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Beaton M, Jiang X, Minto E, Lau CY, Turner L, Hripcsak G, Chaudhari K, Natarajan K. Using patient portals for large-scale recruitment of individuals underrepresented in biomedical research: an evaluation of engagement patterns throughout the patient portal recruitment process at a single site within the All of Us Research Program. J Am Med Inform Assoc 2024; 31:2328-2336. [PMID: 38917428 DOI: 10.1093/jamia/ocae135] [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: 03/06/2024] [Revised: 04/19/2024] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE To evaluate the use of patient portal messaging to recruit individuals historically underrepresented in biomedical research (UBR) to the All of Us Research Program (AoURP) at a single recruitment site. MATERIALS AND METHODS Patient portal-based recruitment was implemented at Columbia University Irving Medical Center. Patient engagement was assessed using patient's electronic health record (EHR) at four recruitment stages: Consenting to be contacted, opening messages, responding to messages, and showing interest in participating. Demographic and socioeconomic data were also collected from patient's EHR and univariate logistic regression analyses were conducted to assess patient engagement. RESULTS Between October 2022 and November 2023, a total of 59 592 patients received patient portal messages inviting them to join the AoURP. Among them, 24 445 (41.0%) opened the message, 8983 (15.1%) responded, and 3765 (6.3%) showed interest in joining the program. Though we were unable to link enrollment data with EHR data, we estimate about 2% of patients contacted ultimately enrolled in the AoURP. Patients from underrepresented race and ethnicity communities had lower odds of consenting to be contacted and opening messages, but higher odds of showing interest after responding. DISCUSSION Patient portal messaging provided both patients and recruitment staff with a more efficient approach to outreach, but patterns of engagement varied across UBR groups. CONCLUSION Patient portal-based recruitment enables researchers to contact a substantial number of participants from diverse communities. However, more effort is needed to improve engagement from underrepresented racial and ethnic groups at the early stages of the recruitment process.
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Affiliation(s)
- Maura Beaton
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Xinzhuo Jiang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Elise Minto
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Chun Yee Lau
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Lennon Turner
- Center for Precision Medicine and Genomics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Kanchan Chaudhari
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
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Rising KL, Guth A, Gentsch AT, Martin Gonzalez K, Hass R, Shughart L, Gelfer S, McVane M, Worster B, Leader AE. Development and Preliminary Validation of a Screener for Digital Health Readiness. JAMA Netw Open 2024; 7:e2432718. [PMID: 39254972 PMCID: PMC11388026 DOI: 10.1001/jamanetworkopen.2024.32718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
Importance While telehealth use has grown, patient uptake is variable, which has the potential to increase health disparities. Identifying and understanding individuals' barriers to digital health readiness can help health systems efficiently deploy resources to provide personalized patient-centered support. Objective To develop and validate an instrument to evaluate digital health readiness to identify and quantify barriers to digital readiness. Design, Setting, and Participants In this qualitative mixed-methods study conducted from April 26, 2022, to June 8, 2023, the instrument was created in 4 phases. Patients and health care professionals were interviewed to explore barriers to telehealth use, scale items were developed for the screener, cognitive interviews were conducted to refine scale items, and psychometric properties of the screener were evaluated. The study was conducted in an urban, multisite academic health system and the surrounding community. Participants were older than 18 years, English-speaking, and able to provide informed consent. Professionals worked within the Jefferson Health system and were involved in telehealth services. Exposure Participants completed a semistructured interview (duration: 6-19 minutes), a cognitive interview (duration: 13-137 minutes), or the draft screener survey (duration: 5-10 minutes). Main Outcomes and Measures Development and validation of a screener for digital health readiness. Results Of 519 patients approached, 19 were ineligible, 122 declined, and 11 were excluded from analysis, resulting in inclusion of 367 participants (32 patient interviews, 16 professional interviews, 15 cognitive interviews, 304 psychometric survey testing). All 16 professionals who were approached participated. Most patient participants were Black (46.7%) or White (37.9%), male (56.4%), and had a high school degree or some college (49.6%); mean (SD) age was 45 (23) years for participants in cognitive interviews, 53 (18) years for survey respondents, and 57 (14) years for patient interviews. The structured interviews uncovered 21 concepts, leading to 48 items that were refined through cognitive interviews. Psychometric analyses of the 29 items that emerged from the cognitive interviews resulted in a final screener with 24 items across 2 factors: technical readiness (18 items; factor loading range, 0.488-0.968) and quality-of-care concerns (6 items; factor loading range, 0.619-0.942). Conclusions and Relevance In this qualitative study of digital health readiness, the findings suggest that the screener items may be valid to assess the complexity of factors influencing digital health uptake and highlight several areas for potential intervention.
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Affiliation(s)
- Kristin L Rising
- Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amanda Guth
- Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexzandra T Gentsch
- Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Richard Hass
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lindsey Shughart
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Serena Gelfer
- Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Megan McVane
- Department of Geriatrics, Edward Hines Jr Veterans Administration Hospital, Hines, Illinois
| | - Brooke Worster
- Division of Supportive Medicine, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amy E Leader
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Tong Y, Rajahraman V, Gupta R, Schwarzkopf R, Rozell JC. Patient Demographic Factors Impact KOOS JR Response Rates for Total Knee Arthroplasty Patients. J Knee Surg 2024; 37:784-788. [PMID: 38776975 DOI: 10.1055/s-0044-1787055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
The Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) is a validated patient-reported measure for assessing pain and function following total knee arthroplasty (TKA). This study investigates how patient demographic factors (i.e., age, sex, and race) correlate with KOOS JR response rates. This was a retrospective cohort study of adult, English-speaking patients who underwent primary TKA between 2017 and 2023 at an academic institution. KOOS JR completion status-complete or incomplete-was recorded within 90 days postoperatively. Standard statistical analyses were performed to assess KOOS JR completion against demographic factors. Among 2,883 total patients, 70.2% had complete and 29.8% had incomplete KOOS JR questionnaires. Complete status (all p < 0.01) was associated with patients aged 60 to 79 (71.8%), white race (77.6%), Medicare (81.7%), marriage (76.8%), and the highest income quartile (75.7%). Incomplete status (all p < 0.001) was associated with patients aged 18 to 59 (64.4%), Medicaid (82.4%), and lower income quartiles (41.6% first quartile, 36.8% third quartile). Multiple patient demographic factors may affect KOOS JR completion rates; patients who are older, white, and of higher socioeconomic status are more likely to participate. Addressing underrepresented groups is important to improve the utility and generalizability of the KOOS JR.
