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Oliveira FESD, Oliveira MCL, Martelli DRB, Trezena S, Sampaio CA, Colosimo EA, A Oliveira E, Martelli Júnior H. The impact of smoking on COVID-19-related mortality: a Brazilian national cohort study. Addict Behav 2024; 156:108070. [PMID: 38796931 DOI: 10.1016/j.addbeh.2024.108070] [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: 03/02/2024] [Revised: 04/30/2024] [Accepted: 05/19/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Current evidence suggests the potential heightened vulnerability of smokers to severe coronavirus disease (COVID-19) outcomes. AIMS This study aimed to analyze the clinical outcomes and mortality related to tobacco use in a cohort of hospitalized Brazilian COVID-19 patients. METHODS This retrospective cohort study analyzed adults hospitalized for COVID-19 in Brazil using the SIVEP-Gripe database (official data reported by public and private healthcare facilities for monitoring severe acute respiratory syndrome cases in Brazil). The inclusion criteria were patients over 18 years of age with a positive RT-qPCR test for SARS-CoV-2. The analysis focused on in-hospital mortality, considering smoking as an exposure variable, and included covariates such as age, gender, and comorbidities. Smoking history was collected from the self-reported field in the database. Statistical analyses included descriptive statistics, crude Odds Ratios, and multivariable binary logistic regression. RESULTS This study included 2,124,285 COVID-19 patients, among whom 44,774 (2.1 %) were smokers. The average age of the smokers was higher than that of the never-smokers (65.3 years vs. 59.7 years). The clinical outcomes revealed that smokers had higher rates of intensive care unit admission (51.6 % vs. 37.2 % for never-smokers), invasive ventilatory support (31.5 % vs. 20.2 % for never-smokers), and higher mortality (42.7 % vs. 31.8 % for never smokers). In the multivariable analysis, smokers demonstrated a heightened risk of death (aOR 1.23; 95 % CI 1.19-1.25). CONCLUSIONS This large populational-based cohort study confirms the current evidence and underscore the critical importance of recognizing smoking as a substantial risk factor for adverse outcomes in COVID-19 patients.
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Affiliation(s)
| | - Maria Christina L Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
| | | | - Samuel Trezena
- Postgraduate Program in Health Sciences, Unimontes, Montes Claros, Minas Gerais, Brazil.
| | | | - Enrico A Colosimo
- Department of Statistics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
| | - Eduardo A Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil; Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, United States.
| | - Hercílio Martelli Júnior
- Postgraduate Program in Health Sciences, Unimontes, Montes Claros, Minas Gerais, Brazil; Postgraduate Program in Primary Health Care, Unimontes, Montes Claros, Minas Gerais, Brazil.
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Eddie D, Prindle J, Somodi P, Gerstmann I, Dilkina B, Saba SK, DiGuiseppi G, Dennis M, Davis JP. Exploring predictors of substance use disorder treatment engagement with machine learning: The impact of social determinants of health in the therapeutic landscape. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209435. [PMID: 38852819 PMCID: PMC11300147 DOI: 10.1016/j.josat.2024.209435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 03/15/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Improved knowledge of factors that influence treatment engagement could help treatment providers and systems better engage patients. The present study used machine learning to explore associations between individual- and neighborhood-level factors, and SUD treatment engagement. METHODS This was a secondary analysis of the Global Appraisal of Individual Needs (GAIN) dataset and United States Census Bureau data utilizing random forest machine learning and generalized linear mixed modelling. Our sample (N = 15,873) included all people entering SUD treatment at GAIN sites from 2006 to 2012. Predictors included an array of demographic, psychosocial, treatment-specific, and clinical measures, as well as environment-level measures for the neighborhood in which patients received treatment. RESULTS Greater odds of treatment engagement were predicted by adolescent age and psychiatric comorbidity, and at the neighborhood-level, by low unemployment and high population density. Lower odds of treatment engagement were predicted by Black/African American race, and at the neighborhood-level by high rate of public assistance and high income inequality. Regardless of the degree of treatment engagement, individuals receiving treatment in areas with high unemployment, alcohol sale outlet concentration, and poverty had greater substance use and related problems at baseline. Although these differences reduced with treatment and over time, disparities remained. CONCLUSIONS Neighborhood-level factors appear to play an important role in SUD treatment engagement. Regardless of whether individuals engage with treatment, greater loading on social determinants of health such as unemployment, alcohol sale outlet density, and poverty in the therapeutic landscape are associated with worse SUD treatment outcomes.
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Affiliation(s)
- David Eddie
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, USA; Department of Psychiatry, Harvard Medical School, USA.
| | - John Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - Paul Somodi
- Viterbi School of Engineering, Computer Science, University of Southern California, USA
| | - Isaac Gerstmann
- Viterbi School of Engineering, Computer Science, University of Southern California, USA
| | - Bistra Dilkina
- Viterbi School of Engineering, Computer Science, University of Southern California, USA
| | - Shaddy K Saba
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - Graham DiGuiseppi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - Michael Dennis
- Lighthouse Institute, Chestnut Health Systems, Normal, IL, USA
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Evenson SE, Hafferty FW, Sharp RR, Tilburt JC. Measuring and Monitoring Health Equity in Health Care Organizations: Why It's Important and How to Move Forward. Mayo Clin Proc 2024; 99:1212-1218. [PMID: 39001775 DOI: 10.1016/j.mayocp.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/08/2024] [Accepted: 04/17/2024] [Indexed: 07/15/2024]
Affiliation(s)
| | | | - Richard R Sharp
- Biomedical Ethics Research Program and Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Jon C Tilburt
- Biomedical Ethics Research Program and Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Division of General Internal Medicine, Mayo Clinic, Scottsdale, AZ
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Ledenko M, Patel T. Poverty Traps and Mortality From Liver Diseases in the United States. Am J Gastroenterol 2024:00000434-990000000-01205. [PMID: 38916206 DOI: 10.14309/ajg.0000000000002899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/12/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Poverty traps, locations with multigenerational poverty, result from structural and economic factors that can affect health of residents within these locations. The aim of this study was to define poverty traps within the contiguous United States and their impact on outcomes from liver diseases or cancers. METHODS A systematic census-tract level analysis was used to spatially define regions that encompassed poverty traps. Clusters of prevalent poverty and mortality from chronic liver diseases or liver cancers were identified. Temporal trends and the relationship between race and ethnicity, type of space and escape from poverty traps on disease mortality within hot spots were determined. RESULTS The proportion of census tracts enduring multigenerational poverty within counties was strongly associated with mortality from liver disease or cancer. There was a highly significant clustering of persistent poverty and increased mortality. Hot spots of high-mortality areas correlated with factors related to income, ethnicity, and access to health care. Location or noneconomic individual factors such as race and ethnicity were important determinants of disparities within hot spots. Distinct groups of poverty traps were defined. The highly characteristic demographics and disease outcomes within each of these groups underscored the need for location-specific interventions. DISCUSSION Poverty traps are a major and important spatially determined risk factor for mortality from liver diseases and cancers. Targeted location-specific interventions and economic development aimed at addressing the underlying causes of poverty and enhancing prosperity will be required to reduce mortality from liver diseases within poverty traps.
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Affiliation(s)
- Matthew Ledenko
- Division of Gastroenterology and Hepatology, Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
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Lauwers EDL, Vandecasteele R, McMahon M, De Maesschalck S, Willems S. The patient perspective on diversity-sensitive care: a systematic review. Int J Equity Health 2024; 23:117. [PMID: 38840119 PMCID: PMC11155005 DOI: 10.1186/s12939-024-02189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/30/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The provision of diversity-sensitive care is a promising approach towards reducing health disparities. Recent criticism and a scientific gap demonstrate the need for the patient perspective on diversity-sensitive care. This systematic review aims to describe the patient perspective, including patient experiences, expectations, and satisfaction with diversity-sensitive care provided by healthcare providers. METHODS In December 2022 the Medline ALL, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO and additionally Google Scholar were searched for original studies that described or measured patient expectations, experiences, and/or satisfaction, specifically focusing on cultural or diversity competence of healthcare providers. Analysis of the collected data was performed using a convergent mixed-methods design based on thematic synthesis. RESULTS From initially 5,387 articles, 117 were selected for full-text screening, and ultimately, 34 articles were included in this study. The concept of diversity-sensitive care was observed to comprise three components. The first component is focused on patient-centered care and includes competencies such as clear and direct communication, shared decision-making, individualized care, empathy, and consideration. The second component centers on providing culturally tailored information, adjusting care to cultural needs, working with interpreters, allyship, community partnerships, self-awareness, and cultural knowledge, and builds upon the first component. Across the first two components of diversity-sensitive care, patients have reported experiencing dissatisfaction and encountering shortcomings in their healthcare providers, sometimes resulting in the third and final component pertaining to provider care. This component underscores the importance of linguistic, ethnic, cultural, and gender concordance in delivering quality care. CONCLUSION In conclusion, the patient perspective on diversity-sensitive care encompasses multiple components, from patient-centered care to concordant care. The components incorporate various competencies as communication skills, empathy, self-awareness and adjusting care to cultural needs. Patients reported experiencing dissatisfaction and shortcomings across all components of diversity-sensitive care provided by healthcare providers.
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Affiliation(s)
- Ewout Daniël Lieven Lauwers
- Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, South Holland, 3015 GD, The Netherlands.
| | - Robin Vandecasteele
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital, Campus Entrance 42, C. Heymanslaan 10, Ghent, 9000, Belgium
| | - Michael McMahon
- Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, Ghent, 9000, Belgium
| | - Stéphanie De Maesschalck
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital, Campus Entrance 42, C. Heymanslaan 10, Ghent, 9000, Belgium
| | - Sara Willems
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital, Campus Entrance 42, C. Heymanslaan 10, Ghent, 9000, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Quality & Safety Ghent, Ghent University, University Hospital, Campus Entrance 42, C. Heymanslaan 10, Ghent, 9000, Belgium
- Centre for the Social Study of Migration and Refugees, Ghent University, H. Dunantlaan 2, Ghent, 9000, Belgium
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Earle-Richardson G, Nestor C, Fisher KA, Soelaeman RH, Calanan RM, Yee D, Craig C, Reese P, Prue CE. Attitudes, Beliefs, and Perceptions Associated with Mask Wearing within Four Racial and Ethnic Groups Early in the COVID-19 Pandemic. J Racial Ethn Health Disparities 2024; 11:1628-1642. [PMID: 37258995 PMCID: PMC10231299 DOI: 10.1007/s40615-023-01638-x] [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: 02/22/2023] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND While previous studies have identified a range of factors associated with mask wearing in the US, little is known about drivers of mask-wearing among racial and ethnic minority groups. This analysis assessed whether factors positively associated with wearing a mask early in the pandemic differed between participants grouped by race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic Asian, and non-Hispanic White). METHOD Data were obtained from a US internet panel survey of 3217 respondents during May-November 2020 (weighted by race/ethnicity, age, gender, and education to the US national population). Within each of the four available racial/ethnic groups, crude and adjusted odds ratios (COR and AOR) were calculated using logistic regression to assess factors positively associated with wearing a mask. Adjusted models were controlled for age, gender, education, county COVID-19 case count, presence of a state-issued mask mandate, and interview month. RESULTS The following variables were most strongly positively associated with mask wearing (p<0.05) in each racial/ethnic group: Hispanic-seeing others wearing masks (AOR: 6.7), importance of wearing a mask combined with social distancing (AOR: 3.0); non-Hispanic Black-belief that wearing a mask would protect others from coronavirus (AOR: 5.1), reporting hearing that one should wear a mask (AOR: 3.6); non-Hispanic Asian-belief that people important to them believe they should wear a mask (COR: 5.1, not statistically significant); and non-Hispanic White-seeing others wearing masks (AOR: 3.1), importance of wearing a mask (AOR: 2.3). CONCLUSION Public health efforts to encourage mask wearing should consider the diversity of behavioral influences within different population groups.
