining index constructed using Home Mortgage Disclosure Act data (2007-2013) to 2021 health data for Black/African American participants in the Study of Active Neighborhoods in Detroit (n = 220 with address data). We used multilevel regression models to examine the relationship between redlining and a suite of mental health outcomes (perceived stress, anxiety, depressive symptoms, and satisfaction with life), accounting for covariates including racial composition of the neighborhood. We considered three mediating factors: perceived neighborhood cohesion, aesthetics, and discrimination. Although all participants lived in redlined neighborhoods compared to the complete Detroit Metropolitan area, participants with very low income, low levels of experienced discrimination, and lower perceptions of neighborhood aesthetics resided in highly redlined neighborhoods (score ≥5). We observed that higher resident-reported neighborhood aesthetics were found in neighborhoods with lower redlining scores and were associated with higher levels of satisfaction with life. We found that lower levels of redlining were significantly associated with higher levels of perceived discrimination, which was significantly, positively associated with anxiety, depressive symptoms, and perceived stress scores. Our findings highlight that contemporary redlining practices may influence the aesthetics of the built environment because these neighborhoods experience less investment, with implications for residents' satisfaction with life. However, areas with lower redlining may be areas where Black/African American people experience increased perceived discrimination.
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Affiliation(s)
- Amber L. Pearson
- Department of Geography, Michigan State University, East Lansing, MI, 48824, USA
| | - Yuhong Zhou
- Institute for Health & Equity, Medical College Wisconsin, Milwaukee, WI, 53226, USA
| | - Rachel T. Buxton
- Department of Biology, Carleton University, Ottawa, K1S 5B6, Canada
| | - Teresa H. Horton
- Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
| | - Karin A. Pfeiffer
- Department of Kinesiology, Michigan State University, East Lansing, MI, 48824, USA
| | - Kirsten M.M. Beyer
- Institute for Health & Equity, Medical College Wisconsin, Milwaukee, WI, 53226, USA
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16
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Smith EA, Smith JE, Codding BF. Toward an evolutionary ecology of (in)equality. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220287. [PMID: 37381851 PMCID: PMC10291428 DOI: 10.1098/rstb.2022.0287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/30/2023] Open
Abstract
Inequality is increasingly recognized as a major problem in contemporary society. The causes and consequences of inequality in wealth and power have long been central concerns in the social sciences, whereas comparable research in biology has focused on dominance and reproductive skew. This theme issue builds on these existing research traditions, exploring ways they might enrich each other, with evolutionary ecology as a possibly unifying framework. Contributors investigate ways in which inequality is resisted or avoided and developed or imposed in societies of past and contemporary humans, as well as a variety of social mammals. Particular attention is paid to systematic, socially driven inequality in wealth (defined broadly) and the effects this has on differential power, health, survival and reproduction. Analyses include field studies, simulations, archaeological and ethnographic case studies, and analytical models. The results reveal similarities and divergences between human and non-human patterns in wealth, power and social dynamics. We draw on these insights to present a unifying conceptual framework for analysing the evolutionary ecology of (in)equality, with the hope of both understanding the past and improving our collective future. This article is part of the theme issue 'Evolutionary ecology of inequality'.
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Affiliation(s)
- Eric Alden Smith
- Department of Anthropology, University of Washington, Seattle, WA 98195, USA
| | - Jennifer E Smith
- Department of Biology, University of Wisconsin Eau Claire, 105 Garfield Avenue, Eau Claire, WI 54702, USA
| | - Brian F Codding
- Department of Anthropology and Archaeological Center, University of Utah, Salt Lake City, UT 84112, USA
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17
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Rooney EJ, Wilson RL, Johnson A. Integration of traditional therapies for first nations people within western healthcare: an integrative review. Contemp Nurse 2023; 59:294-310. [PMID: 37939110 DOI: 10.1080/10376178.2023.2276718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
AIMS To conduct an integrative literature review to reveal any evidence supportive of the integration of traditional therapies for First Nations peoples in Australia within a western healthcare model, and to identify which, if any, of these therapies have been linked to better health outcomes and culturally safe and appropriate care for First Nations peoples. If so, are there indications by First Nations peoples in Australia that these have been effective in providing culturally safe care or the decolonisation of western healthcare practices. DESIGN Integrative literature review of peer-reviewed literature. DATA SOURCES Online databases searched included CINAHL, Medline, Scopus, ScienceDirect InformitHealth, and ProQuest. REVIEW METHODS Databases were searched for papers with full text available and published in English with no date parameter set. The PRISMA guidelines were used during the literature review and the literature was critiqued using the Critical Appraisal Skills tool. RESULTS Seven articles met the inclusion criteria and were included in the review. Four articles selected were qualitative, two used a mixed method design, and one used a quantitative method. Six themes arose: (i) bush medicine, (ii) traditional healers, (iii) traditional healing practices, (iv) bush tucker, (v) spiritual healing, and (vi) therapies that connected to cultures such as yarning and storytelling. CONCLUSION There is limited literature discussing the use of traditional therapies in Western healthcare settings. A need exists to include traditional therapies within a Western healthcare system. Creating a culturally safer and appropriate healthcare experience for First Nations people in Australia and will contribute to advancement in the decolonisation of current healthcare models.
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Affiliation(s)
- Erin J Rooney
- School of Nursing and Midwifery, University of Newcastle, Gosford, Australia
| | - Rhonda L Wilson
- School of Nursing and Midwifery, University of Newcastle, Gosford, Australia
- School of Nursing, Massey University, Palmerston North, New Zealand
| | - Amanda Johnson
- School of Nursing and Midwifery, University of Newcastle, Gosford, Australia
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18
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McDonnell KJ. Leveraging the Academic Artificial Intelligence Silecosystem to Advance the Community Oncology Enterprise. J Clin Med 2023; 12:4830. [PMID: 37510945 PMCID: PMC10381436 DOI: 10.3390/jcm12144830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Over the last 75 years, artificial intelligence has evolved from a theoretical concept and novel paradigm describing the role that computers might play in our society to a tool with which we daily engage. In this review, we describe AI in terms of its constituent elements, the synthesis of which we refer to as the AI Silecosystem. Herein, we provide an historical perspective of the evolution of the AI Silecosystem, conceptualized and summarized as a Kuhnian paradigm. This manuscript focuses on the role that the AI Silecosystem plays in oncology and its emerging importance in the care of the community oncology patient. We observe that this important role arises out of a unique alliance between the academic oncology enterprise and community oncology practices. We provide evidence of this alliance by illustrating the practical establishment of the AI Silecosystem at the City of Hope Comprehensive Cancer Center and its team utilization by community oncology providers.