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Affiliation(s)
- Yixuan Tong
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Vinaya Rajahraman
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Rajan Gupta
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Yoshimi R, Yajima N, Hidekawa C, Sakurai N, Oguro N, Shidahara K, Hayashi K, Ichikawa T, Kishida D, Miyawaki Y, Sada KE, Shimojima Y, Ishikawa Y, Yoshioka Y, Kunishita Y, Kishimoto D, Takase-Minegishi K, Kirino Y, Ohno S, Kurita N, Nakajima H. Effect of Shared Decision-Making on Trust in Physicians in the Management of Systemic Lupus Erythematosus: The Trust Measurement for Physicians and Patients With Systemic Lupus Erythematosus Prospective Cohort Study. Arthritis Care Res (Hoboken) 2024. [PMID: 39099215 DOI: 10.1002/acr.25409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/09/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE Few studies have explored whether the involvement of patients in shared decision-making (SDM) is beneficial to the management of systemic lupus erythematosus (SLE). Therefore, this study investigated the relationship between patient participation in SDM and their trust in physicians using data from the Trust Measurement in Physicians and Patients With SLE (TRUMP2-SLE) study. METHODS Data regarding the nine-item Japanese version of the Shared Decision-Making Questionnaire (SDM-Q-9) scores, Trust in Physician Scale (TIPS) scores, and Abbreviated Wake Forest Physician Trust Scale (A-WFPTS) scores for interpersonal trust in a physician and trust in the medical profession were collected from patients with SLE who visited the outpatient clinics of five facilities in Japan through a self-administered questionnaire. The relationships among these scores were analyzed by general linear models with cluster-robust variance. RESULTS This study included 433 patients with SLE. The median baseline TIPS and A-WFPTS (attending physician version) scores were 82 (73-93) and 80 (70-95), respectively. A higher baseline SDM-Q-9 score was correlated with an increase in the TIPS score at one year (coefficient per 10-point [pt] increase, 0.94 pts, 95% confidence interval [CI] 0.16-1.72). A higher baseline SDM-Q-9 score was correlated with a higher A-WFPTS score for interpersonal trust (coefficient per 10-pt increase, 2.20 pts, 95% CI 1.44-2.96). The baseline SDM-Q-9 score was also correlated with an increase in the general physician version of the A-WFPTS score at one year (coefficient per 10-pt increase, 1.29 pts, 95% CI 0.41-2.18). CONCLUSION Engagement of patients with SLE in SDM elevates their trust in the attending physicians and health care providers, potentially enhancing doctor-patient relationships and overall health care trust.
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Affiliation(s)
- Ryusuke Yoshimi
- Yokohama City University Graduate School of Medicine and Yokohama City University Hospital, Yokohama, Japan
| | - Nobuyuki Yajima
- Showa University School of Medicine, Tokyo, Kyoto University, Kyoto, and Fukushima Medical University, Fukushima, Japan
| | - Chiharu Hidekawa
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Natsuki Sakurai
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nao Oguro
- Showa University School of Medicine, Tokyo, Japan
| | - Kenta Shidahara
- Okayama University Graduate School of Medicine, Okayama, Japan
| | - Keigo Hayashi
- Okayama University Graduate School of Medicine, Okayama, Japan
| | | | - Dai Kishida
- Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshia Miyawaki
- Okayama University Graduate School of Medicine, Okayama, Japan
| | - Ken-Ei Sada
- Okayama University Graduate School of Medicine, Okayama, and Kochi University, Nankoku, Japan
| | | | - Yuichi Ishikawa
- University of Occupational and Environmental Health Japan, Kitakyushu, and Kanagawa University of Human Services, Kawasaki, Japan
| | - Yuji Yoshioka
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yosuke Kunishita
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | | | - Yohei Kirino
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shigeru Ohno
- Yokohama City University Medical Center, Yokohama, Japan
| | - Noriaki Kurita
- Showa University School of Medicine, Tokyo and Fukushima Medical University, Fukushima, and Fukushima Medical University Hospital, Fukushima, Japan
| | - Hideaki Nakajima
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Phillips G, Xu J, Cortez A, Curtis MG, Curry C, Ruprecht MM, Davoudpour S. Influence of Medical Mistrust on Prevention Behavior and Decision-Making Among Minoritized Youth and Young Adults During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02118-6. [PMID: 39093377 DOI: 10.1007/s40615-024-02118-6] [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: 05/29/2024] [Revised: 07/16/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Medical mistrust (MM) is seen as a barrier to assessing healthcare needs and addressing health disparities; however, limited literature has focused on assessing MM for vulnerable populations, especially racial/ethnic minority and sexual/gender minority youth and young adults (YYA). METHODS Between February 2021 and March 2022, we conducted the Youth and Young Adults COVID-19 Study, a prospective cohort of minoritized YYA aged 14 to 24 years (n = 1027), within the United States and its territories. Participants were recruited through a combination of paid social media ads, outreach with organizations serving marginalized youth, and an existing registry, targeting racial and ethnic minority and LGBTQ + youth for a study on COVID-19 health behaviors. Multiple multinomial logistic regression models were developed to examine associations between demographics and three dimensions of MM including healthcare experience, government information, and scientific information. RESULTS Most participants were between the ages of 18 and 21 years (48.3%), identified as Hispanic (33.3%) or white (22.5%), and bisexual or pansexual (34.3%). Queer YYA had higher odds of reporting worse personal healthcare experiences than their straight peers. The odds of gay/lesbian YYA that reported somewhat or extreme trust in doctor's sources were two times higher than their straight peers. Except for those who identified as Asian, racial/ethnic minority YYA were less likely to report somewhat or extreme trust in the CDC's general information or its COVID-19 data than white YYA. Transgender and gender diverse YYA were more than twice as likely to report being very or extremely influenced by statistics of the dangers of COVID-19 than cisgender YYA. CONCLUSIONS Our study indicated the importance of incorporating marginalized identities into the assessment of medical mistrust to better understand YYA's health prevention and treatment behaviors and to develop public health prevention and treatment strategies, especially for minoritized communities.
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Affiliation(s)
- Gregory Phillips
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA.
| | - Jiayi Xu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Alfred Cortez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Michael G Curtis
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Caleb Curry
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Megan M Ruprecht
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Shahin Davoudpour
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA
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Ta A, Kaur S, Mader M, Franklin K, Williams M, Williams R, Blaize JP, Naqvi A, Ananth S, Song M, Warnecke BO, Pandya A, Djoumessi LRD, Nazarewicz P, Espinoza-Gutarra M, Lucero KT, Whitehead J, Al-Abayechi A, Boyle L, Lee S, Roman Souza G, Toro Velez E, Mines I, Nooruddin Z. The impact of race and ethnicity on diffuse large B-cell lymphoma outcomes within the veterans health administration (VHA). Leuk Lymphoma 2024; 65:1090-1099. [PMID: 38619488 DOI: 10.1080/10428194.2024.2338856] [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: 01/22/2024] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Abstract
We performed a retrospective chart review of 6266 randomly selected DLBCL patients treated in the VHA nationwide between 1/1/2011 and 12/31/2021. The 3178 patients who met inclusion criteria were predominantly male (97%) and white (75%). Median age of diagnosis for Black patients was 63 years vs 69 years for the entire cohort (p < 0.001). However, patients in each race/ethnicity subgroup presented with similar rates of stage I/II and III/IV disease, IPI score, cell of origin and HIT status. Outcomes analysis revealed similar treatment, response rates, median overall survival, and 1-, 3-, and 5-year survival across all subgroups. Hispanic patients had a 21% lower risk of death (HR = 0.79) than white patients, and Black patients had no significant difference in survival (HR = 0.98). This large retrospective study shows that when standard of care therapy is given within an equal access system, short-term treatment and survival outcomes are the same for all races.