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Affiliation(s)
- Giulia Earle-Richardson
- National, Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA.
| | - Ciara Nestor
- National, Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Kiva A Fisher
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Rieza H Soelaeman
- National, Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Renee M Calanan
- National, Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA
- US Public Health Service, Rockville, MD, USA
| | - Daiva Yee
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Christina Craig
- National, Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Patricia Reese
- National, Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Christine E Prue
- National, Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA
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Burnett-Bowie SAM, Wright NC, Yu EW, Langsetmo L, Yearwood GMH, Crandall CJ, Leslie WD, Cauley JA. The American Society for Bone and Mineral Research Task Force on clinical algorithms for fracture risk report. J Bone Miner Res 2024; 39:517-530. [PMID: 38590141 DOI: 10.1093/jbmr/zjae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/23/2024] [Accepted: 03/13/2024] [Indexed: 04/10/2024]
Abstract
Using race and ethnicity in clinical algorithms potentially contributes to health inequities. The American Society for Bone and Mineral Research (ASBMR) Professional Practice Committee convened the ASBMR Task Force on Clinical Algorithms for Fracture Risk to determine the impact of race and ethnicity adjustment in the US Fracture Risk Assessment Tool (US-FRAX). The Task Force engaged the University of Minnesota Evidence-based Practice Core to conduct a systematic review investigating the performance of US-FRAX for predicting incident fractures over 10 years in Asian, Black, Hispanic, and White individuals. Six studies from the Women's Health Initiative (WHI) and Study of Osteoporotic Fractures (SOF) were eligible; cohorts only included women and were predominantly White (WHI > 80% and SOF > 99%), data were not consistently stratified by race and ethnicity, and when stratified there were far fewer fractures in Black and Hispanic women vs White women rendering area under the curve (AUC) estimates less stable. In the younger WHI cohort (n = 64 739), US-FRAX without bone mineral density (BMD) had limited discrimination for major osteoporotic fracture (MOF) (AUC 0.53 (Black), 0.57 (Hispanic), and 0.57 (White)); somewhat better discrimination for hip fracture in White women only (AUC 0.54 (Black), 0.53 (Hispanic), and 0.66 (White)). In a subset of the older WHI cohort (n = 23 918), US-FRAX without BMD overestimated MOF. The Task Force concluded that there is little justification for estimating fracture risk while incorporating race and ethnicity adjustments and recommends that fracture prediction models not include race or ethnicity adjustment but instead be population-based and reflective of US demographics, and inclusive of key clinical, behavioral, and social determinants (where applicable). Research cohorts should be representative vis-à-vis race, ethnicity, gender, and age. There should be standardized collection of race and ethnicity; collection of social determinants of health to investigate impact on fracture risk; and measurement of fracture rates and BMD in cohorts inclusive of those historically underrepresented in osteoporosis research.
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Affiliation(s)
- Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Nicole C Wright
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Elaine W Yu
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Lisa Langsetmo
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care Center, Minneapolis, MN 55417, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States
| | - Gabby M H Yearwood
- Department of Anthropology and Center for Civil Rights and Racial Justice, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Carolyn J Crandall
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, United States
| | - William D Leslie
- Departments of Internal Medicine and Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg R3E 0T6, Canada
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States
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Kett PM, Shahrir S, Bekemeier B. Public Health Nurses' Proficiencies and Training Needs in an Emergency Response: A Cross-Sectional Observational Study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:354-366. [PMID: 38489524 DOI: 10.1097/phh.0000000000001888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To address gaps in understanding the public health nursing workforce regarding competencies recognized as critical during an emergency response. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional observational study using data with information on local health department staff- and organizational-level characteristics collected from across the United States in 2021. We used logistic regression to estimate the association between 2 binary nurse-specific predictors-(1) whether the staff person was a nurse and (2) whether the staff worked in a local health department that was "nurse-led" (directed by a nurse)-and reported proficiencies important to the COVID-19 response. Models controlled for relevant local health department and community characteristics. RESULTS In the sample, 19% were nurses and 37% were at nurse-led health departments. Nurse versus nonnurse staff had higher odds of reporting proficiencies in skills related to Justice, Equity, Diversity, and Inclusion and in the skill "identifying/applying evidence-based approaches to address public health issues." However, nurses, compared with their nonnurse peers, had higher odds of reporting training needs in domains related to community engagement, policy engagement, and cross-sectoral collaboration. Conversely, staff at nurse-led health departments, compared with non-nurse-led staff, had higher odds of reporting proficiencies in many of these same areas, including "collaborating across the public health system" and "influencing policies external to the organization that affect community health." There were no areas in which nurse-led staff had lower odds of reporting proficiencies or higher odds of identifying training needs. CONCLUSIONS Findings from this study highlight areas of strength for public health nurses, particularly strengths related to diversity, equity, and inclusion, as well as areas where more training is needed. Such findings can help guide future public health nurse workforce development as well as underscore the value of public health nursing leadership and staff at local health departments for supporting community health.
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Affiliation(s)
- Paula M Kett
- Center for Health Workforce Studies, Department of Family Medicine, School of Medicine (Drs Kett and Shahrir); and Department of Child, Family, and Population Health, School of Nursing (Dr Bekemeier), University of Washington, Seattle, Washington
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Pacheco CM, Bridges KM, Ellerbeck EF, Ablah E, Greiner KA, Chen Y, Collie-Akers V, Ramírez M, LeMaster JW, Sykes K, Parente DJ, Corriveau E, Miras Neira A, Scott A, Knapp KE, Woodward J, Finocchario-Kessler S. Communities organizing to promote equity: engaging local communities in public health responses to health inequities exacerbated by COVID-19-protocol paper. Front Public Health 2024; 12:1369777. [PMID: 38774043 PMCID: PMC11107291 DOI: 10.3389/fpubh.2024.1369777] [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: 01/12/2024] [Accepted: 02/28/2024] [Indexed: 05/24/2024] Open
Abstract
Background The COVID-19 pandemic has disproportionately impacted rural and under-resourced urban communities in Kansas. The state's response to COVID-19 has relied on a highly decentralized and underfunded public health system, with 100 local health departments in the state, few of which had prior experience engaging local community coalitions in a coordinated response to a public health crisis. Methods To improve the capacity for local community-driven responses to COVID-19 and other public health needs, the University of Kansas Medical Center, in partnership with the Kansas Department of Health and Environment, will launch Communities Organizing to Promote Equity (COPE) in 20 counties across Kansas. COPE will establish Local Health Equity Action Teams (LHEATs), coalitions comprised of community members and service providers, who work with COPE-hired community health workers (CHWs) recruited to represent the diversity of the communities they serve. CHWs in each county are tasked with addressing unmet social needs of residents and supporting their county's LHEAT. LHEATs are charged with implementing strategies to improve social determinants of health in their county. Monthly, LHEATs and CHWs from all 20 counties will come together as part of a learning collaborative to share strategies, foster innovation, and engage in peer problem-solving. These efforts will be supported by a multilevel communications strategy that will increase awareness of COPE activities and resources at the local level and successes across the state. Our mixed methods evaluation design will assess the processes and impact of COPE activities as well as barriers and facilitators to implementation using aspects of both the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) models. Discussion This protocol is designed to expand community capacity to strategically partner with local public health and social service partners to prioritize and implement health equity efforts. COPE intentionally engages historically resilient communities and those living in underserved rural areas to inform pragmatic strategies to improve health equity.
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Affiliation(s)
- Christina M. Pacheco
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Kristina M. Bridges
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Edward F. Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS, United States
| | - K. Allen Greiner
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Yvonnes Chen
- School of Journalism and Mass Communications, University of Kansas, Lawrence, KS, United States
| | - Vicki Collie-Akers
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Mariana Ramírez
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Joseph W. LeMaster
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Kevin Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, United States
- Health and Wellness Center, Baylor Scott and White Health, Dallas, TX, United States
| | - Daniel J. Parente
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Erin Corriveau
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Antonio Miras Neira
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Angela Scott
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Kara E. Knapp
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jennifer Woodward
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah Finocchario-Kessler
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
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Fuller TJ, Lambert DN, DiClemente RJ, Wingood GM. Reach and Capacity of Black Protestant Health Ministries as Sites of Community-Wide Health Promotion: A Qualitative Social Ecological Model Examination. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01926-0. [PMID: 38319551 DOI: 10.1007/s40615-024-01926-0] [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: 07/31/2023] [Revised: 12/29/2023] [Accepted: 01/31/2024] [Indexed: 02/07/2024]
Abstract
Black communities in the Southeast United States experience a disproportionate burden of illness and disease. To address this inequity, public health practitioners are partnering with Black Protestant churches to deliver health promotion interventions. Yet, the reach of these programs beyond the organizational level of the Social Ecological Model (SEM) is not well defined. Thus, the aim of this study is to understand Black Protestant church leaders' and members' perceptions about the capacity of their ministries to reach into their communities, beyond their congregations, as providers or hosts of health education or promotion interventions. From 20 Black Protestant churches in Atlanta, GA, 92 church leaders and members participated in semi-structured interviews. Grounded theory guided data analysis and a diverse team coded the interviews. Most participating churches had health ministries. Participants saw the boundaries between their churches at the organizational level of the SEM and the broader Black community to be porous. Those who described their "community" as being broader than their congregation also tended to describe community-wide health promotion their church engaged in. They described church-based health fairs as a strategy to promote engagement in their communities. Some participants, particularly those in a health-related profession, discussed visions of how to utilize their church as a site for community-wide health promotion. We suggest these participants may be boundary leaders who can build relationships between public health professionals, pastors, and congregants. Based on the findings, we suggest that church-based health fairs may be effective sites of community-wide health promotion.
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Affiliation(s)
- Tyler J Fuller
- Graduate Program in Religion, Boston University, Boston, MA, USA.
| | - Danielle N Lambert
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, New York University, New York, NY, USA
| | - Gina M Wingood
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
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Hogans-Mathews S, Flowers K, Terrance TC, Mouratidis R. Tossing and turning: Time to wake up and address racial inequities in insomnia treatment and health care. Sleep Health 2024; 10:7-8. [PMID: 37951774 DOI: 10.1016/j.sleh.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/19/2023] [Accepted: 09/24/2023] [Indexed: 11/14/2023]
Affiliation(s)
| | - Kerwyn Flowers
- Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Traci C Terrance
- University of Rochester Medical Center, Rochester, New York, USA
| | - Roxann Mouratidis
- Florida State University College of Medicine, Tallahassee, Florida, USA
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12
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Vance AJ, Farmer ML, D'Agata A, Moore T, Esser M, Fortney CA. NANN Membership Recommendations: Opportunities to Advance Racial Equity Within the Organization. Adv Neonatal Care 2024; 24:71-77. [PMID: 37703135 DOI: 10.1097/anc.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Neonatal care has advanced significantly in recent years, yet racial health inequities persist in the neonatal intensive care unit (NICU), with infants from racial and ethnic minority groups less likely to receive recommended treatment. Healthcare providers acknowledge that there are steps that can be taken to increase knowledge and awareness regarding health inequities. PURPOSE To better understand current health equity-related initiatives in the neonatal community and solicit feedback from National Association of Neonatal Nurses (NANN) membership about advancing racial equity within the organization. METHODS A cross-sectional survey was conducted in January 2021. The anonymous, onetime survey was distributed to active NANN members via SurveyMonkey and included questions related to racial equity initiatives, recommendations, and demographics. Data analysis was conducted using an exploratory approach using descriptive statistics, and thematic analysis was used to summarize responses to open-ended questions. RESULTS There were 325 members who completed the full survey, of whom were White (83%), female (96%), staff nurses (42%), and those with more than 16 years of experience (69%), and most (69%) were familiar with NANN's racial equity position statement. Recommendations were summarized into the following themes: (1) research, (2) education, (3) workforce diversity, (4) communication, (5) scholarships, (6) resources, and (7) community outreach. IMPLICATIONS FOR PRACTICE AND RESEARCH NANN members offered clear and actionable recommendations to advance health equity within the neonatal community and organization, which included offering more diversity, inclusion, and equity education at the annual conferences, in ANC articles, and newsletters, and the creation of scholarships or reduced membership fees to encourage diverse enrollment in the organization.