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Affiliation(s)
- Kevin J McDonnell
- Center for Precision Medicine, Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
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19
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Johnson JK, Colby A. Cannabis Research and Therapeutics: An International Quasi-experiment in Cannabis Policy. Clin Ther 2023; 45:488-493. [PMID: 37414498 DOI: 10.1016/j.clinthera.2023.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Julie K Johnson
- Massachusetts Cannabis Control Commission, Worcester, Massachusetts.
| | - Alexander Colby
- Massachusetts Cannabis Control Commission, Worcester, Massachusetts
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20
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Sharma S, Reimer-Kirkham S. Exploring racism and racialization in the work of healthcare chaplains: a case for a critical multifaith approach. J Health Care Chaplain 2023:1-13. [PMID: 37184130 DOI: 10.1080/08854726.2023.2209462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The global COVID-19 pandemic has revealed healthcare settings as sites of much-needed scrutiny as to the workings of racism and racialization in shaping healthcare encounters, health outcomes, and workplace conditions. Little research has focused on how healthcare chaplains experience and respond to social processes of racism and racialization. We apply a critical race lens to understand racism and racialization in healthcare chaplaincy, and inspired by Patricia Hill Collins, propose a "critical multifaith approach." Drawing on research in healthcare in Canada and England, we generated four composite narratives to analyze racialization's variability and resistances employed by Indigenous, Arab, Black, and White chaplains. The composites disclose complex intersecting histories of colonialism, religion, race, and gender. Developing a critical multifaith perspective on healthcare delivery is an essential competency for chaplains wanting to impact the systems in which they serve in the direction of more equitable human flourishing.
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Affiliation(s)
- Sonya Sharma
- Social Research Institute, University College London, London, UK
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21
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Farrell TW, Greer AG, Bennie S, Hageman H, Pfeifle A. Academic Health Centers and the Quintuple Aim of Health Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:563-568. [PMID: 36255204 DOI: 10.1097/acm.0000000000005031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The Quintuple Aim of health care adds health equity to the existing Quadruple Aim of improving the individual experience of care for patients, improving the health of populations, reducing the per capita cost of care, and improving the experience of health care professionals. Health equity has previously been subsumed within the other 4 aims. Elevating health equity to the status of a distinct aim is necessary to address persistent health inequities that disproportionately affect underrepresented and minoritized groups. Academic health centers (AHCs) bear a unique responsibility to advance health equity due to the societal importance of their 4 missions: patient care, education, research, and community collaboration. Interprofessional education and practice provide natural connection points that enable AHCs to prepare both health professions students and practicing health care professionals to address all 5 aims. AHCs are well positioned to assess health outcomes related to health equity, develop a health care workforce that is representative of their communities, develop innovative research questions regarding health equity, and engage and invest in the communities they serve.
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Affiliation(s)
- Timothy W Farrell
- T.W. Farrell is professor of medicine and associate chief for age-friendly care, Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, and physician investigator, VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0003-0070-8757
| | - Annette G Greer
- A.G. Greer is associate professor and vice chair of diversity, equity, and inclusion, Department of Bioethics and Interdisciplinary Studies, Brody School of Medicine, East Carolina University, Greenville, North Carolina; ORCID: https://orcid.org/0000-0002-2868-0306
| | - Scott Bennie
- S. Bennie is dean of academic affairs, Kettering College, Kettering, Ohio; ORCID: https://orcid.org/0000-0001-7601-452X
| | - Heather Hageman
- H. Hageman is director, Center for Interprofessional Practice and Education, Washington University Medical Center, a collaboration between Goldfarb School of Nursing at Barnes-Jewish College, the University of Health Sciences and Pharmacy in St Louis, and Washington University School of Medicine, St Louis, Missouri
| | - Andrea Pfeifle
- A. Pfeifle is professor of family and community medicine and associate vice chancellor for interprofessional practice and education, The Ohio State University and Wexner Medical Center, Columbus, Ohio
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22
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Yearwood L, Bone JN, Wen Q, Muraca GM, Lyons J, Razaz N, Joseph K, Lisonkova S. The association between maternal stature and adverse birth outcomes and the modifying effect of race and ethnicity: a population-based retrospective cohort study. AJOG GLOBAL REPORTS 2023; 3:100184. [PMID: 36941862 PMCID: PMC10024135 DOI: 10.1016/j.xagr.2023.100184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND There are known differences in the risk of perinatal and maternal birth outcomes because of maternal factors, such as body mass index and maternal race. However, the association of maternal height with adverse birth outcomes and the potential differences in this relationship by race and ethnicity have been understudied. OBJECTIVE This study aimed to examine the association between maternal stature and adverse perinatal outcomes and the potential modification of the association by race and ethnicity. STUDY DESIGN This retrospective cohort study was conducted using data on all singleton births in the United States in 2016 and 2017 (N=7,361,713) obtained from the National Center for Health Statistics. Short and tall stature were defined as <10th and >90th percentiles of the maternal height distribution (<154.9 and >172.7 cm, respectively). Race and ethnicity categories included non-Hispanic White, non-Hispanic Black, American Indian or Alaskan Native Asian or Pacific Islander, and Hispanic. The primary outcomes were preterm birth (<37 weeks of gestation), perinatal death, and composite perinatal death or severe neonatal morbidity. Logistic regression was used to obtain adjusted odds ratios and 95% confidence intervals with adjustment for confounding by maternal age, body mass index, and other factors. Multiplicative and additive effect modifications by race and ethnicity were assessed. RESULTS The study population included 7,361,713 women with a singleton stillbirth or live birth. Short women had an increased risk of adverse outcomes, whereas tall women had a decreased risk relative to average-stature women. Short women had an increased risk of perinatal death and composite perinatal death or severe neonatal morbidity (adjusted odds ratios, 1.14 [95% confidence interval, 1.10-1.17] and 1.21 [95% confidence interval, 1.19-1.23], respectively). The association between short stature and perinatal death was attenuated in non-Hispanic Black women compared with non-Hispanic White women (adjusted odds ratio, 1.10 [95% confidence interval, 1.03-1.17] vs 1.26 [95% confidence interval, 1.19-1.33]). Compared with average-stature women, tall non-Hispanic White women had lower rates of preterm birth, perinatal death, and composite perinatal death or severe neonatal morbidity (adjusted odds ratios, 0.82 [95% confidence interval, 0.81-0.83], 0.95 [95% confidence interval, 0.91-1.00], and 0.90 [95% confidence interval, 0.88-0.93], respectively). The association between tall and average stature with perinatal death was reversed in Hispanic women (adjusted odds ratio, 1.27; 95% confidence interval, 1.12-1.44). Compared with average-stature women, all tall women had lower rates of preterm birth, particularly among non-Hispanic Black and Hispanic women. CONCLUSION Relative to average-stature women, short women have an increased risk of adverse perinatal outcomes across all race and ethnicity groups; these associations were attenuated in Hispanic women and for some adverse outcomes in non-Hispanic Black and Asian women. Tall mothers have a lower risk of preterm birth in all racial and ethnic groups, whereas tall non-Hispanic White mothers have a lower risk of perinatal death or severe neonatal morbidity compared with average-stature women.