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Affiliation(s)
- Andrew Ta
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Supreet Kaur
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Michael Mader
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | | | - Ryan Williams
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Amna Naqvi
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Snegha Ananth
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | - Brian Oliver Warnecke
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Abhishek Pandya
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Lakene Raissa Djoufack Djoumessi
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | - Manuel Espinoza-Gutarra
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kana Tai Lucero
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | - Alaq Al-Abayechi
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Lauren Boyle
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Sophia Lee
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Gabriel Roman Souza
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Esteban Toro Velez
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Ian Mines
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Zohra Nooruddin
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
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Jolibois MI, Roohani I, Moshal T, Lasky S, Urata M, Munabi NC, Johns AL, Sader N, Durham SR, Urata MM. Sociodemographic Factors Associated with Delayed Presentation in Craniosynostosis Surgery at a Tertiary Children's Hospital. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6035. [PMID: 39220750 PMCID: PMC11365692 DOI: 10.1097/gox.0000000000006035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/04/2024] [Indexed: 09/04/2024]
Abstract
Background Craniosynostosis is a common diagnosis requiring early referral to a pediatric plastic surgeon; however, disparities in healthcare may influence presentation timing and affect treatment options and outcomes. This study aimed to explore sociodemographic factors contributing to delay in craniosynostosis surgical consultation. Methods A retrospective cohort study of 694 California-based craniosynostosis patients at a tertiary children's hospital was performed from 2006 to 2023. State-specific Area Deprivation Index (ADI) and distance to the hospital were calculated using ZIP codes. Multivariate linear and logistic regressions considered race, insurance type, syndromic status, suture type, and ZIP code-based socioeconomic factors. Results Median age of presentation was 4.5 [interquartile range: 2.6-7.6] months with racial/ethnic breakdown of Hispanic/Latinx (41.2%), White (23.6%), Asian (3.7%), Black/African American (2.0%), or other/unreported (29.5%) with 58.4% having public insurance and an average distance to the hospital of 48.3 km. Median ADI was 5.4 [interquartile range: 4.0-7.1]. By linear regression, public insurance (P < 0.001) and higher ADI decile (P < 0.001) independently contributed to an older age of presentation. Patients with public insurance (odds ratio 1.90; P = 0.002) were more likely to present after 4 months of age. Conclusions Patients who had public insurance or resided in more disadvantaged areas presented later for craniosynostosis surgical consultation. Eliminating disparities in these populations ensures more equitable access to surgical options and can improve patient outcomes.
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Affiliation(s)
- Marah I. Jolibois
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
- Albany Medical College, Albany, N.Y
| | - Idean Roohani
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Tayla Moshal
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Sasha Lasky
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Maya Urata
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
| | - Naikhoba C.O. Munabi
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
| | - Alexis L. Johns
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
| | - Nicholas Sader
- Division of Pediatric Neurosurgery, Children’s Hospital Los Angeles, Los Angeles, Calif
| | - Susan R. Durham
- Division of Pediatric Neurosurgery, Children’s Hospital Los Angeles, Los Angeles, Calif
| | - Mark M. Urata
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, Calif
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8
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Qian D, Olumuyide E, Keswani A, Lin HM, Ouyang Y, DeMaria S, Poeran J, Park CH, Burnett GW. The Impact of Race/Ethnicity on Disparities in Utilization and Outcomes of Neuraxial Anesthesia for Hip and Femoral Shaft Fractures. J Clin Med 2024; 13:3999. [PMID: 39064039 PMCID: PMC11277043 DOI: 10.3390/jcm13143999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: The use of neuraxial anesthesia versus general anesthesia for hip fracture surgery remains an active area of research, with recent studies demonstrating mixed findings supporting neuraxial over general anesthesia. The benefits of neuraxial anesthesia have been documented in associated surgeries, including total joint arthroplasty. However, racial disparities in the administration of neuraxial anesthesia have been identified in numerous procedures. We aimed to examine the association of race/ethnicity with neuraxial anesthesia use and the effect of neuraxial anesthesia on length of stay, non-home discharge, 30-day severe adverse events, and rates of readmission among patients undergoing isolated hip and femoral shaft fracture operations. Methods: The American College of Surgeons National Quality Improvement Program database was queried for isolated hip or femoral shaft fractures from 2015 to 2019. Stepwise logistic regression was performed to assess the relationship between race/ethnicity and neuraxial anesthesia use. Within each sex-race stratum, neuraxial anesthesia recipients were propensity-matched to general anesthesia recipients in a 1:2 ratio. Logistic regression and negative binomial regression were performed on the propensity-matched cohort. Results: A total of 12,004 neuraxial and 64,250 general anesthesia hip and femoral shaft fracture patients were identified. Compared to White patients, Black and Hispanic patients were between 0.64 and 0.61 times less likely to receive neuraxial anesthesia over general anesthesia, respectively (p < 0.05). 11,993 patients who received neuraxial anesthesia were propensity matched to 23,946 patients who received general anesthesia. Propensity-matched logistic regressions found that neuraxial anesthesia was associated with decreased length of stay, 30-day severe adverse events, and acute rehab/skilled nursing facility discharge for White patients (p < 0.05 for all), but only decreased length of stay in Black and Hispanic patients (p = 0.01 and p = 0.02, respectively). Conclusions: Notable disparities exist in the administration of neuraxial anesthesia for isolated hip and femoral shaft fracture patients. Hispanic and Black race/ethnicity in particular influences provision of neuraxial anesthesia. Further research is required to understand the degree of effect modification and root causes of regional anesthesia access and benefits for this high-volume patient population.
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Affiliation(s)
- Daniel Qian
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.Q.)
| | - Ezekiel Olumuyide
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.Q.)
| | - Aakash Keswani
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Hung-Mo Lin
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Yuxia Ouyang
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
| | - Samuel DeMaria
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
| | - Jashvant Poeran
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY 10021, USA
| | - Chang H. Park
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
| | - Garrett W. Burnett
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.Q.)