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Affiliation(s)
- Ashlee J Vance
- Henry Ford Health, Detroit, Michigan (Dr Vance); Marietta Neonatology, Marietta, Georgia (Dr Farmer); The Univeristy of Rhode Island College of Nursing, Kingston, Rhode Island (Dr D'Agata); Univeristy of Nebraska Medical Center College of Nursing, Omaha, Nebraska (Dr Moore); Alverno College School of Nursing and Health Professions, Milwaukee, Wisconsin (Dr Esser); and The Ohio State University College of Nursing, Columbus, Ohio (Dr Fortney)
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13
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Schuster RC, Wachter K, McRae K, McDaniel A, Davis OI, Nizigiyimana J, Johnson-Agbakwu CE. "If You Don't Have the Heart to Help, You Cannot Do This Job": The Multidimensional Wellbeing of Community Health Workers Serving Refugees During the COVID-19 Pandemic. QUALITATIVE HEALTH RESEARCH 2024; 34:183-194. [PMID: 37950593 DOI: 10.1177/10497323231209836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Community health workers are members of two groups whose short- and long-term health has been uniquely shaped by the COVID-19 pandemic: health workers and the oft-marginalized populations that they serve. Yet, their wellbeing, particularly of those serving resettled refugees, before and during the pandemic has been largely overlooked. Drawing from a holistic conceptualization of wellness, this study examined the effects of the COVID-19 pandemic on a group of cultural health navigators (CHNs), who serve resettled refugees. We conducted semi-structured individual interviews with CHNs at a southwestern U.S. hospital system between July and August 2020, a critical time in the pandemic. Our analysis produced four themes that encapsulate the effects of the pandemic on CHN wellbeing: (1) "You fear for your life": Chronic risk of COVID-19 exposure takes a toll on physical, emotional, and environmental wellbeing; (2) "It is stressful because it is completely new": Uncertainty diminishes occupational, financial, and emotional wellbeing; (3) "If you don't have the heart to help, you cannot do this job": CHNs remain committed while facing challenges to their occupational wellbeing on multiple fronts; and (4) "Now, you cannot release your stress": Loss of and shifts in outlets integral to social and spiritual wellbeing. The findings deepen empirical understanding of how the pandemic affected the holistic wellbeing of CHNs, as they continued to serve their communities in a time of crisis. We discuss the implications for addressing the multidimensionality of community health worker wellbeing in research, policy, and practice.
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Affiliation(s)
- Roseanne C Schuster
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
- Office of Refugee Health, Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
| | - Karin Wachter
- Office of Refugee Health, Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
- School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Kenna McRae
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
- Department of Bioengineering, Schools of Engineering and Medicine, Stanford University, Stanford, CA, USA
| | - Anne McDaniel
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
| | - Olga I Davis
- Office of Refugee Health, Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
- Hugh Downs School of Human Communication, Arizona State University, Tempe, AZ, USA
- Barrett, The Honors College, Arizona State University, Phoenix, AZ, USA
| | - Jeanne Nizigiyimana
- Office of Refugee Health, Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
- Center for Refugee and Global Health, Valleywise Health, Phoenix, AZ, USA
| | - Crista E Johnson-Agbakwu
- Office of Refugee Health, Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
- Department of Obstetrics & Gynecology, UMass Memorial Health, Worcester, MA, USA
- Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
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14
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Levin J. The challenges of epidemiologic translation: communicating with physicians, policymakers, and the public. Front Public Health 2024; 12:1270586. [PMID: 38327582 PMCID: PMC10847263 DOI: 10.3389/fpubh.2024.1270586] [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: 08/01/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
Translational epidemiology refers to the practical application of population-health research findings to efforts addressing health disparities and other public health issues. A principal focus of epidemiologic translation is on the communication of results to constituencies who can best make use of this information to effect positive health-related change. Indeed, it is contended that findings from epidemiologic research are of greatest use only if adequately communicated to health professionals, legislators and policymakers, and the public. This paper details the challenges faced by efforts to communicate findings to the these constituencies, especially three types of miscommunication that can derail efforts at translation. These include perceived misinformation, perceived disinformation, and perceived censorship. Epidemiologists are ethically obliged to avoid these types of miscommunication, and, accordingly, are advised to place greater emphasis on messaging and media outreach to physicians, government officials, medical educators, and the general public.
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Affiliation(s)
- Jeff Levin
- Institute for Studies of Religion and Medical Humanities Program, Baylor University, Waco, TX, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, United States
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15
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Washington T, Lewinson TD. Healthcare Social Workers' Scope of Practice during COVID-19. Healthcare (Basel) 2024; 12:174. [PMID: 38255063 PMCID: PMC10815567 DOI: 10.3390/healthcare12020174] [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: 11/04/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
The COVID-19 pandemic pushed the U.S. healthcare system to its limits, resulting in the need for flexibility in care delivery. This study aimed to describe healthcare social workers' scope of practice since the start of the pandemic. Semi-structured interviews for this qualitative study were conducted using the Zoom platform between July and August 2020. This study used a basic qualitative content analysis with integrated deductive and inductive coding to explore participant perspectives. Their scope was assessed based on healthcare social work practice standards. Four practice standards and eight themes that emerged from the data were knowledge and skills (care planning and intervention and social worker-patient relationship), workload sustainability (workload expansion and workload facilitators), interdisciplinary collaboration (collaborating beyond the scope of responsibilities and collaboration challenges), and cultural competency (institutional and societal). The findings add a deeper understanding of the roles social workers perform, how they think about these roles, how they want to be understood, and how they are best utilized in ways consistent with their training and expertise. Moving forward, healthcare systems may consider well-delineated roles and responsibilities for everyday practice and during pandemics.
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Affiliation(s)
| | - Terri D. Lewinson
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH 03755, USA;
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16
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Santos Silva L, da Conceição Barbosa RB, Lima JP, Castro-Alves J, Ribeiro-Alves M. Racial Inequalities in the Health Establishment Access to the Treatment of COVID-19 in Brazil in 2020. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01866-1. [PMID: 38189902 DOI: 10.1007/s40615-023-01866-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 01/09/2024]
Abstract
The Brazilian health system simultaneously allows for the existence of the public and private sectors, which often imposes financial barriers to access to services and affects the health of exposed groups. Studies have shown evidence of higher lethality risks among Black/Biracial and Indigenous People admitted to hospitals due to COVID-19 during the pandemic when compared to White People. This paper evaluated the association between access to treatment for COVID-19, race, and COVID-19-related deaths among the five macro-regions of Brazil in 2020. We conducted a retrospective, cross-sectional observational, and population-wide study. Logistical models were used including first-order interactions between race and the health establishment administration sector using deaths as outcome, adjusted for covariates. The lethality risk, defined as the percentage of deaths among hospitalized patients, of Black/Biracial and Indigenous People was up to 78% (in the Midwest) and 29% (in the South) higher when compared to White People, respectively. The association of the race/access interaction with COVID-19-related deaths suggested the possibility of institutional racism in health establishments. The results highlight the need to guarantee adequate funding to the public health sector to improve equity in access to healthcare and the constant development of educational activities and increased participation of racialized minorities in the healthcare workforce at influential positions for health workers on topics such as racism.
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Affiliation(s)
- Lídia Santos Silva
- National Institute of Infectology Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | | | - João Paulo Lima
- National Institute of Infectology Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Julio Castro-Alves
- National Institute of Infectology Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
| | - Marcelo Ribeiro-Alves
- Laboratory of Clinical Research On STD/AIDS, National Institute of Infectology Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
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17
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Jung M. Behavioral Predictors Associated With COVID-19 Vaccination and Infection Among Men Who Have Sex With Men in Korea. J Prev Med Public Health 2024; 57:28-36. [PMID: 38062718 PMCID: PMC10861333 DOI: 10.3961/jpmph.23.381] [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: 08/30/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES This study investigated the impact of socioeconomic factors and sexual orientation-related attributes on the rates of coronavirus disease 2019 (COVID-19) vaccination and infection among men who have sex with men (MSM). METHODS A web-based survey, supported by the National Research Foundation of Korea, was conducted among paying members of the leading online portal for the lesbian, gay, bisexual, transgender, or queer and questioning (LGBTQ+) community in Korea. The study participants were MSM living in Korea (n=942). COVID-19 vaccination and infection were considered dependent variables, while sexual orientation-related characteristics and adherence to non-pharmacological intervention (NPI) practices served as primary independent variables. To ensure analytical precision, nested logistic regression analyses were employed. These were further refined by dividing respondents into 4 categories based on sexual orientation and disclosure (or "coming-out") status. RESULTS Among MSM, no definitive association was found between COVID-19 vaccination status and factors such as socioeconomic or sexual orientation-related attributes (with the latter including human immunodeficiency virus [HIV] status, sexual orientation, and disclosure experience). However, key determinants influencing COVID-19 infection were identified. Notably, people living with HIV (PLWH) exhibited a statistically significant predisposition towards COVID-19 infection. Furthermore, greater adherence to NPI practices among MSM corresponded to a lower likelihood of COVID-19 infection. CONCLUSIONS This study underscores the high susceptibility to COVID-19 among PLWH within the LGBTQ+ community relative to their healthy MSM counterparts. Consequently, it is crucial to advocate for tailored preventive strategies, including robust NPIs, to protect these at-risk groups. Such measures are essential in reducing the disparities that may emerge in a post-COVID-19 environment.
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Affiliation(s)
- Minsoo Jung
- Department of Health Science, Dongduk Women’s University College of Natural Science, Seoul, Korea
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
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18
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Parke DM, Ogbolu Y, Rowthorn V. Global learning: A post-COVID-19 approach to advance health equity. Glob Public Health 2024; 19:2340507. [PMID: 38626120 DOI: 10.1080/17441692.2024.2340507] [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: 06/13/2023] [Accepted: 04/02/2024] [Indexed: 04/18/2024]
Abstract
The COVID-19 pandemic has accelerated acceptance of learning from other countries, especially for high-income countries to learn from low- and middle-income countries, a practice known as global learning. COVID-19's rapid disease transmission underscored how connected the globe is as well as revealed stark health inequities which facilitated looking outside of one's borders for solutions. The Global Learning for Health Equity (GL4HE) Network, supported by Robert Wood Johnson Foundation, held a 3-part webinar series in December 2021 to understand the current state of global learning and explore how global learning can advance health equity in the post-COVID-19 era. This paper reflects on these cutting-edge discussions about the current state of global learning, drawing upon the highlights, perspectives, and conclusions that emerged from these webinars. The paper also comments on best practices for global learning, including adapting for context, addressing biases, funding considerations, ensuring bidirectional partnerships, community engagement, and adopting a multidisciplinary approach.
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Affiliation(s)
| | - Yolanda Ogbolu
- Center for Health Equity and Outcomes Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - Virginia Rowthorn
- Center for Health Equity and Outcomes Research, University of Maryland Baltimore, Baltimore, MD, USA
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19
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Hill AV, Balascio P, Moore M, Hossain F, Dwarkananth M, De Genna NM. Young black women's desired pregnancy and birthing support during coronavirus disease 2019 pandemic. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 4:100333. [PMID: 38106375 PMCID: PMC10722556 DOI: 10.1016/j.ssmqr.2023.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Objective To document pregnancy and birthing experiences of young, Black pregnant women in one geographic area to make recommendations for improving young Black women's pregnancy and birthing experiences. Methods Participants were recruited through The YoungMoms Study (R01 DA04640101A1) in Pittsburgh, Pennsylvania, and included Black or biracial participants ages 16-23 (n = 25). Individual interviews were conducted from March 2022-July 2022 to assess pre-, peri-, and post-natal healthcare system encounters; experiences of structural and obstetric racism and discrimination in healthcare settings while obtaining prenatal care; attitudes around healthcare systems and medical professionals; effects of COVID-19 pandemic on participants lives and the impact of enacted healthcare policies in their perinatal experience; substance use changes during pregnancy; and coping mechanisms for stress. NVivo 13 was used to code transcripts, then major themes and subthemes were identified using thematic content analysis and based on grounded theory. Results Twenty-five interviews were conducted, and four themes emerged from participant experiences of racial discrimination in healthcare settings; (1) awareness of historical racism that influences perinatal care; (2) clinical providers assume participant substance use and enact reproductive coercion; (3) clinical providers question validity of Black women's birthing complaint; and (4) Young Black pregnant women know and will express what they desire in their perinatal experience if asked. Conclusions Young Black pregnant women encounter structural racism and intersectional bias from healthcare providers. By centering the perspectives and experiences of this overlooked population, public health researchers and clinical providers can utilize anti-racist frameworks to create more equitable, just practices in reproductive healthcare.