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Affiliation(s)
- Lauren Yearwood
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
| | - Jeffrey N. Bone
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada (XX Bone, XX Joseph, and Dr Lisonkova)
| | - Qi Wen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
| | - Giulia M. Muraca
- Department of Obstetrics and Gynecology and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada (XX Muraca)
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden (XX Muraca and XX Razaz)
| | - Janet Lyons
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
| | - Neda Razaz
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden (XX Muraca and XX Razaz)
| | - K.S. Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada (XX Bone, XX Joseph, and Dr Lisonkova)
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (XX Joseph and Dr Lisonkova)
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada (XX Bone, XX Joseph, and Dr Lisonkova)
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (XX Joseph and Dr Lisonkova)
- Corresponding author: Sarka Lisonkova, MD, PhD.
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23
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Nguyen TT, Merchant JS, Criss S, Makres K, Gowda KN, Mane H, Yue X, Hswen Y, Glymour MM, Nguyen QC, Allen AM. Examining Twitter-Derived Negative Racial Sentiment as Indicators of Cultural Racism: Observational Associations With Preterm Birth and Low Birth Weight Among a Multiracial Sample of Mothers, 2011-2021. J Med Internet Res 2023; 25:e44990. [PMID: 37115602 PMCID: PMC10182466 DOI: 10.2196/44990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Large racial and ethnic disparities in adverse birth outcomes persist. Increasing evidence points to the potential role of racism in creating and perpetuating these disparities. Valid measures of area-level racial attitudes and bias remain elusive, but capture an important and underexplored form of racism that may help explain these disparities. Cultural values and attitudes expressed through social media reflect and shape public norms and subsequent behaviors. Few studies have quantified attitudes toward different racial groups using social media with the aim of examining associations with birth outcomes. OBJECTIVE We used Twitter data to measure state-level racial sentiments and investigate associations with preterm birth (PTB) and low birth weight (LBW) in a multiracial or ethnic sample of mothers in the United States. METHODS A random 1% sample of publicly available tweets from January 1, 2011, to December 31, 2021, was collected using Twitter's Academic Application Programming Interface (N=56,400,097). Analyses were on English-language tweets from the United States that used one or more race-related keywords. We assessed the sentiment of each tweet using support vector machine, a supervised machine learning model. We used 5-fold cross-validation to assess model performance and achieved high accuracy for negative sentiment classification (91%) and a high F1 score (84%). For each year, the state-level racial sentiment was merged with birth data during that year (~3 million births per year). We estimated incidence ratios for LBW and PTB using log binomial regression models, among all mothers, Black mothers, racially minoritized mothers (Asian, Black, or Latina mothers), and White mothers. Models were controlled for individual-level maternal characteristics and state-level demographics. RESULTS Mothers living in states in the highest tertile of negative racial sentiment for tweets referencing racial and ethnic minoritized groups had an 8% higher (95% CI 3%-13%) incidence of LBW and 5% higher (95% CI 0%-11%) incidence of PTB compared to mothers living in the lowest tertile. Negative racial sentiment referencing racially minoritized groups was associated with adverse birth outcomes in the total population, among minoritized mothers, and White mothers. Black mothers living in states in the highest tertile of negative Black sentiment had 6% (95% CI 1%-11%) and 7% (95% CI 2%-13%) higher incidence of LBW and PTB, respectively, compared to mothers living in the lowest tertile. Negative Latinx sentiment was associated with a 6% (95% CI 1%-11%) and 3% (95% CI 0%-6%) higher incidence of LBW and PTB among Latina mothers, respectively. CONCLUSIONS Twitter-derived negative state-level racial sentiment toward racially minoritized groups was associated with a higher risk of adverse birth outcomes among the total population and racially minoritized groups. Policies and supports establishing an inclusive environment accepting of all races and cultures may decrease the overall risk of adverse birth outcomes and reduce racial birth outcome disparities.
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Affiliation(s)
- Thu T Nguyen
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Junaid S Merchant
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Shaniece Criss
- Department of Health Sciences, Furman University, Greenville, SC, United States
| | - Katrina Makres
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Krishik N Gowda
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Heran Mane
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Xiaohe Yue
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Yulin Hswen
- Department of Epidemiology and Biostatistics, Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, United States
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Quynh C Nguyen
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Amani M Allen
- Divisions of Community Health Sciences and Epidemiology, University of California, Berkeley, Berkeley, CA, United States
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24
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Vaughn RM, Bagatell N, McGovern H, Feinberg R, Hendry K, Chowdhury R, Cassidy JM. Politics, policies, and patient care: Rehabilitation therapists' experiences during the COVID-19 Pandemic. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2023; 7:10823. [PMID: 37441129 PMCID: PMC10336862 DOI: 10.4081/qrmh.2023.10823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/18/2023] [Indexed: 07/15/2023] Open
Abstract
The year 2020 represents a historically turbulent period for the United States marked by the COVID-19 pandemic, a contentious political season, and heightened awareness of racism among citizens. This intersection of medicine, politics, and social unrest generated a demanding clinical environment for healthcare workers, including understudied groups such as physical therapists, occupational therapists, and speech-language pathologists. This descriptive qualitative study focused on experiences and perspectives of clinical rehabilitation therapists working in inpatient rehabilitation and acute-care units from September to November, 2020. Thirteen participants completed individual, semi-structured interviews focused on clinical practice and coping strategies. The analysis included a multi-step, inductive process. Four interconnecting factors chronicling participants' experiences emerged: sociopolitical, institutional, hospital unit, and personal. Stressors and buffers were noted that further shaped individual experiences. Utilization of an ecological framework provided a way to recognize the impact of a complex range of social and environmental factors affecting participants' experiences on personal and professional levels. Awareness of rehabilitation therapists' experiences enriches understanding of the pandemic's effect on healthcare workers and presents clinical implications for healthcare systems to promote therapist well-being.