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
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Howie CM, Cichos KH, Shoreibah MG, Jordan EM, Niknam KR, Chen AF, Hansen EN, McGwin GG, Ghanem ES. Racial Disparities in Treatment and Outcomes of Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty. J Arthroplasty 2024; 39:1671-1678. [PMID: 38331360 DOI: 10.1016/j.arth.2024.01.054] [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: 06/14/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND African Americans have the highest prevalence of chronic Hepatitis C virus (HCV) infection. Racial disparities in outcome are observed after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). This study sought to identify if disparities in treatments and outcomes exist between Black and White patients who have HCV prior to elective THA and TKA. METHODS Patient demographics, comorbidities, HCV characteristics, perioperative variables, in-hospital outcomes, and postoperative complications at 1-year follow-up were collected and compared between the 2 races. Patients who have preoperative positive viral load (PVL) and undetectable viral load were identified. Chi-square and Fisher's exact tests were used to compare categorical variables, while 2-tailed Student's Kruskal-Wallis t-tests were used for continuous variables. A P value of less than .05 was statistically significant. RESULTS The liver function parameters, including aspartate aminotransferase and model for end-stage liver disease scores, were all higher preoperatively in Black patients undergoing THA (P = .01; P < .001) and TKA (P = .03; P = .003), respectively. Black patients were more likely to undergo THA (65.8% versus 35.6%; P = .002) and TKA (72.1% versus 37.3%; 0.009) without receiving prior treatment for HCV. Consequently, Black patients had higher rates of preoperative PVL compared to White patients in both THA (66% versus 38%, P = .006) and TKA (72% versus 37%, P < .001) groups. Black patients had a longer length of stay for both THA (3.7 versus 3.3; P = .008) and TKA (4.1 versus 3.0; P = .02). CONCLUSIONS The HCV treatment prior to THA and TKA with undetectable viral load has been shown to be a key factor in mitigating postoperative complications, including joint infection. We noted that Black patients were more likely to undergo joint arthroplasty who did not receive treatment and with a PVL. While PVL rates decreased over time for both races, a significant gap persists for Black patients.
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Affiliation(s)
- Cole M Howie
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kyle H Cichos
- Hughston Foundation, Columbus, Georgia; Hughston Clinic, Columbus, Georgia
| | - Mohamed G Shoreibah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eric M Jordan
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Kian R Niknam
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Erik N Hansen
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Gerald G McGwin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elie S Ghanem
- Department of Orthopaedic Surgery, University of Missouri at Columbia, Columbia, Missouri
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Burton WN, Schultz AB, Shepherd ME, Hines D. The Association Between Social Determinants of Health, Risk Factors, Job Performance, and Health Care Costs in an Employed Population. J Occup Environ Med 2024; 66:536-541. [PMID: 38531827 DOI: 10.1097/jom.0000000000003106] [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: 03/28/2024]
Abstract
OBJECTIVE The aim of the study is to compare employees of a US school district based on their social determinants of health (SDoH). Methods: Employees ( N = 5006) were categorized into low-, medium-, or high-need SDoH tiers. Of them, n = 2469 also participated in a health risk appraisal in 2019. Subjects' average health care costs, health risk factors, and self-rated job performance were compared by SDoH tier and race. Results: Significant differences were observed among the SDoH comparison groups regarding age, gender, race, and marital status. SDoH was associated with health care costs, number of health risk factors, and self-rated job performance differently for Black and White employees. Conclusions: SDoH are complex and multifaceted. Black employees in the high-need SDoH group had higher average health care costs, lower self-rated job performance, and more average health risk factors than subjects in the lower need tiers.
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Affiliation(s)
- Wayne N Burton
- From the Environmental and Occupational Sciences, University of Illinois School of Public Health, Chicago, Illinois (W.N.B.); Global Health Management Research Core, Ann Arbor, Michigan (A.B.S.); Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee (M.E.S.); and Metro Nashville Public Schools, Nashville, Tennessee (D.H.)
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11
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Oser CB, Moody MD, Hansen AC, Stevens-Watkins D, Staton M, Bunting AM. Predictors of substance use disorder treatment and mutual support group participation among Black women across the criminal legal spectrum: A latent class approach. Drug Alcohol Depend 2024; 260:111326. [PMID: 38733734 DOI: 10.1016/j.drugalcdep.2024.111326] [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: 07/20/2023] [Revised: 04/01/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND The purpose of this study includes: 1) identifying classes of substance-related needs among Black women, and 2) examining the effect of substance-related need classes and culturally-relevant factors on Black women's use of substance use disorder (SUD) treatment and mutual support groups. METHODS As part of a longitudinal cohort study, Black women were recruited in prison nearing release, on probation, and in the community without involvement in the criminal legal system (CLS, n=565) and followed-up at 18-months. We conducted a baseline latent class analysis of substance-related needs among Black women. Logistic regression models adjusted for culturally-relevant factors to predict the use of treatment and frequency of mutual support group participation over 18-months among Black women who use drugs. RESULTS Four classes by level of needs were found: low, daily marijuana use, high mental health, and high comorbidity. During the 18-month follow-up, women characterized by the high comorbidity need class and with higher scores of religious well-being were more likely to frequently participate in mutual support groups. Non-CLS-involved women were less likely to engage with both treatment and mutual support groups than women from the prison sample at 18-months. CONCLUSIONS This study highlights four distinct classes of substance-related needs among Black women, highlighting the complex patterns of behavior and within-racial group differences among Black women. Black women with high comorbidity needs were more likely to participate in mutual support groups, but the latent classes did not predict SUD treatment indicating other non-medical and social contextual need factors may be at play.
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Affiliation(s)
- Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY 40506, United States.
| | - Myles D Moody
- Department of Sociology, The University of Alabama at Birmingham, Heritage Hall, Room 460, 1401 University Blvd, Birmingham, AL 35233, United States
| | - Anna C Hansen
- Department of Sociology, College of Medicine, University of Kentucky, 1519 Patterson Office Tower, Lexington, KY 40506, United States
| | - Danelle Stevens-Watkins
- Department of Counseling Psychology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, 251c Dickey Hall, Lexington, KY 40506, United States
| | - Michele Staton
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, 117 Medical Behavioral Science Building, Lexington, KY 40506, United States
| | - Amanda M Bunting
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, United States
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12
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Thompson J. Mediation Analysis of Racial Disparity for Infant Mortality Using Bayesian Estimation of Potential Outcomes. J Clin Med 2024; 13:3464. [PMID: 38929992 PMCID: PMC11204795 DOI: 10.3390/jcm13123464] [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: 05/06/2024] [Revised: 06/08/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: While the overall rate of infant mortality in the United States has been decreasing over decades, the racial disparity, defined as the difference between races, has increased. Even though a person's race cannot change, it may be possible to identify factors that mediate or cause this racial disparity. Evaluating the factors that mediate or cause racial disparity is imperative because current clinical recommendations could be based on preventative modalities that are more effective for white women and their children. Methods: A Bayesian approach modeled the data from the full United States National Natality Database for the years 2016 to 2018. The binomial rate parameters for each combination of race and mediators provided the potential outcomes. Estimating the mediation outcomes, including total effect, controlled direct effect, mediated effect, and proportion mediated used common counterfactual definitions for these probabilities. Results: Maternal smoking, low birthweight, and teenage maternity interacted in causing racial disparity for infant mortality. The proportion of racial disparity attributable to low birthweight was approximately 0.73, with only small variations attributable to maternal smoking and teenage maternity. Conclusions: The novel approach facilitated modeling of multiple mediators. Low birthweight caused racial disparity for infant mortality. The model can be extended to evaluate additional mediational factors with the objective of identifying the preventable causes.