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Affiliation(s)
- Ashley V. Hill
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Phoebe Balascio
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Mikaela Moore
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Fahmida Hossain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Megana Dwarkananth
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Natacha M. De Genna
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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20
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Mackie AS, Bravo-Jaimes K, Keir M, Sillman C, Kovacs AH. Access to Specialized Care Across the Lifespan in Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:267-282. [PMID: 38161668 PMCID: PMC10755796 DOI: 10.1016/j.cjcpc.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 01/03/2024]
Abstract
Individuals living with tetralogy of Fallot require lifelong specialized congenital heart disease care to monitor for and manage potential late complications. However, access to cardiology care remains a challenge for many patients, as does access to mental health services, dental care, obstetrical care, and other specialties required by this population. Inequities in health care access were highlighted by the COVID-19 pandemic and continue to exist. Paradoxically, many social factors influence an individual's need for care, yet inadvertently restrict access to it. These include sex and gender, being a member of a racial or ethnic historically excluded group, lower educational attainment, lower socioeconomic status, living remotely from tertiary care centres, transportation difficulties, inadequate health insurance, occupational instability, and prior experiences with discrimination in the health care setting. These factors may coexist and have compounding effects. In addition, many patients believe that they are cured and unaware of the need for specialized follow-up. For these reasons, lapses in care are common, particularly around the time of transfer from paediatric to adult care. The lack of trained health care professionals for adults with congenital heart disease presents an additional barrier, even in higher income countries. This review summarizes challenges regarding access to multiple domains of specialized care for individuals with tetralogy of Fallot, with a focus on the impact of social determinants of health. Specific recommendations to improve access to care within Canadian and American systems are offered.
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Affiliation(s)
- Andrew S. Mackie
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christina Sillman
- Adult Congenital Heart Disease Program, Sutter Heart and Vascular Institute, Sacramento, California, USA
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21
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De Genna NM, Hossain F, Dwarakanath M, Balascio PM, Moore MM, Hill AV. Pandemic stressors and vaccine hesitancy among young, pregnant Black people: A qualitative study of health disparities during a global pandemic. Birth Defects Res 2023; 115:1912-1922. [PMID: 37807480 PMCID: PMC11061795 DOI: 10.1002/bdr2.2262] [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: 03/24/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The novel coronavirus 2019 (COVID-19) pandemic exacerbated existing health inequities in the United States, but no studies have focused on the lived experiences of younger Black birthing people. The goal of this qualitative study was to center the experiences of younger pregnant and birthing Black and Biracial people during the pandemic. METHODS We recruited 25 Black and Biracial pregnant and birthing people ages 16-23 for individual semi-structured interviews. Participants were asked about experiences with the healthcare system during the pandemic, and interviews were transcribed verbatim and coded for qualitative analysis using nVivo. We adhered to the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS Participants identified pandemic-related stressors such as fears about infection, lack of support, and pressure to get vaccinated. Reasons for vaccine hesitancy included mistrust in the government and racism experienced during reproductive healthcare. Provider appeals highlighting patient autonomy and science were more effective in encouraging vaccine uptake than emotional appeals that made participants feel guilty about potentially infecting loved ones. CONCLUSIONS Restrictions on children and support people created barriers to timely prenatal care and reduced tangible support for young Black and Biracial birthing people during the pandemic. Their vaccine hesitancy was related to mistrust, concerns that the vaccines had not been tested enough prior to roll-out, and possible side effects of the vaccine including infection with the virus and pregnancy loss. Obstetric providers need to understand and recognize the ongoing impact of obstetric and scientific racism on health communication with younger Black and Biracial patients.
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Affiliation(s)
- Natacha M. De Genna
- Department of Psychiatry and Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Fahmida Hossain
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Megana Dwarakanath
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Phoebe Ms. Balascio
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Mikaela Ms. Moore
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Ashley V. Hill
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
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22
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Taff SD, Yoo MG, Carlson KA, Bakhshi P. Climate Change and Occupational Therapy: Meeting the Urgent Need for Adaptation, Mitigation, and Resilience. Occup Ther Health Care 2023:1-18. [PMID: 37975196 DOI: 10.1080/07380577.2023.2277220] [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: 02/24/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
Climate change may be the most pressing existential threat to human health and wellbeing in the twenty first century. In this paper, the authors provide context and critique on barriers to climate action in the United States and other high-income countries, including the profit-driven approach to health, consumerism, and the climate change countermovement. The reciprocal connections between occupational engagement and climate damage are examined from a lens of collective and irresponsible occupations and subsequent accountability. The authors propose the United Nations' Sustainable Development Goals as a basis for recommendations occupational therapy practitioners could implement within the priorities of adaptation, mitigation, and resilience.
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Affiliation(s)
- Steven D Taff
- Program in Occupational Therapy and Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Madelyn G Yoo
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Kelly A Carlson
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Parul Bakhshi
- Program in Occupational Therapy and Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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23
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Percival V, Thoms OT, Oppenheim B, Rowlands D, Chisadza C, Fewer S, Yamey G, Alexander AC, Allaham CL, Causevic S, Daudelin F, Gloppen S, Guha-Sapir D, Hadaf M, Henderson S, Hoffman SJ, Langer A, Lebbos TJ, Leomil L, Lyytikäinen M, Malhotra A, Mkandawire P, Norris HA, Ottersen OP, Phillips J, Rawet S, Salikova A, Shekh Mohamed I, Zazai G, Halonen T, Kyobutungi C, Bhutta ZA, Friberg P. The Lancet Commission on peaceful societies through health equity and gender equality. Lancet 2023; 402:1661-1722. [PMID: 37689077 DOI: 10.1016/s0140-6736(23)01348-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/01/2023] [Accepted: 06/26/2023] [Indexed: 09/11/2023]
Affiliation(s)
- Valerie Percival
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada; The Wilson Center, Washington DC, USA.
| | - Oskar T Thoms
- Department of Political Science, University of Toronto, Mississauga, ON, Canada
| | - Ben Oppenheim
- Ginkgo Bioworks, Boston, MA, USA; New York University Center on International Cooperation, New York, NY, USA
| | - Dane Rowlands
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Carolyn Chisadza
- Department of Economics, University of Pretoria, Pretoria, South Africa
| | - Sara Fewer
- Department of Global Public Health, Stockholm, Sweden; Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Amy C Alexander
- Quality of Government Institute, Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Chloe L Allaham
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Sara Causevic
- Department of Global Public Health, Stockholm, Sweden; Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden; Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - François Daudelin
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siri Gloppen
- University of Bergen, Bergen, Norway; LawTransform, CMI-UiB Centre on Law and Social Transformation, Bergen, Norway
| | - Debarati Guha-Sapir
- Institute of Health and Society, UC Louvain, Brussels, Belgium; Johns Hopkins Center for Humanitarian Health, Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Maseh Hadaf
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Samuel Henderson
- Department of Political Science, University of Toronto, Toronto, ON, Canada
| | | | - Ana Langer
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Toni Joe Lebbos
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
| | - Luiz Leomil
- Department of Political Science, Carleton University, Ottawa, ON, Canada
| | | | - Anju Malhotra
- Center for Women's Health and Gender Equality, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Paul Mkandawire
- Human Rights and Social Justice Program, Carleton University, Ottawa, ON, Canada
| | - Holly A Norris
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Ole Petter Ottersen
- Office of the President, Karolinska Institutet, Stockholm, Sweden; University of Oslo, Oslo, Norway
| | - Jason Phillips
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Sigrún Rawet
- Department for Multilateral Development Banks, Sustainability and Climate, Ministry for Foreign Affairs, Stockholm, Sweden
| | | | - Idil Shekh Mohamed
- Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden
| | - Ghazal Zazai
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | | | | | - Zulfiqar A Bhutta
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; The Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan; SickKids Centre for Global Child Health, Toronto, ON, Canada
| | - Peter Friberg
- Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden; School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Johnson-Agbakwu CE, Chen M, Salad M, Chaisson N, Connor JJ, Robinson BBE. Female genital cutting (FGC) type: proposing a multifaceted, interactive method for FGC self-assessment. J Sex Med 2023; 20:1292-1300. [PMID: 37721131 PMCID: PMC10627780 DOI: 10.1093/jsxmed/qdad101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Self-reporting female genital cutting (FGC) status and types by patients and clinicians is often inconsistent and inaccurate, particularly in community settings where clinically verifiable genital exams are not feasible or culturally appropriate. AIM In this study we sought to discern whether integrating multiple dimensions of participant engagement through self-reflection, visual imagery, and iterative discourse informed the determination of FGC status by a panel of health and cultural experts using World Health Organization (WHO) typology. METHODS Using community-based participatory research, we recruited 50 Somali women from the Minneapolis-St. Paul, MN, metropolitan area through convenience and snowball sampling to participate in semi-structured interviews. Participants were asked to discuss their recollection of their original circumcision-including the procedure itself and their assessment of the type of circumcision they experienced. Anatomical drawings of uncircumcised and circumcised vulvas were shown to participants to assist them in identifying their FGC type. A panel of health and cultural experts reviewed and independently assessed participant FGC type. Interrater reliability and degree of concordance between participants and panel were determined. OUTCOMES Outcomes included the following: (1) development of WHO-informed, anatomically accurate visual depictions of vulvas representing FGC typology, (2) development of an iterative, self-reflective process by which participants self-described their own FGC status aided by visual depictions of vulvas, (3) application of WHO FGC typology by a panel of health and cultural experts, and (4) determination of the degree of concordance between participants and panel in the classification of FGC type. RESULTS High interrater reliability (kappa = 0.64) and concordance (80%) between panel and participants were achieved. CLINICAL TRANSLATION Incorporation of FGC visual imagery combined with women's empowered use of their own self-described FGC status would optimize clinical care, patient education, and informed decision making between patients and their providers when considering medical and/or surgical interventions, particularly among women possessing limited health and anatomic literacy. STRENGTHS AND LIMITATIONS Strengths of this study include the incorporation of anatomically accurate visual representations of FGC types; the iterative, educational process by which participants qualitatively self-described their FGC status; and the high interrater reliability and concordance achieved between panel and participants. Study limitations include the inability to conduct clinical genital exams (due to the community-based methodology used), recall bias, and small sample size (n = 50). CONCLUSION We propose a new patient-informed educational method for integrating anatomically accurate visual imagery and iterative self-reflective discourse to investigate sensitive topics and guide clinicians in providing patient-centered, culturally informed care for patients with FGC.
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Affiliation(s)
- Crista E Johnson-Agbakwu
- Office of Health Equity and Division of Preventive and Behavioral Medicine, Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Muzi Chen
- Obstetrics and Gynecology, UMass Memorial Health, Worcester, MA, United States
| | - Munira Salad
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Nicole Chaisson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Jennifer Jo Connor
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Beatrice Bean E Robinson
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
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Hoyt CR, Clifton M, Smith CR, Woods L, Taff SD. Transforming Occupational Therapy for the 21st Century PAIRE: Recognize Privilege, Acknowledge Injustice, and Reframe Perspective to Reach Equity. Occup Ther Health Care 2023:1-24. [PMID: 37837307 PMCID: PMC11016132 DOI: 10.1080/07380577.2023.2265479] [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: 03/13/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023]
Abstract
Theories, models, and frameworks provide the foundation for occupational therapy education, research, and clinical practice. While most have a systems approach focus, other factors, such as societal influences and structural inequities, also contribute to health. Using a cross-sectional design, this study identified the gaps in occupational therapy models of practice and presents a novel approach, the PAIRE (Recognize Privilege, Acknowledge Injustice, and Reframe Perspective to Reach Equity) Model. PAIRE is focused on achieving occupational equity through the reciprocal and intersectional impact of the provider/team, the person/people seeking occupational therapy, and the occupation-in-context, with continuous influences of access, context, and justice. We describe the components of PAIRE and illustrate its functionality in education, research, and clinical practice contexts as well as case examples.
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Affiliation(s)
- Catherine R Hoyt
- Program in Occupational Therapy, WA University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Maribeth Clifton
- College of Allied Health Professions, Department of Health and Rehabilitation Sciences, Occupational Therapy Program, University of NE Medical Center, Omaha, NE, USA
| | | | | | - Steven D Taff
- Program in Occupational Therapy, WA University School of Medicine, St. Louis, MO, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Office of Education, Washington University School of Medicine, St. Louis, MO, USA
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Weeks WB, Chang JE, Pagán JA, Lumpkin J, Michael D, Salcido S, Kim A, Speyer P, Aerts A, Weinstein JN, Lavista JM. Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002420. [PMID: 37788228 PMCID: PMC10547156 DOI: 10.1371/journal.pgph.0002420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023]
Abstract
While rural-urban disparities in health and health outcomes have been demonstrated, because of their impact on (and intervenability to improve) health and health outcomes, we sought to examine cross-sectional and longitudinal inequities in health, clinical care, health behaviors, and social determinants of health (SDOH) between rural and non-rural counties in the pre-pandemic era (2015 to 2019), and to present a Health Equity Dashboard that can be used by policymakers and researchers to facilitate examining such disparities. Therefore, using data obtained from 2015-2022 County Health Rankings datasets, we used analysis of variance to examine differences in 33 county level attributes between rural and non-rural counties, calculated the change in values for each measure between 2015 and 2019, determined whether rural-urban disparities had widened, and used those data to create a Health Equity Dashboard that displays county-level individual measures or compilations of them. We followed STROBE guidelines in writing the manuscript. We found that rural counties overwhelmingly had worse measures of SDOH at the county level. With few exceptions, the measures we examined were getting worse between 2015 and 2019 in all counties, relatively more so in rural counties, resulting in the widening of rural-urban disparities in these measures. When rural-urban gaps narrowed, it tended to be in measures wherein rural counties were outperforming urban ones in the earlier period. In conclusion, our findings highlight the need for policymakers to prioritize rural settings for interventions designed to improve health outcomes, likely through improving health behaviors, clinical care, social and environmental factors, and physical environment attributes. Visualization tools can help guide policymakers and researchers with grounded information, communicate necessary data to engage relevant stakeholders, and track SDOH changes and health outcomes over time.