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Affiliation(s)
| | | | | | | | | | | | - Jessica M. Cassidy
- Department of Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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25
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Emani S, Rodriguez JA, Bates DW. Racism and Electronic Health Records (EHRs): Perspectives for research and practice. J Am Med Inform Assoc 2023; 30:995-999. [PMID: 36869772 PMCID: PMC10114075 DOI: 10.1093/jamia/ocad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/17/2023] [Accepted: 02/19/2023] [Indexed: 03/05/2023] Open
Abstract
Informatics researchers and practitioners have started exploring racism related to the implementation and use of electronic health records (EHRs). While this work has begun to expose structural racism which is a fundamental driver of racial and ethnic disparities, there is a lack of inclusion of concepts of racism in this work. This perspective provides a classification of racism at 3 levels-individual, organizational, and structural-and offers recommendations for future research, practice, and policy. Our recommendations include the need to capture and use structural measures of social determinants of health to address structural racism, intersectionality as a theoretical framework for research, structural competency training, research on the role of prejudice and stereotyping in stigmatizing documentation in EHRs, and actions to increase the diversity of private sector informatics workforce and participation of minority scholars in specialty groups. Informaticians have an ethical and moral obligation to address racism, and private and public sector organizations have a transformative role in addressing equity and racism associated with EHR implementation and use.
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Affiliation(s)
- Srinivas Emani
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jorge A Rodriguez
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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26
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Murong M, Giannopoulos E, Pirrie L, Giuliani ME, Fazelzad R, Bender J, Jones J, Papadakos J. The Experience of Informal Newcomer Cancer Caregivers with Limited Language Proficiency: A Scoping Review. J Immigr Minor Health 2023; 25:436-448. [PMID: 36538206 DOI: 10.1007/s10903-022-01442-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
This scoping review explored what is known about the experiences of informal cancer caregivers (CGs) who are newcomers with limited language proficiency. A literature search was performed in seven databases and the search yielded 11,289 articles. After duplicate removal and title and abstract screening, 216 articles underwent full text review and 57 articles and were synthesized. Most studies (n = 41, 72%) were qualitative and were published in North America (n = 35, 61%). Most CG participants were female (69%) and only 19 studies explicitly identified the CG country of origin. Of those that did, 26% originated from Asia, with most migrating from East Asia. Significant challenges were experienced by newcomer CGs and chief among these were related to communication challenges with HCPs that were exacerbated by a lack of availability of medical interpreters and the complexity of oncology health information. Efforts are needed to better integrate newcomer CGs into cancer care.
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Affiliation(s)
- Mijia Murong
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Eleni Giannopoulos
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada
| | - Lorraine Pirrie
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Meredith Elana Giuliani
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada.,The Institute for Education Research, University Health Network, Toronto, Canada.,Department of Radiation of Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jacqueline Bender
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jennifer Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Janet Papadakos
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,The Institute for Education Research, University Health Network, Toronto, Canada.
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27
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Structural racism in healthcare and research: A community-led model of curriculum development and implementation. J Clin Transl Sci 2023; 7:e18. [PMID: 36755546 PMCID: PMC9879883 DOI: 10.1017/cts.2022.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/10/2022] Open
Abstract
Structural racism in the USA has roots that extend deep into healthcare and medical research, and it remains a key driver of illness and early death for Black, Indigenous, People of Color (BIPOC). Furthermore, the persistence of racism within academic medicine compels an interrogation of education and research within this context. In the spirit of this interrogation, this article highlights a unique model of community-engaged education that integrates cultural humility. As an individual and institutional stance, cultural humility denotes lifelong learning and self-critique, the mitigation of power imbalances, and accountability. The integration of cultural humility emphasizes that when space is created for BIPOC communities to lead the way, education regarding healthcare and research can be effectively reimagined. Demonstrating this effectiveness, six community partners led the development and implementation of a five-module Structural Racism in Healthcare and Research course. Using a cohort model approach, the pilot course enrolled 12 community members and 12 researchers. The curriculum covered topics such as history of racism in healthcare and research, and introduced participants to a cultural resilience framework. Evaluation results demonstrated a significant increase in participants' knowledge and ability to identify and take action to address inequities related to racism in healthcare and research.
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28
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Howe CJ, Morone J, Hawkes CP, Lipman TH. Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents' Perspectives. Sci Diabetes Self Manag Care 2023; 49:55-64. [PMID: 36609201 DOI: 10.1177/26350106221145323] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of the study was to describe differences in non-Hispanic Black (NHB) and non-Hispanic White (NHW) parents' perceptions of factors that influence the use of diabetes technology. METHODS Focus groups were conducted with parents of NHB and NHW children at a pediatric diabetes center in the Northeast United States. Kilbourne's health disparities framework informed the focus group guide and a priori coding for directed content analysis. Further analysis allowed subcategories to emerge inductively. RESULTS Twenty-one parents participated. Five subcategories emerged, describing differences in NHB and NHW parent decisions regarding diabetes technology: (1) child's choice, (2) shame versus pride, (3) pros and cons of technology, (4) time frame, and (5) blood glucose indications of readiness. NHB parents feared technology malfunction, worried that visible devices could worsen experienced stigma of diabetes diagnosis, and described the diabetes team as gatekeepers, who changed eligibility criteria for diabetes technology use for their research purposes. In contrast, NHW parents reported diabetes team expectation of diabetes technology use and did not report provider-related barriers. CONCLUSION This study adds to existing literature advancing our understanding of the patient and provider mechanisms underlying racial disparities in diabetes technology use. This understanding may guide development of interventions focused on patients, providers, and structural factors to improve equity in use of diabetes technology by youth with type 1 diabetes.
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Affiliation(s)
- Carol J Howe
- Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, Texas
| | - Jennifer Morone
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Colin P Hawkes
- Diabetes Center for Children, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia
| | - Terri H Lipman
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia
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29
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McCallaghan S. Work-place diversity climate: Its association with racial microaggressions and employee work-place well-being. JOURNAL OF PSYCHOLOGY IN AFRICA 2022. [DOI: 10.1080/14330237.2022.2121476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Sean McCallaghan
- Optentia Research Focus Area, Faculty of Humanities, North-West University, Vanderbijlpark Campus, Vanderbijlpark, South Africa
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30
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Avila MM, Vining CB, Allison-Burbank J, Velez C. Health Equity for Abenaki Indigenous People: Improving Access to Quality Mental Health and Substance Use Services. Health Equity 2022; 6:787-793. [PMID: 36338801 PMCID: PMC9629907 DOI: 10.1089/heq.2022.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to learn about the Abenaki Indigenous communities' access to services, specifically, their beliefs and knowledge about different types of mental health and substance abuse services and supports within their communities. METHODS This was an exploratory qualitative study using a focus group approach. Two focus groups were conducted in spring 2020 with community members and tribal leaders from different Abenaki Bands in Franklin, Chittenden, and Addison Counties and the Northeast Kingdom in Vermont. Participants were recruited via a mix of convenience and snowball sampling approaches. RESULTS A total of 15 Abenaki community members participated in 2 separate focus groups, including 5 current and former Chiefs who served or were currently serving as the primary leadership of this state-recognized tribe. Members of the Abenaki community communicated that the loss and erasure of their culture combined with lack of trust of community support agencies impacted the ways in which the Abenaki community conceptualizes health and wellness for themselves and thus impacts parenting and youth substance use as well as opioid use and prescription drug misuse for participants in this study. CONCLUSION Abenaki Indigenous experience many obstacles to effective prevention and intervention services. Recruitment of American Indian and Alaska Native (AI/AN) individuals, specifically Abenaki, into the health and mental health workforce can support health equity efforts for this population. Finally, better efforts to foster and support AI/AN culture, specifically Abenaki culture, can support substance use and suicide prevention with this vulnerable community.