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Affiliation(s)
- James Thompson
- College of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station, TX 77843-4475, USA
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13
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Raschein TS, Lammers S, Nickel A, Louie JP, Bergmann KR. Racial and Ethnic Differences in Hospital Admission and Diagnostic Evaluation for Febrile Seizures in the Emergency Department. J Pediatr 2024; 269:113960. [PMID: 38369236 DOI: 10.1016/j.jpeds.2024.113960] [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: 11/30/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To examine differences in hospital admission and diagnostic evaluation for febrile seizure by race and ethnicity. STUDY DESIGN We conducted a cross-sectional study among children 6 months to 6 years with simple or complex febrile seizure between January 1, 2016, and December 31, 2021, using data from the Pediatric Health Information System. The primary outcome was hospital admission. Secondary outcomes included the proportion of encounters with neuroimaging or lumbar puncture. We used mixed-effects logistic regression model with random intercept for hospital and patient to estimate the association between outcomes and race and ethnicity after adjusting for covariates, including seizure type. RESULTS In total, 94 884 encounters were included. Most encounters occurred among children of non-Hispanic White (37.0%), Black (23.9%), and Hispanic/Latino (24.6%) race and ethnicity. Black and Hispanic/Latino children had 29% (aOR 0.71; 95% CI 0.66-0.75) and 26% (aOR 0.74; 95% CI 0.69-0.80) lower odds of hospital admission compared with non-Hispanic White children, respectively. Black and Hispanic/Latino children had 21% (aOR 0.79; 95% CI 0.73-0.86) and 22% (aOR 0.78; 95% CI 0.71-0.85) lower adjusted odds of neuroimaging compared with non-Hispanic White children. For complex febrile seizure, the adjusted odds of lumbar puncture was significantly greater among Asian children (aOR 2.12; 95% CI 1.19-3.77) compared with non-Hispanic White children. There were no racial differences in the odds of lumbar puncture for simple febrile seizure. CONCLUSIONS Compared with non-Hispanic White children, Black and Hispanic/Latino children with febrile seizures are less likely to be hospitalized or receive neuroimaging.
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Affiliation(s)
- Taryn S Raschein
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Shea Lammers
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Amanda Nickel
- Department of Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN
| | - Jeffrey P Louie
- Division of Emergency Medicine, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Kelly R Bergmann
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN.
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Zimney KJ, Puentedura E, Kolber MJ, Louw A. The relationship between trust and outcomes during physical therapy care for chronic low back pain. Physiother Theory Pract 2024; 40:1164-1171. [PMID: 36282774 DOI: 10.1080/09593985.2022.2138731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/14/2022] [Accepted: 10/07/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Enhancing the therapeutic alliance has been associated with improved outcomes for patients with chronic low back pain (CLBP). Qualitatively trust has been described to be part of the therapeutic alliance, but it has not been measured quantitatively within the physical therapy literature. OBJECTIVE Examine the relationship between trust and outcomes during physical therapy for CLBP. METHODS Observational study of patients with CLBP being seen for physical therapy were assessed through self-report measures. The Primary Care Assessment Survey (PCAS) trust measurement scale was completed by patients at initial, post-initial, and discharge visit. These measurements were compared for correlations with patient reported outcome measures for pain and function recorded at initial visit and discharge. RESULTS A convenience sample of 29 patients (49.3 ± 15 years old) with CLBP were measured. The PCAS showed correlations for changes in trust throughout treatment for improvements in pain and discharge pain rating. Average discharge pain rating correlated to changes in the PCAS (rs = -0.692, p < .001), with lower pain ratings relating to higher changes in trust over time. Average change in pain (rs = 0.745, p < .001) throughout treatment also correlated with higher changes in trust. Higher trust scores at discharge also correlated with improved Global Rating of Change and Oswestry Disability Index scores at discharge. The linear regression model showed adjusted R2 values for the trust scores and outcomes varied between 0.247 and 0.642. CONCLUSION Both increases in trust throughout the treatment and end trust scores during physical therapy were related to improved outcomes for patients with CLBP.
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Affiliation(s)
- Kory J Zimney
- School of Health Sciences, Department of Physical Therapy, University of South Dakota, Vermillion, SD, USA
| | | | - Morey J Kolber
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, FL, USA
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15
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Billings BK, Kramer B, Augustine TN, Brits D, Hutchinson EF, Libhaber E, Štrkalj G. Leading the transition to ethical human body sourcing in Africa: The South African experience. Ann Anat 2024; 254:152263. [PMID: 38588731 DOI: 10.1016/j.aanat.2024.152263] [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: 12/15/2023] [Revised: 03/01/2024] [Accepted: 04/04/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The use of human bodies for anatomy education and research forms an integral part of the training of health professionals around the world. However, the ethical acquisition of human remains for this purpose has been a challenge in many countries, particularly for those on the African continent. South African institutions have however, been able to progressively transition to a more ethical approach to human body acquisition. The aim of the current study was to investigate the provenance of human bodies and the number used in South African health sciences institutions during the period 2017-2021. METHODS an online self-administered anonymised questionnaire was circulated to all health sciences institutions in South Africa. Questions were focused on establishing the provenance and the associated number of bodies and body donor programmes. RESULTS responses were received from thirteen of the fourteen South African institutions. All thirteen institutions use human bodies for teaching and research, with the majority of the institutions being reliant on bequests (77%) and family donations (62%), and less on unclaimed remains (46%). Most institutions have established body donor programmes. Four institutions were negatively affected by the effects of the pandemic. Memorial services, which continued during the pandemic, were conducted by eight of the thirteen institutions. CONCLUSION South Africa is leading the transition to the ethical acquisition of human remains on the African continent. It is hoped that South African institutions will soon transform to the exclusive sourcing of bodies through willed donation and provide guidance and support for the other countries on the continent.