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Affiliation(s)
- William B. Weeks
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Ji E. Chang
- School of Global Public Health, New York University, New York, New York, United States of America
| | - José A. Pagán
- School of Global Public Health, New York University, New York, New York, United States of America
| | - Jeffrey Lumpkin
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Divya Michael
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Santiago Salcido
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Allen Kim
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | | | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - James N. Weinstein
- Microsoft Research, Microsoft Corporation, Redmond, Washington, United States of America
- The Dartmouth Institute and Tuck School of Business, Dartmouth College, Hanover, New Hampshire, United States of America
- Kellogg School of Business, Northwestern University, Evanston, Illinois, United States of America
| | - Juan M. Lavista
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
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Eapen D, Mbango C, Daniels G, Mathew Joseph N, Mary A, Mathews N, Carr KK, Wells C, Suriaga A, Saint Fleur A. Recommendations to improve maternal health equity among Black women in "The South": A position paper from the SNRS minority health research interest & implementation group. Res Nurs Health 2023; 46:457-461. [PMID: 37525299 DOI: 10.1002/nur.22332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
Black women in the United States experience a higher maternal mortality rate compared to other racial groups. The maternal mortality rate among non-Hispanic Black women is 3.5 times that of non-Hispanic White women and is higher in the South compared to other regions. The majority of pregnancy-related deaths in Black women are deemed to be preventable. Healthy People 2030 directs healthcare providers to advance health equity through societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. The Southern Nursing Research Society has put forward this position paper to provide recommendations to improve maternal health equity among Black women. Recommendations for nurses, multidisciplinary healthcare providers, policymakers, and researchers are discussed.
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Affiliation(s)
- Doncy Eapen
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Catherine Mbango
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Glenda Daniels
- Harris College of Nursing & Health Sciences, Texas Christian University, Fort Worth, Texas, USA
| | - Nitha Mathew Joseph
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Annapoorna Mary
- Loewenberg College of Nursing, The University of Memphis, Memphis, Tennessee, USA
| | - Nisha Mathews
- College of Human Sciences and Humanities, University of Houston-Clear Lake (Pearland), Pearland, Texas, USA
| | - Kathryn Kravetz Carr
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Cheryl Wells
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Armiel Suriaga
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
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Devine C, Ghosal R, Weller M, Doren T, Yu CH, Marsillo R, Kenton N. Longitudinal Policy and Systems Change as a Component of Community Power. FAMILY & COMMUNITY HEALTH 2023; 46:S41-S51. [PMID: 37696015 DOI: 10.1097/fch.0000000000000371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Community power represents the ability of communities to develop, sustain, and grow the capacity to participate in and advance systems change that addresses health inequities but is difficult to assess because of its multifaceted, longitudinal nature. Using California's school-based Local Control Funding Formula (LCFF) as an example, this article examines the interconnectedness of longitudinal policy and systems changes as one approach to understanding and visualizing evolving community power. Data on policy and systems changes were collected during the 10-year, place-based Building Healthy Communities initiative and coded using thematic analysis. Related changes within sites and between community and state levels were linked to show how changes built and overlapped over time. Around 45% of changes were interconnected and cascaded to build momentum within sites; in addition, a substantial proportion of statewide changes (68%) overlapped with community ones. The state-level LCFF policy led to multiple community-based changes over time, involving ongoing engagement from various community groups across communities. Local implementation of the LCFF policy change was used to illustrate the usefulness of connecting community-driven policy and systems changes over time to explore the dynamics of community power and address some of the limitations of that approach.
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Affiliation(s)
- Claire Devine
- Center for Outcomes Research & Education, Providence St Joseph Health, Portland, Oregon
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Heyn PC, Terhune EA, Dagne MB, Piper C, Welch VA, Francis D, Pizarro AB, Rizvi A, Sathe N, Dewidar O, Ovelman C, Duque T, Baker TA, Turner RW, Viswanathan M, Riddle D. Definitions, terminology, and related concepts of "racial health equity": a scoping review protocol. Syst Rev 2023; 12:185. [PMID: 37777803 PMCID: PMC10542690 DOI: 10.1186/s13643-023-02357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/24/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND In the USA, access to quality healthcare varies greatly across racial and ethnic groups, resulting in significant health disparities. A new term, "racial health equity" (RHE), is increasingly reported in the medical literature, but there is currently no consensus definition of the term. Additionally, related terms such as "health disparities," "health inequities," and "equality" have been inconsistently used when defining RHE. METHODS The primary purpose of this scoping review is to investigate the current use and underlying concepts used to define racial health equity. The study will address two key questions: (1) "What terminology and definitions have been used to characterize RHE?" and (2) "What knowledge gaps and challenges are present in the current state of RHE research and theory?" The review will collect and analyze data from three sources: (1) websites from key national and international health organizations, (2) theoretical and narrative published articles, and (3) evidence synthesis studies addressing interventions targeting racial health equity and minority stakeholder engagement. DISCUSSION Defining "racial health equity" and related terminology is the first step to advancing racial health equity within the USA. This review aims to offer an improved understanding of RHE constructs and definitions, bringing greater unity to national racial health equity research efforts across disciplines. SYSTEMATIC REVIEW REGISTRATION This protocol is registered with the Open Science Framework at https://osf.io/7pvzq .
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Affiliation(s)
- Patricia C Heyn
- Center for Optimal Aging, Marymount University, 2807 N. Glebe Road, Arlington, VA, 22207, USA.
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Elizabeth A Terhune
- Center for Optimal Aging, Marymount University, 2807 N. Glebe Road, Arlington, VA, 22207, USA
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Christi Piper
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Vivian A Welch
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Damian Francis
- Georgia College and State University, Milledgeville, GA, USA
| | - Ana B Pizarro
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
| | - Anita Rizvi
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Nila Sathe
- RTI International, RTI-UNC US Cochrane Affiliate, Chapel Hill, NC, USA
| | | | - Colleen Ovelman
- RTI International, RTI-UNC US Cochrane Affiliate, Chapel Hill, NC, USA
| | | | - Tamara A Baker
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Robert W Turner
- Department of Clinical Research and Leadership, George Washington University, Washington, DC, USA
| | - Meera Viswanathan
- RTI International, RTI-UNC US Cochrane Affiliate, Chapel Hill, NC, USA
| | - Dru Riddle
- Center for Translational Research, Texas Christian University, Fort Worth, TX, USA
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Pattillo M, Stieglitz S, Angoumis K, Gottlieb N. Racism against racialized migrants in healthcare in Europe: a scoping review. Int J Equity Health 2023; 22:201. [PMID: 37770879 PMCID: PMC10540333 DOI: 10.1186/s12939-023-02014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Racism is frequently mentioned as a social determinant of migrants' health and a barrier to health services. However, in the European context, racism and its impact on racialized migrants' access to healthcare is remarkably under-researched. This scoping review makes a first step toward filling this void by mapping the existing literature on racial and ethnic discrimination against racialized migrants in healthcare in Europe, identifying evidence gaps, and offering recommendations for future research on this topic. METHODS Following PRISMA guidelines, four databases were searched for empirical studies published in English between 1992 and 2022. Studies were included if they report findings on manifestations, experiences and/or impacts of racial or ethnic discrimination against racialized migrants in a healthcare setting in a European country. They were summarized by study characteristics (geographical scope, study design, research question and measures) and research findings were synthesized. RESULTS Out of 2365 initial hits, 1724 records were included in the title/abstract-screening, 87 records in the full text-screening, and 38 records in the data extraction. For many country and healthcare contexts, evidence on racism in healthcare is lacking. Most studies apply an explorative qualitative research design; comparability and generalizability of research results are low. Our analysis furthermore shows a near-exclusive research focus on racism on the interpersonal level as compared to institutional and structural levels. Our synthesis of study results identifies three interrelated ways in which racism manifests in and impacts migrants' healthcare: 1) general anti-migration bias, 2) health- and healthcare-related prejudice, and 3) differential medical treatment. CONCLUSIONS Our review underscores how racism reinforces inequities in healthcare access and quality for racialized migrants. It also highlights the need for more research on racism in Europe across a greater scope of country contexts, healthcare settings and migrant/racialized categories in order to understand specific forms of racism and capture race as a context-contingent social construct. It is critical that future research includes the consideration of individual-level racism as embedded in racism on institutional and structural levels. Methods and insights from other disciplines may help to critically examine concepts in light of underlying historical, sociopolitical and socioeconomic processes and structures, and to improve methods for researching racialization and racism in healthcare.
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Affiliation(s)
- Mia Pattillo
- Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10021, USA
| | - Sigsten Stieglitz
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany
| | - Konstantinos Angoumis
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany
| | - Nora Gottlieb
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany.
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Buckner A, Khau A, Martin A. Responding to multiple events in 2020: A qualitative study exploring areas of growth and development among California college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 37722866 DOI: 10.1080/07448481.2023.2253917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/25/2023] [Indexed: 09/20/2023]
Abstract
In 2020, the US was consumed by the COVID-19 pandemic and racial justice protests. California was further compounded by a devastating fall wildfire season. Negative effects related to these events have been documented in research. Objective: This study sought to expand the literature by exploring areas of personal growth and development among college students with a lens on the impact of these three events. Methods: A diverse group of undergraduate and graduate students enrolled in a large public university system in California were recruited to participate in one of six focus groups held during the winter of 2020/2021 with 35 students. Findings: Thematic analysis was used to develop three themes: 1) experiencing fluctuation and repetition, 2) understanding myself and the world, and 3) finding hope and wanting action. Conclusions: Findings suggest opportunities for academic institutions to enhance critical thinking about contemporary issues and support students in developing skills to navigate change and transition successfully.
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Affiliation(s)
- Anji Buckner
- Public Health and Recreation Department, San José State University, San José, California, USA
| | - Allyson Khau
- Public Health and Recreation Department, San José State University, San José, California, USA
- SJV PRIME Program, University of California San Francisco, San Francisco, California, USA
| | - Alana Martin
- Public Health and Recreation Department, San José State University, San José, California, USA
- Emergency Management, University of California Davis, Davis, California, USA
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Sabir M, Al-Tarshan Y, Snapp C, Brown M, Walker R, Han A, Kostrominova T. Analysis of COVID-19 Case Demographics and Disease Outcomes in Gary, Indiana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6729. [PMID: 37754588 PMCID: PMC10531445 DOI: 10.3390/ijerph20186729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/07/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND The COVID-19 pandemic further exposed the prevalence of existing health disparities in Black communities in the U.S. The current study evaluates COVID-19 data collected in Gary, Indiana, from June 2020 to June 2021. We hypothesized that the number of COVID-19 cases, hospitalizations, and deaths were influenced by race and income. METHODS In collaboration with the Gary Health Department (GHD), we analyzed demographic data on COVID-19-positive cases. RESULTS Compared to Gary's non-Black population, age- and population-adjusted rates of hospitalizations and deaths in the Black population were 3-fold (p < 0.0001) and 2-fold (p < 0.05) higher, respectively. This is despite a higher infection rate (p < 0.0001) in the non-Black population. The median household income of a zip code was negatively correlated with COVID-19 hospitalizations (R2 = 0.6345, p = 0.03), but did not correlate with infections and deaths. CONCLUSIONS The current study demonstrates clear health disparities of income and race in the context of COVID-19-related infections and outcomes in the city of Gary. Indiana University School of Medicine Northwest and GHD officials can collaborate to utilize these data for the reallocation of resources and health education efforts in Gary's highly populated, low-income, and predominantly Black neighborhoods. It should also prompt further investigation into national health resource allocation.