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Affiliation(s)
- Maria Mercedes Avila
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.,Address correspondence to: Maria Mercedes Avila, PhD, Department of Pediatrics, University of Vermont Larner College of Medicine, UHC Campus Rehab 4, 1 South Prospect Street, Burlington, VT 05401, USA.
| | - Christine Begay Vining
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.,Department of Audiology & Speech-Language Pathology, Arizona School of Health Sciences, A.T. Still University, Mesa, Arizona, USA
| | - Joshuaa Allison-Burbank
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.,Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christine Velez
- Department of Social Work, University of Vermont, Burlington, Vermont, USA
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31
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Phan VTD. Institutional racism: a discursive paper. Contemp Nurse 2022; 58:388-392. [PMID: 35719105 DOI: 10.1080/10376178.2022.2092521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The purpose of this paper is to provide discourse regarding awareness of institutional racism, from a non-Indigenous, Australian nursing student's perspective. The discussion has a focus on the presence of institutional racism in the Australian healthcare system, its impact on the health of First Nation Peoples and a commitment to ensuring culturally safe practice. It will be argued that institutional racism is pervasive in healthcare as a consequence of three factors: exclusion of First Nations Peoples from governance roles, inherent racism impacting on socio-cultural treatment bias, and institutional racism influencing key relationships in healthcare delivery.
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Affiliation(s)
- Van Thanh Danh Phan
- Susan Wakil School of Nursing and Midwifery, Faculty of Health and Medicine, University of Sydney, Sydney, Australia
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32
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Leighton SC, Nieforth LO, O’Haire ME. Assistance dogs for military veterans with PTSD: A systematic review, meta-analysis, and meta-synthesis. PLoS One 2022; 17:e0274960. [PMID: 36129950 PMCID: PMC9491613 DOI: 10.1371/journal.pone.0274960] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022] Open
Abstract
Psychiatric assistance dogs for military veterans with posttraumatic stress disorder (PTSD) currently make up over 19% of assistance dog partnerships globally. We conducted a systematic review of the literature relating to these partnerships, with specific aims to (1) summarize their characteristics, (2) evaluate the quality of existing evidence, and (3) summarize outcomes. A total of 432 records were independently screened (Cohen’s kappa = 0.90). Of these, 41 articles (29 peer-reviewed publications and 12 unpublished dissertations) met inclusion criteria. Data extraction was conducted to address the research aims, including a meta-analysis (quantitative outcomes) and meta-synthesis (qualitative outcomes). All peer-reviewed publications on the topic of psychiatric assistance dogs for veterans with PTSD were published within the last five years. The majority of included articles were quantitative (53%), 41% were qualitative, and 6% employed mixed methods. Mean methodological rigor scores were 80% for peer reviewed articles and 71% for dissertations, where higher scores represent more rigorous methodology. Quantitative articles reported significant improvements in the domains of PTSD severity, mental health, and social health. Impacts on physical health and global quality of life appear inconclusive. Meta-analysis (9 articles) revealed that partnership with an assistance dog had a clinically meaningful, significant, and large effect on PTSD severity scores (g = −1.129; p<0.0001). Qualitative meta-synthesis identified two third order constructs: (1) Impact on the individual: mental & physical health and (2) Impact beyond the individual: building relationships & connection. This synthesis of increasingly prevalent research on assistance dogs for veterans with PTSD provides support for the impact of this complementary and integrative health intervention on PTSD symptom severity, and signs of meaningful improvements in adjacent domains including mental and social health. Gaps between quantitative and qualitative findings, along with the need to report greater demographic detail, highlight key opportunities for future research.
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Affiliation(s)
- Sarah C. Leighton
- Center for the Human-Animal Bond, Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, United States of America
- * E-mail:
| | - Leanne O. Nieforth
- College of Veterinary Medicine, University of Arizona, Oro Valley, AZ, United States of America
| | - Marguerite E. O’Haire
- College of Veterinary Medicine, University of Arizona, Oro Valley, AZ, United States of America
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33
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Room for all: Inclusive diversity, equity, and access in acupuncture practice, education, and research. Explore (NY) 2022; 18:627-629. [DOI: 10.1016/j.explore.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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34
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da Silva PHA, Aiquoc KM, da Silva Nunes AD, Medeiros WR, de Souza TA, Jerez-Roig J, Barbosa IR. Prevalence of Access to Prenatal Care in the First Trimester of Pregnancy Among Black Women Compared to Other Races/Ethnicities: A Systematic Review and Meta-Analysis. Public Health Rev 2022; 43:1604400. [PMID: 35860809 PMCID: PMC9289875 DOI: 10.3389/phrs.2022.1604400] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To analyze the prevalence of access to prenatal care in the first trimester of pregnancy among black women compared to other races/ethnicities through a systematic review and meta-analysis.Methods: Searches were carried out at PUBMED, LILACS, Web of Science, Scopus, CINAHL, and in the grey literature. The quality of the studies and the risk of bias were analyzed using the Joanna Briggs Critical Appraisal Checklist for Analytical Cross-Sectional Studies instrument. The extracted data were tabulatesd and analyzed qualitatively and quantitatively through meta-analysis.Results: Black women had the lowest prevalence of access to prenatal services in the first trimester, with prevalence ranging from 8.1% to 74.81%, while among white women it varied from 44.9 to 94.0%; 60.7% of black women started prenatal care in the first trimester, while 72.9% of white women did so.Conclusion: Black women compared to other racial groups had lower prevalence of access to prenatal care, with less chance of access in the first trimester, and it can be inferred that the issue of race/skin color is an important determinant in obtaining obstetric care.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020159968_, PROSPERO CRD42020159968.