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Affiliation(s)
- Brendon K Billings
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Beverley Kramer
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tanya N Augustine
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Desiré Brits
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Erin F Hutchinson
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elena Libhaber
- Health Sciences Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Goran Štrkalj
- Department of Anatomy, Faculty of Medicine and Health, The University of New South Wales, Sydney, Australia
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Xavier SM, Malla A, Mohan G, Mustafa S, Padmavati R, Rangaswamy T, Joober R, Schmitz N, Margolese HC, Iyer SN. Trust of patients and families in mental healthcare providers and institutions: a cross-cultural study in Chennai, India, and Montreal, Canada. Soc Psychiatry Psychiatr Epidemiol 2024; 59:813-825. [PMID: 37848572 DOI: 10.1007/s00127-023-02576-z] [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: 02/14/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Cross-cultural psychosis research has typically focused on a limited number of outcomes (generally symptom-related). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to fundamental treatment processes like trust. Addressing this gap, we studied two similar first-episode psychosis programs in Montreal, Canada, and Chennai, India. We hypothesized higher trust in healthcare institutions and providers among patients and families in Chennai at baseline and over follow-up. METHODS Upon treatment entry and at months 3, 12 and 24, trust in healthcare providers was measured using the Wake Forest Trust scale and trust in the healthcare and mental healthcare systems using two single items. Nonparametric tests were performed to compare trust levels across sites and mixed-effects linear regression models to investigate predictors of trust in healthcare providers. RESULTS The study included 333 patients (Montreal = 165, Chennai = 168) and 324 family members (Montreal = 128, Chennai = 168). Across all timepoints, Chennai patients and families had higher trust in healthcare providers and the healthcare and mental healthcare systems. The effect of site on trust in healthcare providers was significant after controlling for sociodemographic characteristics known to impact trust. Patients' trust in doctors increased over follow-up. CONCLUSION This study uniquely focuses on trust as an outcome in psychosis, via a comparative longitudinal analysis of different trust dimensions and predictors, across two geographical settings. The consistent differences in trust levels between sites may be attributable to local cultural values and institutional structures and processes and underpin cross-cultural variations in treatment engagement and outcomes.
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Affiliation(s)
- Salomé M Xavier
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
- University of Warwick, Coventry, CV4 7AL, UK
| | - Sally Mustafa
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Ramachandran Padmavati
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
| | - Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
- University of Tübingen, Geschwister-Scholl-Platz 72074, Tübingen, Germany
| | - Howard C Margolese
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
- Prevention and Early Intervention Program for Psychosis, McGill University Health Centre (PEPP-MUHC), 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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McNamara C, Cook S, Brown LM, Palta M, Look KA, Westergaard RP, Burns ME. Prompt access to outpatient care post-incarceration among adults with a history of substance use: Predisposing, enabling, and need-based factors. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209277. [PMID: 38142041 PMCID: PMC11060918 DOI: 10.1016/j.josat.2023.209277] [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: 06/19/2023] [Revised: 09/30/2023] [Accepted: 12/15/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION As expanded Medicaid coverage reduces financial barriers to receiving health care among formerly incarcerated adults, more information is needed to understand the factors that predict prompt use of health care after release among insured adults with a history of substance use. This study's aim was to estimate the associations between characteristics suggested by the Andersen behavioral model of health service use and measures of health care use during the immediate reentry period and in the presence of Medicaid coverage. METHODS In this retrospective cohort study, we linked individual-level data from multiple Wisconsin agencies. The sample included individuals aged 18-64 released from a Wisconsin State Correctional Facility between April 2014 and June 2017 to a community in the state who enrolled in Medicaid within one month of release and had a history of substance use. We grouped predictors of outpatient care into variable domains within the Andersen model: predisposing- individual socio-demographic characteristics; enabling characteristics including area-level socio-economic resources, area-level health care supply, and characteristics of the incarceration and release; and need-based- pre-release health conditions. We used a model selection algorithm to select a subset of variable domains and estimated the association between the variables in these domains and two outcomes: any outpatient visit within 30 days of release from a state correctional facility, and receipt of medication for opioid use disorder within 30 days of release. RESULTS The size and sign of many of the estimated associations differed for our two outcomes. Race was associated with both outcomes, Black individuals being 12.1 p.p. (95 % CI, 8.7-15.4, P < .001) less likely than White individuals to have an outpatient visit within 30 days of release and 1.3 p.p. (95 % CI, 0.48-2.1, P = .002) less likely to receive MOUD within 30 days of release. Chronic pre-release health conditions were positively associated with the likelihood of post-release health care use. CONCLUSIONS Conditional on health insurance coverage, meaningful differences in post-incarceration outpatient care use still exist across adults leaving prison with a history of substance use. These findings can help guide the development of care transition interventions including the prioritization of subgroups that may warrant particular attention.
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Affiliation(s)
- Cici McNamara
- School of Economics, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Steven Cook
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI, USA.
| | - Lars M Brown
- Division of Medicaid Services, Wisconsin Department of Health Services, Madison, WI, USA.
| | - Mari Palta
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA.
| | - Kevin A Look
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
| | - Ryan P Westergaard
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
| | - Marguerite E Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
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Bedford S, Vachuska K. Assessing interstate racial and socioeconomic disparities in newborn screening policies in the United States. Front Public Health 2024; 12:1310516. [PMID: 38741907 PMCID: PMC11089229 DOI: 10.3389/fpubh.2024.1310516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/12/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction This paper explores racial and socioeconomic disparities in newborn screening (NBS) policies across the United States. While inter-state inequality in healthcare policies is often considered a meaningful source of systemic inequity in healthcare outcomes, to the best of our knowledge, no research has explored racial and socioeconomic disparities in newborn screening policies based on state of residence. Methods We investigate these disparities by calculating weighted average exposure to specific NBS tests by racial and socioeconomic group. We additionally estimate count models of the number (and type) of NBS conditions screened for by state racial and socioeconomic composition. Results Adding to the knowledge base that social determinants of health and health disparities are linked, our analysis surprisingly reveals little evidence of substantial inter-state inequity in newborn screenings along racial and socioeconomic lines. Discussion While there is substantial nationwide racial and socioeconomic inequity in terms of infant health, the distribution of state-level policies does not appear to be structured in a manner to be a driver of these disparities. Our findings suggest that efforts to reduce inequities in outcomes related to NBS should shift focus toward the delivery of screening results and follow-up care as discussion builds on expanding NBS to include more conditions and genomic testing.
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Affiliation(s)
| | - Karl Vachuska
- School of Medicine and Public Health and Department of Sociology, University of Wisconsin-Madison, Madison, WI, United States
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Mi J, Du X, Aili Y, Li M, Liu Y. Unveiling Patient Trust in Physicians Across China: Insights from a Nationwide Cross-Sectional Study. Risk Manag Healthc Policy 2024; 17:1039-1052. [PMID: 38680478 PMCID: PMC11055546 DOI: 10.2147/rmhp.s456585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/23/2024] [Indexed: 05/01/2024] Open
Abstract
Background Trust is a major factor affecting patient-physician relationship and healthcare quality. However, there has been a lack of comprehensive study on the extent of and major factors affecting patient trust in healthcare providers of China, the world's largest developing country. The objective of this study is to elucidate the current status of outpatient trust in physicians in China and its influencing factors, providing empirical evidence to enhance doctor-patient trust and improve doctor-patient relationships. Methods Between December 2017 and January 2018, 28,760 patients seeking care at the outpatient departments of 136 tertiary hospitals were interviewed, where they were asked to rate their trust in physicians. We applied a multilevel logistic regression model to explore the association between patients trust and characteristics of hospitals, physicians and patient characteristics. We conducted a series of sensitivity analysis to check the robustness of our findings. Results Among 28,760 participants included in this study, 91.54% expressed trust in their physicians, while 7.52% showed moderate trust. Only 0.94% expressly distrusted or strongly distrusted their physicians. Outpatients of hospitals with convenient payment, volunteer guidance and enough seats available in the rest and waiting area showed higher levels of trust. Physicians who had a senior title, showed patience and protection of the patient's privacy were more likely to be trusted by their patients in the outpatient setting. Compared to their female counterparts, male outpatients showed a higher degree of trust. Conclusion While this study highlights an overall high level of Trust in physicians (TIP) among patients in China's tertiary hospitals, it is found to vary with patient demographic factors as well as provider's attributes. Hospitals with a more keen sense of protecting patients privacy and better meeting patients' need for efficient and caring service provision process appeared to yield a higher level of trust.