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Affiliation(s)
- Maryam Sabir
- Northwest Campus, Indiana University School of Medicine, Gary, IN 46408, USA; (M.S.); (Y.A.-T.); (C.S.)
| | - Yazan Al-Tarshan
- Northwest Campus, Indiana University School of Medicine, Gary, IN 46408, USA; (M.S.); (Y.A.-T.); (C.S.)
| | - Cameron Snapp
- Northwest Campus, Indiana University School of Medicine, Gary, IN 46408, USA; (M.S.); (Y.A.-T.); (C.S.)
| | - Martin Brown
- Gary Health Department, Gary, IN 46402, USA; (M.B.); (R.W.)
| | - Roland Walker
- Gary Health Department, Gary, IN 46402, USA; (M.B.); (R.W.)
| | - Amy Han
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Tatiana Kostrominova
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Weeks WB, Chang JE, Pagán JA, Aerts A, Weinstein JN, Ferres JL. An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health. Int J Equity Health 2023; 22:181. [PMID: 37670348 PMCID: PMC10478428 DOI: 10.1186/s12939-023-01984-6] [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: 06/20/2023] [Accepted: 08/10/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Socioeconomic status has long been associated with population health and health outcomes. While ameliorating social determinants of health may improve health, identifying and targeting areas where feasible interventions are most needed would help improve health equity. We sought to identify inequities in health and social determinants of health (SDOH) associated with local economic distress at the county-level. METHODS For 3,131 counties in the 50 US states and Washington, DC (wherein approximately 325,711,203 people lived in 2019), we conducted a retrospective analysis of county-level data collected from County Health Rankings in two periods (centering around 2015 and 2019). We used ANOVA to compare thirty-three measures across five health and SDOH domains (Health Outcomes, Clinical Care, Health Behaviors, Physical Environment, and Social and Economic Factors) that were available in both periods, changes in measures between periods, and ratios of measures for the least to most prosperous counties across county-level prosperity quintiles, based on the Economic Innovation Group's 2015-2019 Distressed Community Index Scores. RESULTS With seven exceptions, in both periods, we found a worsening of values with each progression from more to less prosperous counties, with least prosperous counties having the worst values (ANOVA p < 0.001 for all measures). Between 2015 and 2019, all except six measures progressively worsened when comparing higher to lower prosperity quintiles, and gaps between the least and most prosperous counties generally widened. CONCLUSIONS In the late 2010s, the least prosperous US counties overwhelmingly had worse values in measures of Health Outcomes, Clinical Care, Health Behaviors, the Physical Environment, and Social and Economic Factors than more prosperous counties. Between 2015 and 2019, for most measures, inequities between the least and most prosperous counties widened. Our findings suggest that local economic prosperity may serve as a proxy for health and SDOH status of the community. Policymakers and leaders in public and private sectors might use long-term, targeted economic stimuli in low prosperity counties to generate local, community health benefits for vulnerable populations. Doing so could sustainably improve health; not doing so will continue to generate poor health outcomes and ever-widening economic disparities.
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Affiliation(s)
| | - Ji E Chang
- NYU School of Global Public Health, New York, NY, USA
| | - José A Pagán
- NYU School of Global Public Health, New York, NY, USA
| | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
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Karalliedde J, French O, Burnhill G, Malhotra B, Spellman C, Jessel M, Ayotunde A, Newcombe L, Smith A, Thomas S, Rajasingam D. A pragmatic digital health informatics based approach for aiding clinical prioritisation and reducing backlog of care: A study in cohort of 4022 people with diabetes. Diabetes Res Clin Pract 2023; 203:110834. [PMID: 37478978 DOI: 10.1016/j.diabres.2023.110834] [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] [Received: 04/13/2023] [Revised: 06/17/2023] [Accepted: 07/17/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND AND AIMS The backlog of care in resource stretched healthcare systems requires innovative approaches to aid clinical prioritisation. Our aim was to develop an informatics tool to identify and prioritise people with diabetes who are likely to deteriorate whilst awaiting an appointment to optimise clinical outcomes and resources. MATERIALS AND METHODS Using data from electronic health care records we identified 6 risk-factors that could be addressed in 4022 people (52% male, 30% non-Caucasian) with diabetes attending a large university hospital in London. The risk-factors were new clinical events/data occurring since their last routine clinic visit. To validate and compare data-led prioritisation tool to a traditional 'clinical approach' a sample of 450 patients were evaluated. RESULTS Of the 4022 people, 549 (13.6%) were identified as having one or more risk events/factors. People with risk were more likely to be non-Caucasian and had greater socio-economic deprivation. Taking clinical prioritisation as the gold standard, informatics tool identified high risk patients with a sensitivity of 83% and lower risk patients with a specificity of 81%. An operational pilot pathway over 3 months using this approach demonstrated in 101 high risk people that 40% received interventions/care optimisation to prevent deterioration in health. CONCLUSION A pragmatic data-driven method identifies people with diabetes at highest need for clinical prioritisation within restricted resources. Health informatics systems such as our can enhance care and improve operational efficiency and better healthcare delivery for people with diabetes.
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Affiliation(s)
- J Karalliedde
- Guy's & St Thomas' NHS Foundation Trust London UK; School of Cardiovascular Medicine and Sciences, King's College London, London UK.
| | - O French
- Factor 50 Limited, Nottingham UK
| | | | - B Malhotra
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - C Spellman
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - M Jessel
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - A Ayotunde
- Guy's & St Thomas' NHS Foundation Trust London UK
| | | | - A Smith
- Factor 50 Limited, Nottingham UK
| | - S Thomas
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - D Rajasingam
- Guy's & St Thomas' NHS Foundation Trust London UK
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Charbonneau EJ, Grover P, Johns JS, McDowell SM, Stillo JV. Baseline Characteristics and Outcomes for People With and Without COVID-19 Diagnoses Receiving Inpatient Rehabilitation Care Across the US in 2020-2021. Arch Rehabil Res Clin Transl 2023; 5:100281. [PMID: 37744204 PMCID: PMC10517355 DOI: 10.1016/j.arrct.2023.100281] [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] [Indexed: 09/26/2023] Open
Abstract
Objective To assess sociodemographic, medical complexity, and outcomes of persons receiving care at inpatient rehabilitation facilities (IRFs) with and without a diagnosis of COVID-19. Design A retrospective cohort study using electronic medical record (EMR) data from 138 IRFs across 34 states and Puerto Rico. Setting N/A. Participants IRF EMR data for 212,663 patients discharged between 04/01/2020 and 05/31/2021 (N=212,663), of which 16,199 (COVID-19 group) had a primary or secondary COVID-19 diagnosis based upon ICD codes set (ICD-10 codes U07.1, B94.8, Z86.19, Z86.16). Main Outcome Measures Four categories: (a) sociodemographic, (b) medical complexity, (c) process, that is, standard IRF processes, and clinical outcomes (collected routinely as part of administrative reporting), and (d) functional outcomes. Patients with missing functional data associated with short/incomplete stays (n=623) were excluded from analysis of functional outcomes category only. Standard descriptive analysis techniques were employed for comparing categorical and continuous variables between groups. Results Statistically significant differences were noted between the COVID-19 group and non-COVID groups for race (26.0% vs 19.7% non-minority, P<.001), Case Mix Index (1.49 vs 1.46, P<.001), Center for Medicare and Medicaid Services 60% rule qualification (79.0% vs 73.4%, P<.001), time to onset (24.3 vs 18.0 days, P<.001), length of stay (14.2 vs 12.9 days, P<.001), and discharge disposition (to community: 75.3% vs 81%, P<.001; to acute care facility: 15.6% vs 10.8%, P<.001). The COVID-19 group had higher frequency of respiratory and cardiovascular disease, diabetes, encephalopathy, morbid obesity, and critical illness neuropathy and myopathy. Clinically insignificant differences were noted for age, sex, depression, and cognitive assessment. Ability to participate and functional outcomes were comparable between the groups. Conclusion There are significant differences between the COVID-19 and non-COVID group in some sociodemographic, medical complexity, process and clinical outcomes, but not in functional outcomes. The ability to participate in the IRF-required intensity of therapy services along with attainment of comparable levels of functional outcomes supports the benefit of IRFs for persons with COVID-19.
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Affiliation(s)
| | - Prateek Grover
- Encompass Health Corp, Birmingham, AL
- Washington University School of Medicine, St Louis, MO
| | - Jeffery S. Johns
- Encompass Health Corp, Birmingham, AL
- Vanderbilt University Medical Center, Nashville, TN
| | - Susan M. McDowell
- Encompass Health Corp, Birmingham, AL
- University of Kentucky, Lexington, KY
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Buckner-Capone A, Dougan M. Mandating COVID-19 Vaccination on Campus: A Qualitative Analysis of a Cross-Sectional Study of California College Students. Health Promot Pract 2023:15248399231192997. [PMID: 37615063 DOI: 10.1177/15248399231192997] [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: 08/25/2023]
Abstract
The purpose of this study was to examine college student perceptions related to institutional vaccine mandates. We utilized qualitative data (n = 2,212) from five open-ended questions in a cross-sectional study of students enrolled or intending to enroll in an institute of higher education in California in fall 2021. Data were collected between June and August 2021. Thematic analysis was employed to analyze student beliefs, and four themes were developed from the data: (1) Polarizing views and language; (2) deciding who to trust; (3) conveying rights and risk; and (4) staying focused on education. The themes represented vaccinated and nonvaccinated student perspectives, capturing views about trust, rights, and risk. Many responses were polarizing and included language that was emotional and political. Despite the range of responses, most students expressed appreciation and approval of the vaccination mandate on college campuses. Findings illustrate the important contributions of qualitative research and suggest opportunities for public health practitioners to lead and engage in critical dialogue about science and public health practices as we aim to promote public perceptions of vaccination programs and health promotion practice.
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Jenks JD, Nipp E, Tadikonda A, Karumuri N, Morales-Lagunes K, Carrico S, Mortiboy M, Zitta JP. Relationship Between Sexually Transmitted Infections and Social Determinants of Health in Durham County, North Carolina, United States. Open Forum Infect Dis 2023; 10:ofad368. [PMID: 37520426 PMCID: PMC10372853 DOI: 10.1093/ofid/ofad368] [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: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
Background Sexually transmitted infections (STIs) are increasing in the United States, and certain populations are more at risk than others. One explanation for this is inequities in underlying social determinants of health (SDOH). Methods We analyzed chlamydia, gonorrhea, and syphilis cases in Durham County, North Carolina, from 01/01/2020 to 12/31/2020 by select SDOH at the census tract level. We included 48 variables of interest, including variables related to income, education, transportation, and health insurance. For each variable, we modeled STI incidence at the census tract level using Poisson regression. Wald's chi-square was used to determine which variables were significantly associated with STI incidence. Results Of 24 variables that were statistically associated with STI incidence at the census tract level, 9 were negatively associated and 15 positively associated with STI incidence. Having employer health insurance was most strongly associated with lower-than-expected STI incidence, and having Medicaid insurance, no health insurance, using public transportation, and income below the poverty level were most strongly associated with higher-than-expected STI incidence. Lastly, STI incidence was not associated with race or ethnicity overall across Durham County, except in historically marginalized areas, where we found higher-than-expected STI incidence. Conclusions We found that lacking health insurance, having Medicaid insurance, using public transportation, and income below the poverty level were most strongly associated with higher-than-expected STI incidence. Strategies to combat increasing STIs may include improving access to health insurance, reducing barriers to cost-effective and timely transportation to medical appointments, and raising wages to bring individuals out of poverty.