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Affiliation(s)
| | - Kezauyn Miranda Aiquoc
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Talita Araujo de Souza
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
- *Correspondence: Talita Araujo de Souza,
| | - Javier Jerez-Roig
- Faculty of Health Sciences and Welfare, University of Vic–Central University of Catalonia, Barcelona, Spain
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Jackson CG, Moore KN, Cantrell L, Erickson BK, Duska LR, Richardson DL, Landrum LM, Holman LL, Walker JL, Mannel RS, Moxley KM, Queimado L, Cohoon A, Ding K, Dockery LE. A phase II trial of bevacizumab and rucaparib in recurrent carcinoma of the cervix or endometrium. Gynecol Oncol 2022; 166:44-49. [PMID: 35491267 PMCID: PMC10428664 DOI: 10.1016/j.ygyno.2022.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to examine the tolerability and efficacy of combination bevacizumab rucaparib therapy in patients with recurrent cervical or endometrial cancer. PATIENTS & METHODS Thirty-three patients with recurrent cervical or endometrial cancer were enrolled. Patients were required to have tumor progression after first line treatment for metastatic, or recurrent disease. Rucaparib was given at 600 mg BID twice daily for each 21-day cycle. Bevacizumab was given at 15 mg/kg on day 1 of each 21-day cycle. The primary endpoint was efficacy as determined by objective response rate or 6-month progression free survival. RESULTS Of the 33 patients enrolled, 28 were evaluable. Patients with endometrial cancer had a response rate of 17% while patients with cervical cancer had a response rate of 14%. Median progression free survival was 3.8 months (95% C·I 2.5 to 5.7 months), and median overall survival was 10.1 months (95% C·I 7.0 to 15.1 months). Patients with ARID1A mutations displayed a better response rate (33%) and 6-month progression free survival (PFS6) rate (67%) than the entire study population. Observed toxicity was similar to that of previous studies with bevacizumab and rucaparib. CONCLUSIONS The combination of bevacizumab with rucaparib did not show significantly increased anti-tumor activity in all patients with recurrent cervical or endometrial cancer. However, patients with ARID1A mutations had a higher response rate and PFS6 suggesting this subgroup may benefit from the combination of bevacizumab and rucaparib. Further study is needed to confirm this observation. No new safety signals were seen.
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Affiliation(s)
- C G Jackson
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - K N Moore
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L Cantrell
- Division of Gynecologic Oncology, University of Virginia, Department of Obstetrics and Gynecology; Charlottesville, VA, USA
| | - B K Erickson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Minnesota; Minneapolis, MN, USA
| | - L R Duska
- Division of Gynecologic Oncology, University of Virginia, Department of Obstetrics and Gynecology; Charlottesville, VA, USA
| | - D L Richardson
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L M Landrum
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L L Holman
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - J L Walker
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - R S Mannel
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - K M Moxley
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L Queimado
- Department of Otolaryngology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - A Cohoon
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - K Ding
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L E Dockery
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina; Chapel Hill, NC, USA.
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36
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Lee LCB. Shifting Ethics of Care in Hong Kong. ARTS IN PSYCHOTHERAPY 2022. [DOI: 10.1016/j.aip.2022.101916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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37
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Hostiuc S, Isailă OM, Curcă GC. Perceptions of Dental Medicine Students on Equity within Healthcare Systems in Romania: A Pilot Study. Healthcare (Basel) 2022; 10:857. [PMID: 35627993 PMCID: PMC9141564 DOI: 10.3390/healthcare10050857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
The scope of this paper is to evaluate the opinion of future dentists on equity within healthcare systems from a social and medical perspective. MATERIAL AND METHODS We conducted an observational study based on a survey among year five students from the "Carol Davila" Faculty of Dental Medicine Bucharest using an online questionnaire composed of graded answers to 14 statements on the theme of equity within healthcare systems before taking this course. RESULTS The questionnaire was sent to 300 students, of whom 151 (50.3%) responded; 79.47% of these were female and 20.53% were male; 9.3% had a rural background and 90.7% had an urban background. The majority of respondents expressed strong agreement that equity in public healthcare and acknowledging disadvantaged populations was important. The majority of students also strongly agreed that inequity came about from a lack of accessibility to medical care, lack of financial resources, and the absence of a second medical opinion. There were no statistically significant differences specific to the gender and background environment of the respondents. CONCLUSIONS The notion of equity is known to future dentists. However, contextual clarifications of the concept itself and its adequate quantification are necessary.
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Affiliation(s)
- Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Mina Minovici” National Institute of Legal Medicine, 042122 Bucharest, Romania;
| | - Oana-Maria Isailă
- Department of Legal Medicine and Bioethics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Mina Minovici” National Institute of Legal Medicine, 042122 Bucharest, Romania;
| | - George-Cristian Curcă
- “Mina Minovici” National Institute of Legal Medicine, 042122 Bucharest, Romania;
- Department of Legal Medicine and Bioethics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Thomas-Hawkins C, Flynn L, Zha P, Ando S. The effects of race and workplace racism on nurses' intent to leave the job: The mediating roles of job dissatisfaction and emotional distress. Nurs Outlook 2022; 70:590-600. [PMID: 35523600 DOI: 10.1016/j.outlook.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is scant evidence of quantifiable effects of workplace racism on nurses' job-related outcomes. PURPOSE The study aimed to examine associations among race, workplace racism, emotional distress, job dissatisfaction, and intent to leave among hospital-based nurses. METHODS This study used a correlational design with six measures in a statewide sample of 788 hospital-based nurses. FINDINGS Non-White nurses intended to leave the job at a higher rate than White nurses. Non-White nurses reported negative racial climates, multiple racial microaggression experiences, and high job dissatisfaction and emotional distress. Non-white race and workplace racism had significant individual effects on intent to leave. Job dissatisfaction and emotional distress significantly mediated indirect effects of non-White race, negative racial climates, and racial microaggressions on nurses' intent to leave. DISCUSSION In efforts to retain nurses of color in hospitals, there is an urgent need to mitigate workplace racism in these settings.
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Affiliation(s)
| | - Linda Flynn
- Division of Nursing Science, Rutgers University School of Nursing, Newark, NJ
| | - Peijia Zha
- Division of Nursing Science, Rutgers University School of Nursing, Newark, NJ
| | - Sakura Ando
- Rutgers University School of Nursing, Newark, NJ
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Culturally and linguistically diverse voices and views in COVID-19 pandemic plans and policies. Western Pac Surveill Response J 2022; 13:1-3. [PMID: 35546908 PMCID: PMC9062600 DOI: 10.5365/wpsar.2022.13.2.915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This paper presents a rapid assessment of coronavirus disease 2019 (COVID-19) pandemic plans and explores the representation of culturally and linguistically diverse (CALD) communities in such plans. Four levels of pandemic plans were reviewed: regional, state, national and international. Methods Discussions with representatives from four CALD communities informed the development of search and selection criteria for the COVID-19 plans, which were gathered and assessed using a CALD lens. Six COVID-19 pandemic plans that met the inclusion criteria were critically assessed. Results The reviewed plans did not report any CALD community voices, views or consultations with community groups in the development phase, nor did they acknowledge the diversity of CALD populations. A few plans noted the vulnerability of CALD communities, but none discussed the challenges CALD communities face in accessing health information or health services during the pandemic, or other structural barriers (social determinants of health). Discussion Our analysis revealed major gaps in all pandemic plans in terms of engaging with immigrant or CALD communities. Policies and plans that address and consider the complex needs and challenges of CALD communities are essential. Collaboration between public health services, multicultural services and policy-makers is vital for the inclusion of this higher-risk population.