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Affiliation(s)
- Jiarun Mi
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Xinyu Du
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Yilixiati Aili
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Mingkun Li
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
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20
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Nogueira LM, May FP, Yabroff KR, Siegel RL. Racial Disparities in Receipt of Guideline-Concordant Care for Early-Onset Colorectal Cancer in the United States. J Clin Oncol 2024; 42:1368-1377. [PMID: 37939323 DOI: 10.1200/jco.23.00539] [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: 03/09/2023] [Revised: 07/27/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023] Open
Abstract
PURPOSE Young individuals racialized as Black are more likely to die after a colorectal cancer (CRC) diagnosis than individuals racialized as White in the United States. This study examined racial disparities in receipt of timely and guideline-concordant care among individuals racialized as Black and White with early-onset CRC. METHODS Individuals age 18-49 years racialized as non-Hispanic Black and White (self-identified) and newly diagnosed with CRC during 2004-2019 were selected from the National Cancer Database. Patients who received recommended care (staging, surgery, lymph node evaluation, chemotherapy, and radiotherapy) were considered to have received guideline-concordant care. Odds ratios (ORs) were adjusted for age and sex. The decomposition method was used to estimate the relative contribution of demographic characteristics (age and sex), comorbidities, health insurance, and facility type to the racial disparity in receipt of guideline-concordant care. The product-limit method was used to evaluate differences in time to treatment between patients racialized as Black and White. RESULTS Of the 84,882 patients with colon cancer and 62,573 patients with rectal cancer, 20.8% and 14.5% were racialized as Black, respectively. Individuals racialized as Black were more likely to not receive guideline-concordant care for colon (adjusted OR [aOR], 1.18 [95% CI, 1.14 to 1.22]) and rectal (aOR, 1.27 [95% CI, 1.21 to 1.33]) cancers. Health insurance explained 28.2% and 21.6% of the disparity among patients with colon and rectal cancer, respectively. Individuals racialized as Black had increased time to adjuvant chemotherapy for colon cancer (hazard ratio [HR], 1.28 [95% CI, 1.24 to 1.32]) and neoadjuvant chemoradiation for rectal cancer (HR, 1.42 [95% CI, 1.37 to 1.47]) compared with individuals racialized as White. CONCLUSION Patients with early-onset CRC racialized as Black receive worse and less timely care than individuals racialized as White. Health insurance, a modifiable factor, was the largest contributor to racial disparities in receipt of guideline-concordant care in this study.
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Affiliation(s)
- Leticia M Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Folasade P May
- Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA Kaiser Permanente Center for Health Equity, UCLA, Los Angeles, CA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
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21
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Marks J, Sridhar A, Ai A, Kiel L, Kaufman R, Abioye O, Mantz C, Florez N. Precision Immuno-Oncology in NSCLC through Gender Equity Lenses. Cancers (Basel) 2024; 16:1413. [PMID: 38611091 PMCID: PMC11010825 DOI: 10.3390/cancers16071413] [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: 03/07/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Precision immuno-oncology involves the development of personalized cancer treatments that are influenced by the unique nature of an individual's DNA, immune cells, and their tumor's molecular characterization. Biological sex influences immunity; females typically mount stronger innate and adaptive immune responses than males. Though more research is warranted, we continue to observe an enhanced benefit for females with lung cancer when treated with combination chemoimmunotherapy in contrast to the preferred approach of utilizing immunotherapy alone in men. Despite the observed sex differences in response to treatments, women remain underrepresented in oncology clinical trials, largely as a result of gender-biased misconceptions. Such exclusion has resulted in the development of less efficacious treatment guidelines and clinical recommendations and has created a knowledge gap in regard to immunotherapy-related survivorship issues such as fertility. To develop a more precise approach to care and overcome the exclusion of women from clinical trials, flexible trial schedules, multilingual communication strategies, financial, and transportation assistance for participants should be adopted. The impact of intersectionality and other determinants of health that affect the diagnosis, treatment, and outcomes in women must also be considered in order to develop a comprehensive understanding of the unique impact of immunotherapy in all women with lung cancer.
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Affiliation(s)
- Jennifer Marks
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA;
| | | | - Angela Ai
- Olive View-UCLA Medical Center, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Lauren Kiel
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Rebekah Kaufman
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Oyepeju Abioye
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Courtney Mantz
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
- Harvard Medical School, Boston, MA 02115, USA
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22
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Lui E, Gill J, Hamid M, Wen C, Singh N, Okoh P, Xu X, Boakye P, James CE, Waterman AD, Edwards B, Mucsi I. Racialized and Immigrant Status and the Pursuit of Living Donor Kidney Transplant - a Canadian Cohort Study. Kidney Int Rep 2024; 9:960-972. [PMID: 38765593 PMCID: PMC11101831 DOI: 10.1016/j.ekir.2024.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Both immigrant and racialized status may be associated with the pursuit of living donor kidney transplant (LDKT). Methods This study was a secondary analysis of a convenience cross-sectional sample of patients with kidney failure in Toronto, obtained from our "Comprehensive Psychosocial Research Data System" research database. The exposures included racialized, immigrant, and combined immigrant and racialized status (White nonimmigrant, racialized nonimmigrant, White immigrant and racialized immigrant). Outcomes include the following: (i) having spoken about LDKT with others, (ii) having a potential living donor (LD) identified, (iii) having allowed others to share the need for LDKT, (iv) having directly asked a potential donor to be tested, and (v) accept a hypothetical LDKT offer. We assessed the association between exposure and outcomes using univariable, and multivariable binary or multinominal logistic regression (reference: White or White nonimmigrant participants). Results Of the 498 participants, 281 (56%) were immigrants; 142 (28%) were African, Caribbean, and Black (ACB); 123 (25%) were Asian; and 233 (47%) were White. Compared to White nonimmigrants, racialized immigrants (relative risk ratio [RRR]: 2.98; 95% confidence interval [CI]: 1.76-5.03) and racialized nonimmigrants (RRR: 2.84; 95% CI: 1.22-6.65) were more likely not to have spoken about LDKT with others (vs. having spoken or planning to do so). Both racialized immigrant (odds ratio [OR]: 4.07; 95% CI: 2.50-6.34), racialized nonimmigrants (OR: 2.68; 95% CI: 1.31-5.51) and White immigrants (OR: 2.68; 95% CI: 1.43-5.05) were more likely not to have a potential LD identified. Conclusion Both racialized and immigrant status are associated with less readiness to pursue LDKT. Supporting patients to communicate their need for LDKT may improve equitable access to LDKT.