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Affiliation(s)
- Jeffrey D Jenks
- Correspondence: Jeffrey Jenks, MD, MPH, Durham County Department of Public Health, Human Services Building, 414 East Main Street, Durham, NC 27701 ()
| | - Emma Nipp
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ananya Tadikonda
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nishitha Karumuri
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristie Morales-Lagunes
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Savannah Carrico
- Durham County Department of Public Health, Durham, North Carolina, USA
| | - Marissa Mortiboy
- Durham County Department of Public Health, Durham, North Carolina, USA
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Huff M, Jhaveri SV, Khan A, Pedraza L, Pesantez Borja M, Santos Cantu D, Chang C. Cultural Competence Guides for COVID-19 Messaging in Hispanic Communities. Cureus 2023; 15:e40820. [PMID: 37485110 PMCID: PMC10362974 DOI: 10.7759/cureus.40820] [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] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
PURPOSE The Rio Grande Valley in South Texas comprises 5% percent of Texas's population yet 17%of Texas's COVID-19 deaths. We aimed to address underlying mistrust and systemic racism in our Hispanic community that contributes to health inequities by developing a cultural competence guide for public health messaging. METHODS We employed a mixed method design (e.g., focus groups, surveys, interviews) to develop and implement a cultural competence guide in an iterative community-informed process. We created a general cultural competence guide, one for the Hispanic community and one for the hard-of-hearing community. RESULTS Our cultural competence guides provide an interpretation as to whether the message is culturally competent or requires revisions. The guides have the following five categories: content and clarity, emotions and values, audience and inclusivity, call to action, and gestalt. CONCLUSIONS The Hispanic community needs more culturally competent public health messaging to address a key root cause of health inequities surrounding COVID-19. Our novel, concise guides can help organizations and individuals seeking to create culturally sensitive and, therefore, more effective public health messaging for Hispanic or deaf and hard-of-hearing communities.
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Affiliation(s)
- Madeline Huff
- Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, USA
| | - Shuchita V Jhaveri
- Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, USA
| | - Ayesha Khan
- Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, USA
| | - Lina Pedraza
- Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, USA
| | - Maria Pesantez Borja
- Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, USA
| | - Daniela Santos Cantu
- Family Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, USA
| | - Chelsea Chang
- Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, USA
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Cai J. Food Insecurity and COVID-19 Infection: Findings From the 2020-2021 National Health Interview Survey. AJPM FOCUS 2023; 2:100069. [PMID: 36687320 PMCID: PMC9847318 DOI: 10.1016/j.focus.2023.100069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Introduction The purpose of this study was to examine the sociodemographic and health-related factors associated with food insecurity and the association between food insecurity and COVID-19 infection using a nationally representative sample in the U.S. Methods Cross-sectional data of 61,050 adults (aged ≥18 years) from the 2020 and 2021 National Health Interview Survey were analyzed. Food insecurity was measured by the 10-item U.S. Department of Agriculture Food Security Survey Module. Weighted multivariable logistic regression models were used to estimate associations with food insecurity. Results A total of 6.8% of the National Health Interview Survey participants lived in food-insecure households, and 18.9% tested positive for COVID-19 infection. Young (aged 18-34 years) or middle (aged 35-64 years) age, female sex, minor race/ethnicity (Hispanic/non-Hispanic Black/non-Hispanic Asian/others), education level less than high school, unmarried status, unemployment, poverty (below the federal poverty level), having no health insurance, a larger number of adults and children in the household, poorer self-reported health status, and the presence of chronic conditions were significantly associated with food insecurity (AOR ranged from 1.20 to 3.15, all p<0.0001). Food insecurity was independently associated with positive COVID-19 infection (AOR=1.25, 95% CI=1.11, 1.40), controlling for sociodemographic and health-related factors. The greatest magnitude of the association was observed for the non-Hispanic Black participants (AOR=1.47, 95% CI=1.15, 1.88), female participants (AOR=1.44, 95% CI=1.20, 1.71), and those below the federal poverty level (AOR=1.39, 95% CI=1.12, 1.73) across all the subgroups. Conclusions Food insecurity disproportionately affected vulnerable subgroups such as young adults, female individuals, minority race/ethnicity groups, and those with lower socioeconomic status, and was associated with positive COVID-19 infection. Policies addressing food insecurity may help to reduce the likelihood of COVID-19 infection, especially for those vulnerable subgroups.
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Affiliation(s)
- Jiahui Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, Indiana
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Anneser E, Stopka TJ, Naumova EN, Spangler KR, Lane KJ, Acevedo A, Griffiths JK, Lin Y, Levine P, Corlin L. Environmental equity and COVID-19 experiences in the United States: Results from three survey waves of a nationally representative study conducted between 2020-2022. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.16.23290050. [PMID: 37293071 PMCID: PMC10246057 DOI: 10.1101/2023.05.16.23290050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Certain environmental exposures, such as air pollution, are associated with COVID-19 incidence and mortality. To determine whether environmental context is associated with other COVID-19 experiences, we used data from the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Study data (n=1785; three survey waves 2020-2022). Environmental context was assessed using self-reported climate stress and county-level air pollution, greenness, toxic release inventory site, and heatwave data. Self-reported COVID-19 experiences included willingness to vaccinate against COVID-19, health impacts from COVID-19, receiving assistance for COVID-19, and provisioning assistance for COVID-19. Self-reported climate stress in 2020 or 2021 was associated with increased COVID-19 vaccination willingness by 2022 (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 1.47, 3.76), even after adjusting for political affiliation (OR = 1.79; 95% CI = 1.09, 2.93). Self-reported climate stress in 2020 was also associated with increased likelihood of receiving COVID-19 assistance by 2021 (OR = 1.89; 95% CI = 1.29, 2.78). County-level exposures (i.e., less greenness, more toxic release inventory sites, more heatwaves) were associated with increased vaccination willingness. Air pollution exposure in 2020 was positively associated with likelihood of provisioning COVID-19 assistance in 2020 (OR = 1.16 per μg/m3; 95% CI = 1.02, 1.32). Associations between certain environmental exposures and certain COVID-19 outcomes were stronger among those who identify as a race/ethnicity other than non-Hispanic White and among those who reported experiencing discrimination; however, these trends were not consistent. A latent variable representing a summary construct for environmental context was associated with COVID-19 vaccination willingness. Our results add to the growing body of literature suggesting that intersectional equity issues affecting likelihood of exposure to adverse environmental conditions are also associated with health-related outcomes.
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Affiliation(s)
- Elyssa Anneser
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Tufts Clinical and Translational Sciences Institute, Boston, MA, USA
| | - Elena N. Naumova
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, USA
- Division of Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Keith R. Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Kevin J. Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Andrea Acevedo
- Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA, USA
| | - Jeffrey K. Griffiths
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, USA
- Department of Infectious Disease and Global Health, Tufts University Cummings School of Veterinary Medicine, Grafton, MA, USA
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Yan Lin
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Peter Levine
- Jonathan Tisch College of Civic Life, Tufts University, Medford, MA, USA
| | - Laura Corlin
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, USA
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Besera G, Goldberg H, Okoroh EM, Snead MC, Johnson-Agbakwu CE, Goodwin MM. Attitudes and Experiences Surrounding Female Genital Mutilation/Cutting in the United States: A Scoping Review. J Immigr Minor Health 2023; 25:449-482. [PMID: 36542264 PMCID: PMC10981529 DOI: 10.1007/s10903-022-01437-2] [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] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
To identify research and gaps in literature about FGM/C-related attitudes and experiences among individuals from FGM/C-practicing countries living in the United States, we conducted a scoping review guided by Arksey and O'Malley's framework. We searched Medline (OVID), Embase (OVID), PubMed, and SCOPUS and conducted a grey literature search for studies assessing attitudes or experiences related to FGM/C with data collected directly from individuals from FGM/C-practicing countries living in the United States. The search yielded 417 studies, and 40 met the inclusion criteria. Findings suggest that women and men from FGM/C-practicing countries living in the United States generally oppose FGM/C, and that women with FGM/C have significant physical and mental health needs and have found US healthcare providers to lack understanding of FGM/C. Future research can improve measurement of FGM/C by taking into account the sociocultural influences on FGM/C-related attitudes and experiences.
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Affiliation(s)
- Ghenet Besera
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, Georgia
| | | | - Ekwutosi M Okoroh
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, Georgia
| | - Margaret Christine Snead
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, Georgia.
| | - Crista E Johnson-Agbakwu
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, Georgia
- Obstetrics and Gynecology, Valleywise Health, University of Arizona College of Medicine, Phoenix, AZ, Georgia
- Creighton University School of Medicine, Phoenix, AZ, Georgia
- District Medical Group, Phoenix, AZ, Georgia
| | - Mary M Goodwin
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, Georgia
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Johnson-Agbakwu CE, Fox KA, Banke-Thomas A, Michlig GJ. Influence of Female Genital Mutilation/Cutting on Health Morbidity, Health Service Utilization and Satisfaction with Care among Somali Women and Teenage Girls in the United States. J Racial Ethn Health Disparities 2023; 10:788-796. [PMID: 35258838 PMCID: PMC9988763 DOI: 10.1007/s40615-022-01266-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is scant evidence on the health morbidities experienced by Somali women and girls affected by female genital mutilation/cutting (FGM/C) and their resultant health-seeking behavior in the USA as compared to those who have not undergone the procedure. To fill this gap, we conducted a comprehensive examination of health morbidity among women and teenage girls with and without FGM/C in a Somali migrant community. METHODS Using a comprehensive community-based participatory research approach, a cross-sectional survey was administered to 879 Somali women and teenage girls in Phoenix and Tucson, Arizona. We employed Chi-square and analysis of variance to disentangle health and healthcare use among those with and without FGM/C. RESULTS The majority of respondents had undergone FGM/C (79%). Respondents with FGM/C experienced significantly more health concerns compared to uncut women and girls, with those possessing Type III FGM/C experiencing significantly more obstetric, gynecologic, sexual, and mental health morbidity than those with Type I or Type II. Rates of service use, while varied, were low overall, particularly for mental health services, even with health insurance. The majority of respondents who sought care indicated that their concerns were resolved, and they were satisfied with the healthcare received. CONCLUSIONS Community-engaged strategies that build upon satisfaction with care of women who seek care to enhance trust, nurture community embeddedness and facilitate peer navigation, while equipping health and social service providers with the competency and tools to provide respectful, trauma-informed care, will be critical to advance health equity for FGM/C-affected communities.
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Affiliation(s)
- Crista E Johnson-Agbakwu
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA.,School of Medicine, Creighton University, Phoenix, AZ, USA.,District Medical Group, Phoenix, AZ, USA
| | - Kathleen A Fox
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA.,School of Criminology and Criminal Justice, Arizona State University, Phoenix, AZ, USA
| | - Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, London, UK. .,LSE Health, London School of Economics and Political Science, London, UK.
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Mavragani A, Purushothaman V, Calac AJ, McMann T, Li Z, Mackey T. Estimating County-Level Overdose Rates Using Opioid-Related Twitter Data: Interdisciplinary Infodemiology Study. JMIR Form Res 2023; 7:e42162. [PMID: 36548118 PMCID: PMC9909516 DOI: 10.2196/42162] [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: 08/24/2022] [Revised: 10/26/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There were an estimated 100,306 drug overdose deaths between April 2020 and April 2021, a three-quarter increase from the prior 12-month period. There is an approximate 6-month reporting lag for provisional counts of drug overdose deaths from the National Vital Statistics System, and the highest level of geospatial resolution is at the state level. By contrast, public social media data are available close to real-time and are often accessible with precise coordinates. OBJECTIVE The purpose of this study is to assess whether county-level overdose mortality burden could be estimated using opioid-related Twitter data. METHODS International Classification of Diseases (ICD) codes for poisoning or exposure to overdose at the county level were obtained from CDC WONDER. Demographics were collected from the American Community Survey. The Twitter Application Programming Interface was used to obtain tweets that contained any of the 36 terms with drug names. An unsupervised classification approach was used for clustering tweets. Population-normalized variables and polynomial population-normalized variables were produced. Furthermore, z scores of the Getis Ord Gi clustering statistic were produced, and both these scores and their polynomial counterparts were explored in regression modeling of county-level overdose mortality burden. A series of linear regression models were used for predictive modeling to explore the interpretability of the analytical output. RESULTS Modeling overdose mortality with normalized demographic variables alone explained only 7.4% of the variability in county-level overdose mortality, whereas this was approximately doubled by the use of specific demographic and Twitter data covariates based on a backward selection approach. The highest adjusted R2 and lowest AIC (Akaike Info Criterion) were obtained for the model with normalized demographic variables, normalized z scores from geospatial analyses, and normalized topic counts (adjusted R2=0.133, AIC=8546.8). The z scores of the Getis Ord Gi statistic appeared to have improved utility over population-normalization alone. In this model, median age, female population, and tweets about web-based drug sales were positively associated with opioid mortality. Asian race and Hispanic ethnicity were significantly negatively associated with county-level burdens of overdose mortality. CONCLUSIONS Social media data, when transformed using certain statistical approaches, may add utility to the goal of producing closer to real-time county-level estimates of overdose mortality. Prediction of opioid-related outcomes can be advanced to inform prevention and treatment decisions. This interdisciplinary approach can facilitate evidence-based funding decisions for various substance use disorder prevention and treatment programs.