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40
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Thomas-Hawkins C, Zha P, Flynn L, Ando S. Effects of Race, Workplace Racism, and COVID Worry on the Emotional Well-Being of Hospital-Based Nurses: A Dual Pandemic. Behav Med 2022; 48:95-108. [PMID: 35318891 DOI: 10.1080/08964289.2021.1977605] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Persons of color in the US experience the worst COVID-related outcomes and account for the majority of COVID-19 cases and hospitalizations among healthcare workers. In a pandemic where minority populations and healthcare workers are among the hardest hit, nurses of color are undoubtedly taxed. Moreover, their workplace racism experiences represent a dual pandemic in that the effects of COVID-19 worries and workplace racism may synergize to the detriment of their emotional well-being. The purpose of this study was to examine the direct, indirect, and interactive effects of individual (race, COVID worry), interpersonal (workplace racial microaggressions), and institutional (racial climate) factors on hospital-based nurses' emotional well-being. A sample of 788 registered nurses who worked in New Jersey hospitals completed an electronic survey. Compared to White nurses, nonwhite nurses reported higher emotional distress, more negative racial climates, more racial microaggressions, and higher levels of COVID worry. Nurses' worry about getting sick from COVID and multiple racial microaggression experiences had the largest effects on the likelihood of high emotional distress. Racism variables and worry about COVID mediated indirect effects of nonwhite race on emotional distress. Racial microaggressions mediated an indirect effect of racial climate on this outcome. Nurses who were worried about getting sick from COVID and experienced multiple microaggressions and/or the most negative racial climates had severe emotional distress. There is a need for sustained investment in a racially diverse nursing workforce. Mitigating workplace racism in hospitals is crucial, particularly during public health crises that disproportionately threaten minority populations and healthcare workers.
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Affiliation(s)
| | - Peijia Zha
- School of Nursing, Rutgers, the State University of New Jersey, Newark, NJ, USA
| | - Linda Flynn
- School of Nursing, Rutgers, the State University of New Jersey, Newark, NJ, USA
| | - Sakura Ando
- School of Nursing, Rutgers, the State University of New Jersey, Newark, NJ, USA
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Long C. Racial identity and uncertainty in psychotherapy: Perspectives of Black clients and their therapists. INTERNATIONAL JOURNAL OF APPLIED PSYCHOANALYTIC STUDIES 2022. [DOI: 10.1002/aps.1737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Carol Long
- Department of Psychology University of the Witwatersrand Johannesburg South Africa
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42
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Hirko KA, Rocque G, Reasor E, Taye A, Daly A, Cutress RI, Copson ER, Lee DW, Lee KH, Im SA, Park YH. The impact of race and ethnicity in breast cancer-disparities and implications for precision oncology. BMC Med 2022; 20:72. [PMID: 35151316 PMCID: PMC8841090 DOI: 10.1186/s12916-022-02260-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 12/14/2022] Open
Abstract
Breast cancer is the most commonly diagnosed cancer worldwide and is one of the leading causes of cancer death. The incidence, pathological features, and clinical outcomes in breast cancer differ by geographical distribution and across racial and ethnic populations. Importantly, racial and ethnic diversity in breast cancer clinical trials is lacking, with both Blacks and Hispanics underrepresented. In this forum article, breast cancer researchers from across the globe discuss the factors contributing to racial and ethnic breast cancer disparities and highlight specific implications of precision oncology approaches for equitable provision of breast cancer care to improve outcomes and address disparities.
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Affiliation(s)
- Kelly A Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, 48824, USA.
| | - Gabrielle Rocque
- Department of Internal Medicine, Division of Hematology Oncology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erica Reasor
- Department of Internal Medicine, Division of Hematology Oncology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ammanuel Taye
- Department of Internal Medicine, Division of Hematology Oncology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alex Daly
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, SO16 6YD, UK
| | - Ramsey I Cutress
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, SO16 6YD, UK
| | - Ellen R Copson
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, SO16 6YD, UK
| | - Dae-Won Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeon Hee Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, Korea
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43
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Mohottige D, Boulware LE, Ford CL, Jones C, Norris KC. Use of Race in Kidney Research and Medicine: Concepts, Principles, and Practice. Clin J Am Soc Nephrol 2022; 17:314-322. [PMID: 34789476 PMCID: PMC8823929 DOI: 10.2215/cjn.04890421] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Black Americans and other racially and ethnically minoritized individuals are disproportionately burdened by higher morbidity and mortality from kidney disease when compared with their White peers. Yet, kidney researchers and clinicians have struggled to fully explain or rectify causes of these inequalities. Many studies have sought to identify hypothesized genetic and/or ancestral origins of biologic or behavioral deficits as singular explanations for racial and ethnic inequalities in kidney health. However, these approaches reinforce essentialist beliefs that racial groups are inherently biologically and behaviorally different. These approaches also often conflate the complex interactions of individual-level biologic differences with aggregated population-level disparities that are due to structural racism (i.e., sociopolitical policies and practices that created and perpetuate harmful health outcomes through inequities of opportunities and resources). We review foundational misconceptions about race, racism, genetics, and ancestry that shape research and clinical practice with a focus on kidney disease and related health outcomes. We also provide recommendations on how to embed key equity-enhancing concepts, terms, and principles into research, clinical practice, and medical publishing standards.
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Affiliation(s)
- Dinushika Mohottige
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina,Center for Community and Population Health Improvement, Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina
| | - L. Ebony Boulware
- Center for Community and Population Health Improvement, Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Chandra L. Ford
- Department of Community Health Science, University of California, Los Angeles School of Public Health, Los Angeles, California,Center for the Study of Racism, Social Justice & Health, University of California, Los Angeles School of Public Health, Los Angeles, California
| | - Camara Jones
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia,Department of Epidemiology, Rollins School of Public Health at Emory University, Atlanta, Georgia,Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, Georgia
| | - Keith C. Norris
- Center for the Study of Racism, Social Justice & Health, University of California, Los Angeles School of Public Health, Los Angeles, California,Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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44
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Roberts KM, Trejo AN. Provider, Heal Thy System: An Examination of Institutionally Racist Healthcare Regulatory Practices and Structures. CONTEMPORARY FAMILY THERAPY 2022; 44:4-15. [PMID: 35106026 PMCID: PMC8794600 DOI: 10.1007/s10591-021-09630-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/25/2022]
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45
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Shirani A. It Is Time to Stop Racial Exclusion in Scholarly Citations. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:547-548. [PMID: 34674156 DOI: 10.1007/s11673-021-10137-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Afsaneh Shirani
- Department of Neurological Sciences, University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE, 68198-8440, USA.