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Affiliation(s)
| | - Vidya Purushothaman
- Global Health Policy and Data Institute, San Diego, CA, United States.,San Diego Supercomputer Center, San Diego, CA, United States
| | - Alec J Calac
- School of Medicine, University of California, San Diego, La Jolla, CA, United States.,Global Health Policy and Data Institute, San Diego, CA, United States
| | - Tiana McMann
- Global Health Policy and Data Institute, San Diego, CA, United States.,San Diego Supercomputer Center, San Diego, CA, United States.,Department of Anthropology, University of California, San Diego, La Jolla, CA, United States.,S-3 Research, San Diego, CA, United States
| | - Zhuoran Li
- Global Health Policy and Data Institute, San Diego, CA, United States.,San Diego Supercomputer Center, San Diego, CA, United States.,S-3 Research, San Diego, CA, United States
| | - Tim Mackey
- Global Health Policy and Data Institute, San Diego, CA, United States.,San Diego Supercomputer Center, San Diego, CA, United States.,Department of Anthropology, University of California, San Diego, La Jolla, CA, United States.,S-3 Research, San Diego, CA, United States
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The Hospitalized Adolescent. Pediatrics 2023; 151:190500. [PMID: 37184363 DOI: 10.1542/peds.2022-060647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/25/2023] Open
Abstract
This clinical report provides pediatricians evidence-based information on the developmentally appropriate, comprehensive clinical care for hospitalized adolescents. Included in this report are opportunities and challenges facing pediatricians when caring for specific hospitalized adolescent populations. The companion policy statement, “The Hospitalized Adolescent,” includes detailed descriptions of adolescent hospital admission demographics, personnel recommendations, and hospital setting and design advice, as well as sections on educational services, legal and ethical matters, and transitions to adult facilities.
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Barriers to Breast Cancer-Screening Adherence in Vulnerable Populations. Cancers (Basel) 2023; 15:cancers15030604. [PMID: 36765561 PMCID: PMC9913751 DOI: 10.3390/cancers15030604] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/19/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
Breast cancer screening through periodic mammography has been effective in decreasing mortality and reducing the impact of this disease. However, adherence to screening does not meet the desired expectations from all populations. The main objective of this review is to explore the barriers that affect adherence to breast cancer-screening programs in vulnerable populations according to race and/or ethnicity in order to propose measures to reduce the lack of adherence. We conducted a search of publications in the PubMed Central and Scopus databases. The eligible criteria for the articles were as follows: original quantitative studies appearing in SJR- and/or JCR-indexed journals from 2016 to 2021 in English or Spanish. Most of them present common barriers, such as race/ethnicity (47%), low socioeconomic (35.3%) and educational levels (29.4%), no family history of cancer and being single (29.4%), medical mistrust and a health information gap (23.5%), lack of private health insurance (17.6%) and not having annual health checks (17.6%). The target populations with the lowest adherence were Black, Asian, Hispanic and foreign women. Implementing awareness campaigns focused on these populations should be promoted, as well as working on diversity, cultural acceptance and respect with healthcare workers, in order to improve breast cancer-screening adherence worldwide.
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Barrett NJ, Boehmer L, Schrag J, Benson AB, Green S, Hamroun-Yazid L, Howson A, Matin K, Oyer RA, Pierce L, Jeames SE, Winkfield K, Yang ES, Zwicker V, Bruinooge S, Hurley P, Williams JH, Guerra CE. An Assessment of the Feasibility and Utility of an ACCC-ASCO Implicit Bias Training Program to Enhance Racial and Ethnic Diversity in Cancer Clinical Trials. JCO Oncol Pract 2023; 19:e570-e580. [PMID: 36630671 DOI: 10.1200/op.22.00378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Cancer trial participants do not reflect the racial and ethnic diversity in the population of people with cancer in the United States. As a result of multiple system-, patient-, and provider-level factors, including implicit bias, cancer clinical trials are not consistently offered to all potentially eligible patients. MATERIALS AND METHODS ASCO and ACCC evaluated the utility (pre- and post-test knowledge changes) and feasibility (completion rates, curriculum satisfaction metrics, survey questions, and interviews) of a customized online training program combined with facilitated peer-to-peer discussion designed to help research teams identify their own implicit biases and develop strategies to mitigate them. Discussion focused on (1) specific elements of the training modules; (2) how to apply lessons learned; and (3) key considerations for developing a facilitation guide to support peer-to-peer discussions in cancer clinical research settings. We evaluated discussion via a qualitative assessment. RESULTS Participant completion rate was high: 49 of 50 participating cancer programs completed training; 126 of 129 participating individuals completed the training (98% response rate); and 119 completed the training and evaluations (92% response rate). Training increased the mean percentage change in knowledge scores by 19%-45% across key concepts (eg, causes of health disparities) and increased the mean percentage change in knowledge scores by 10%-31% about strategies/actions to address implicit bias and diversity concerns in cancer clinical trials. Knowledge increases were sustained at 6 weeks. Qualitative evaluation validated the utility and feasibility of facilitated peer-to-peer discussion. CONCLUSION The pilot implementation of the training program demonstrated excellent utility and feasibility. Our evaluation affirms that an online training designed to raise awareness about implicit bias and develop strategies to mitigate biases among cancer research teams is feasible and can be readily implemented in cancer research settings.
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Affiliation(s)
- Nadine J Barrett
- Duke Clinical and Translational Science Institute and Duke Cancer Institute, Durham, NC
| | - Leigh Boehmer
- Association of Community Cancer Centers, Rockville, MD
| | | | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Sybil Green
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | - Randall A Oyer
- Penn Medicine Lancaster General Health Ann B Barshinger Cancer Institute, Lancaster, PA
| | | | | | - Karen Winkfield
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN
| | - Eddy S Yang
- O'Neal Comprehensive Cancer Center at University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - Carmen E Guerra
- University of Pennsylvania Raymond and Ruth Perelman School of Medicine, Philadelphia, PA
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Xu D, Arling G. Are Frail Older People from Racial/Ethnic Minorities at Double Jeopardy of Putting off Healthcare during the Pandemic? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1034. [PMID: 36673788 PMCID: PMC9859101 DOI: 10.3390/ijerph20021034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Given the differential impacts of COVID-19 on racial and ethnic groups, it is unclear how racial/ethnic status and frailty combine to influence pandemic-related healthcare disruptions. This study aimed to test the double jeopardy hypothesis: racial/ethnic minority older adults suffer a double disadvantage in access to health care during the pandemic due to the interactive effects of frailty and race. This study uses the linked National Health and Aging Trends Study (NHATS) and COVID-19 public use data files. A multivariate logistic regression model was performed. Overall, approximately two out of five (41%) older adults reported postponing care due to the pandemic. The likelihood of putting off care increased slightly by frailty status. We found no significant difference between Whites and non-Whites in putting off care. However, the simple comparison masked significant variation across frailty status. Robust non-White older people were less likely to put off care than robust Whites (robust non-Whites: 29% vs. robust Whites: 39%); in contrast, frail non-White older people were more likely to put off care (frail non-Whites: 55% vs. frail Whites: 42%). Being frail and non-White creates double jeopardy, which has a negative impact on access to healthcare. Timely access to care is essential for frail older people, particularly non-Whites, because of their complex health conditions accentuated by health and social disparities.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Purdue University, West Lafayette, IN 47907, USA
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Mittal S, Alsbrook D, Okwechime RT, Iqbal F, Nobleza COS. The landscape of disparities in obstetric neurocritical care and a path forward. Front Neurol 2023; 13:1008544. [PMID: 36686512 PMCID: PMC9853894 DOI: 10.3389/fneur.2022.1008544] [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: 07/31/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
Health disparities in the obstetric population affect maternal morbidity and mortality. In the past years, there has been no significant improvement in disparities in care in the obstetric population. Patients who are pregnant are known to have a higher risk of pregnancy-associated neurologic conditions such as stroke and intracerebral hemorrhage. They can also experience concomitant neurocritical care disease states such as status epilepticus and traumatic brain injury. Studies exploring the disparities of care among pregnant patients who are neurotically ill are lacking. We aim to provide the landscape of disparities of care among the obstetric neurocritically-ill population and provide potential actionable opportunities to address these disparities in care.
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Affiliation(s)
- Shilipi Mittal
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Diana Alsbrook
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Remi T. Okwechime
- NeuroMedicine ICU, Critical Care Program University of Rochester Medical Center, Rochester, NY, United States
| | - Farhana Iqbal
- Maimonides Medical Center, Brooklyn, NY, United States
| | - Christa O'Hana S. Nobleza
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States,Baptist Memorial Hospital/Baptist Medical Group, Memphis, TN, United States,*Correspondence: Christa O'Hana S. Nobleza ✉
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Johnson-Agbakwu CE, Michlig GJ, Koukoui S, Akinsulure-Smith AM, Jacobson DS. Health outcomes and female genital mutilation/cutting: how much is due to the cutting itself? Int J Impot Res 2023; 35:218-227. [PMID: 36599966 PMCID: PMC10159850 DOI: 10.1038/s41443-022-00661-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 10/13/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023]
Abstract
While Female Genital Mutilation/Cutting (FGM/C) continues to garner global attention, FGM/C-affected migrant communities, who are often racialized minorities in the U.S., face additional challenges which may impact their physical and mental health and well-being. It has been proposed that an overly narrow focus on the female genitalia or FGM/C status alone, while ignoring the wider social experiences and perceptions of affected migrant women, will result in incomplete or misleading conclusions about the relationship between FGM/C and migrant women's health. A cross-sectional study was conducted across two waves of Somali and Somali Bantu women living in the United States, (n = 879 [wave 1], n = 654 [wave 2]). Socio-demographics, self-reported FGM/C status, perceived psychological distress, and self-reported FGM/C-related health morbidity was examined against self-reported experiences of everyday discrimination and perceived psychosocial support. In statistical models including age and educational attainment as potentially confounding socio-demographic variables, as well as self-reported FGM/C status, self-reported discrimination, and perceived psychosocial support, self-reported discrimination was the variable most strongly associated with poor physical health and psychological distress (i.e., FGM/C-related health morbidity and psychological distress), with greater perceived psychosocial support negatively associated with psychological distress, when controlling for all the other variables in the model. FGM/C status was not significantly associated with either outcome. Discrimination, more frequently reported among 'No FGM/C' (i.e., genitally intact or unmodified) women, was most frequently perceived as linked to religion and ethnicity. Our findings are consistent with views that discrimination drives negative outcomes. In this population, discrimination may include the 'quadruple jeopardy' of intersecting relationships among gender, race, religion, and migration status. We find that self-reported experiences of discrimination-and not FGM/C status per se-is associated with adverse physical and mental health consequences in our sample drawn from Somali migrant communities living in the United States, and that social support may help to mitigate these consequences. Our findings thus reinforce calls to better contextualize the relationship between FGM/C and measures of health and well-being among Somali women in the United States (regardless of their FGM/C status), taking psychosocial factors more centrally into account.Clinical Trials.Gov ID no. NCT03249649, Study ID no. 5252. Public website: https://clinicaltrials.gov/ct2/show/NCT03249649.
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Affiliation(s)
- Crista E Johnson-Agbakwu
- Southwest Interdisciplinary Research Center, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, USA. .,Refugee Women's Health Clinic, Valleywise Health, Phoenix, AZ, USA. .,Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA. .,District Medical Group, Phoenix, AZ, USA.
| | | | - Sophia Koukoui
- Université de Montréal, Psychology Department, Montreal, QC, Canada.,CIUSS Centre Ouest-de-l'ile-de-Montréal-Sherpa, Montreal, QC, Canada
| | - Adeyinka M Akinsulure-Smith
- The City College of New York, Department of Psychology, New York, NY, USA.,City University of New York, The Graduate Center, New York, NY, USA
| | - Danielle S Jacobson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Maiers MJ. The John A. Sweaney Lecture: Virtual, September 2021, Given by Dr Michele Maiers. A Time to Lead: Reflections During a Pandemic. JOURNAL OF CHIROPRACTIC HUMANITIES 2022; 29:7-14. [PMID: 35899149 PMCID: PMC9307899 DOI: 10.1016/j.echu.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
The following is The John A. Sweaney Lecture delivered by Dr Michele Maiers at the biannual Congress of the World Federation of Chiropractic that was held virtually on September 25, 2021.
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Affiliation(s)
- Michele J. Maiers
- American Chiropractic Association, Arlington, Virginia
- Northwestern Health Sciences University, Bloomington, Minnesota
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