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46
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Images in Health-related Communications from Sri Lanka: Is there a Racial Bias? Asian Bioeth Rev 2021; 14:207-212. [PMID: 35462968 PMCID: PMC8986920 DOI: 10.1007/s41649-021-00195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022] Open
Abstract
Racial bias and language discrimination are recognized in the health sector in countries such as Sri Lanka. This may extend to images used in health communication and educational literature. We analyzed the racial and ethnic representation in a sample of newspapers and websites related to health obtained over a period. Most of the human figures in health-related messages in newspapers had an overrepresentation of Caucasians. This trend was absent in websites where 73% of the images of Sri Lankans. The reasons for this pattern could be due to the availability of image-quality photographs and exposure to a norm that is racially biased. For example, a majority of images in medical textbooks and prestigious journals are of white Caucasians. A predominance of such images could have two impacts. At an individual level, it would affect acquiring skills of visual diagnoses. At a societal level, it may reinforce a view that most forms of health-related knowledge are created in the West and could add to existing discrimination based on skin color (i.e., colorism). The latter is a known psychosocial stressor that contributes to psychological distress among socially disadvantaged populations and promotes behaviors adverse to health and residential segregation. These may contribute to poorer physical, mental, and infant health outcomes in dark-skinned individuals compared to lighter-skinned in the USA and Canada. Such discrimination within the health system would compromise basic human dignity, disempower patients, and violate the principle of autonomy. Sri Lankan media, the healthcare profession, and educationists need to recognize the relevance and importance of using images that appropriately reflect the realities of their own environment, its people, and patients.
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Beech BM, Ford C, Thorpe RJ, Bruce MA, Norris KC. Poverty, Racism, and the Public Health Crisis in America. Front Public Health 2021; 9:699049. [PMID: 34552904 PMCID: PMC8450438 DOI: 10.3389/fpubh.2021.699049] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/06/2021] [Indexed: 01/13/2023] Open
Abstract
The purpose of this article is to discuss poverty as a multidimensional factor influencing health. We will also explicate how racism contributes to and perpetuates the economic and financial inequality that diminishes prospects for population health improvement among marginalized racial and ethnic groups. Poverty is one of the most significant challenges for our society in this millennium. Over 40% of the world lives in poverty. The U.S. has one of the highest rates of poverty in the developed world, despite its collective wealth, and the burden falls disproportionately on communities of color. A common narrative for the relatively high prevalence of poverty among marginalized minority communities is predicated on racist notions of racial inferiority and frequent denial of the structural forms of racism and classism that have contributed to public health crises in the United States and across the globe. Importantly, poverty is much more than just a low-income household. It reflects economic well-being, the ability to negotiate society relative to education of an individual, socioeconomic or health status, as well as social exclusion based on institutional policies, practices, and behaviors. Until structural racism and economic injustice can be resolved, the use of evidence-based prevention and early intervention initiatives to mitigate untoward effects of socioeconomic deprivation in communities of color such as the use of social media/culturally concordant health education, social support, such as social networks, primary intervention strategies, and more will be critical to address the persistent racial/ethnic disparities in chronic diseases.
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Affiliation(s)
- Bettina M. Beech
- Department of Health Systems and Population Health Science, University of Houston College of Medicine, Houston, TX, United States
| | - Chandra Ford
- Department of Community Health Sciences, Center for the Study of Racism, Social Justice and Health at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Roland J. Thorpe
- Department of Health, Behavior, and Society, Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Marino A. Bruce
- Program for Research on Faith, Justice, and Health, Department of Behavioral and Social Sciences, University of Houston College of Medicine, Houston, TX, United States
| | - Keith C. Norris
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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48
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Gatwiri K, Rotumah D, Rix E. BlackLivesMatter in Healthcare: Racism and Implications for Health Inequity among Aboriginal and Torres Strait Islander Peoples in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094399. [PMID: 33919080 PMCID: PMC8122304 DOI: 10.3390/ijerph18094399] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022]
Abstract
Despite decades of evidence showing that institutional and interpersonal racism serve as significant barriers to accessible healthcare for Aboriginal and Torres Strait Islander Peoples, attempts to address this systemic problem still fall short. The social determinants of health are particularly poignant given the socio-political-economic history of invasion, colonisation, and subsequent entrenchment of racialised practices in the Australian healthcare landscape. Embedded within Euro-centric, bio-medical discourses, Western dominated healthcare processes can erase significant cultural and historical contexts and unwittingly reproduce unsafe practices. Put simply, if Black lives matter in healthcare, why do Aboriginal and Torres Strait Islander Peoples die younger and experience 'epidemic' levels of chronic diseases as compared to white Australians? To answer this, we utilise critical race perspectives to theorise this gap and to de-center whiteness as the normalised position of 'doing' healthcare. We draw on our diverse knowledges through a decolonised approach to promote a theoretical discussion that we contend can inform alternative ways of knowing, being, and doing in healthcare practice in Australia.
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Affiliation(s)
- Kathomi Gatwiri
- Center for Children & Young People, Faculty of Health, Southern Cross University, Gold Coast, QLD 4225, Australia
- Correspondence:
| | - Darlene Rotumah
- Gnibi College, Southern Cross University, Gold Coast, QLD 4225, Australia;
| | - Elizabeth Rix
- Faculty of Health, Southern Cross University, Gold Coast, QLD 4225, Australia;
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49
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Mayes C, Paradies Y, Elias A. Lead Essay-Institutional Racism, Whiteness, and the Role of Critical Bioethics. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:9-12. [PMID: 33822283 PMCID: PMC8022304 DOI: 10.1007/s11673-021-10103-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 05/31/2023]
Affiliation(s)
- Christopher Mayes
- Alfred Deakin Institute, Faculty of Arts and Education, Deakin University, Geelong, VIC Australia
| | - Yin Paradies
- Alfred Deakin Institute, Faculty of Arts and Education, Deakin University, Geelong, VIC Australia
| | - Amanuel Elias
- Alfred Deakin Institute, Faculty of Arts and Education, Deakin University, Geelong, VIC Australia
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50
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Ashby MA. The Shifts in Human Consciousness. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:1-4. [PMID: 33835305 PMCID: PMC8033095 DOI: 10.1007/s11673-021-10102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Michael A Ashby
- Cancer, Chronic Disease and Sub-Acute Stream, Royal Hobart Hospital, Tasmanian Health Service, School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia.
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