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Affiliation(s)
- Eric Lui
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jasleen Gill
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marzan Hamid
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Stanford University School of Medicine, Stanford, California, USA
| | - Cindy Wen
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Navneet Singh
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Princess Okoh
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Xihui Xu
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Priscilla Boakye
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Carl E. James
- Faculty of Education, York University, Toronto, Ontario, Canada
| | - Amy D. Waterman
- Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Beth Edwards
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Istvan Mucsi
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
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23
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Bharmal N, Sack E, Guo N, Alejandro-Rodriguez M, Holmes JC, Modlin C, Pfoh ER. Healthcare and Social Needs Assessment and Response Quality Among Black Men. J Community Health 2024; 49:187-192. [PMID: 37634220 DOI: 10.1007/s10900-023-01272-y] [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] [Accepted: 08/03/2023] [Indexed: 08/29/2023]
Abstract
To understand Black men's healthcare and social needs and determine if the resources that healthcare systems offer meet expectations. We surveyed men who had previously participated in at least one Minority Men's Health Fair in Cleveland, Ohio. In this descriptive study, we spoke with men up to three times (i.e., phases) between May and October 2020 by email and/or telephone. Phase 1 was a needs assessment survey. Phase 2 involved outreach to those who identified a need to provide a resource. Phase 3 determined whether the resource met individuals' needs. We described the demographic characteristics of the survey respondents, the percentage of men reporting a need and wanting a resource, and whether the resource resolved their need. Of the 768 men contacted, 275 completed the survey (36% response rate). The majority of respondents were 50-69 years old, identified as Black, and had at least a bachelor's degree. Eighty-five percent reported a need, of which wellness, financial, and healthcare access were among the top-reported needs. Among the men identifying a need, 35% were interested in a resource. Resources that were provided for employment, behavioral health, oral health, vision, or wellness needs were deemed insufficient. A few individuals reported that resources for food/personal hygiene, financial support, health care access, annual health screening, and medication met their needs. Among men with healthcare and social needs, only a fraction were interested in a resource, and fewer reported that the resource met their needs. These results warrant a greater understanding of what constitutes a resolution of healthcare and social needs from patients' perspectives.
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Affiliation(s)
| | | | - Ning Guo
- Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Charles Modlin
- Cleveland Clinic, Cleveland, OH, USA
- The MetroHealth System, Cleveland, OH, USA
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24
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Ragunanthan NW, Lamb J, Hauspurg A, Beck S. Assessment of Racial Disparities in Aspirin Prophylaxis for Preeclampsia Prevention. Am J Perinatol 2024; 41:635-640. [PMID: 35189651 PMCID: PMC9900494 DOI: 10.1055/s-0042-1743142] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Low-dose aspirin is recommended for preeclampsia prevention among women with high-risk conditions, including chronic hypertension. Black women have higher rates of hypertensive disorders of pregnancy, and whether this is related to disparities in aspirin prophylaxis is unknown. We investigated the relationship between race and counseling/prescription and uptake of aspirin among a cohort of women with chronic hypertension. STUDY DESIGN This is a single-institution, retrospective cohort study of women with chronic hypertension who delivered between 2016 and 2018. Medical record review was performed to assess counseling/prescription of aspirin prophylaxis and self-reported uptake. Self-reported uptake was determined by mention in the provider's notes or by inclusion in the medication reconciliation system. Demographic and obstetric outcome data were compared by self-reported race (Black vs. all other races) in univariate analysis. Multivariable logistic regression analysis was performed to evaluate the association between race and aspirin adherence. RESULTS We included 872 women: 361 (41.4%) Black women and 511 (58.6%) white or other race women. Overall, 567 (65.0%) women were counseled and/or given a prescription for aspirin, and 411 (72.4%) of those women reported uptake. Black women were equally likely to be counseled and/or prescribed aspirin compared with all other races (67.3 vs. 63.4%; p = 0.7). However, Black women were less likely to report uptake of aspirin (63.8 vs. 79.0%; p < 0.001). After adjustment for total prenatal visits and tobacco use, Black race was associated with an adjusted odds ratio of 0.53 (95% confidence interval: 0.36-0.78) for uptake of aspirin. CONCLUSION In our cohort, recommendation for aspirin prophylaxis was suboptimal in all groups, reaching only 65% of eligible women. Black women were equally likely as women of other races to receive counseling about aspirin, but rates of uptake were lower. Our findings suggest that counseling and prescription of aspirin alone in high-risk Black women are not sufficient for utilization of this intervention. KEY POINTS · Rates of counseling about aspirin prophylaxis for preeclampsia did not vary by race.. · Black women had lower rates of uptake of aspirin compared with women of other races.. · Counseling about aspirin was inadequate in general, reaching only 65% of eligible women..
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Affiliation(s)
- Nina W. Ragunanthan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jordan Lamb
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alisse Hauspurg
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stacy Beck
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Patel N, Rock M, Dowlati E, Phan T, Sanchez CE, Myseros JS, Oluigbo C, Syed HR, Donoho DA, Keating RF. Socioeconomic Disparities Affecting the Presentation and Outcomes in Pediatric Subdural Empyema Patients. Neurosurgery 2024; 94:764-770. [PMID: 37878410 DOI: 10.1227/neu.0000000000002741] [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: 02/01/2023] [Accepted: 06/12/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric subdural empyemas (SDE) carry significant morbidity and mortality, and prompt diagnosis and treatment are essential to ensure optimal outcomes. Nonclinical factors affect presentation, time to diagnosis, and outcomes in several neurosurgical conditions and are potential causes of delay in presentation and treatment for patients with SDE. To evaluate whether socioeconomic status, race, and insurance status affect presentation, time to diagnosis, and outcomes for children with subdural empyema. METHODS We conducted a retrospective cohort study with patients diagnosed with SDE between 2005 and 2020 at our institution. Information regarding demographics (age, sex, zip code, insurance status, race/ethnicity) and presentation (symptoms, number of prior visits, duration of symptoms) was collected. Outcome measures included mortality, postoperative complications, length of stay, and discharge disposition. RESULTS 42 patients were diagnosed with SDE with a mean age of 9.5 years. Most (85.7%) (n = 36) were male ( P = .0004), and a majority, 28/42 (66.7%), were African American ( P < .0001). There was no significant difference in socioeconomic status based on zip codes, although a significantly higher number of patients were on public insurance ( P = .015). African American patients had a significantly longer duration of symptoms than their Caucasian counterparts (8.4 days vs 1.8 days P = .0316). In total, 41/42 underwent surgery for the SDE, most within 24 hours of initial neurosurgical evaluation. There were no significant differences in the average length of stay. The average length of antibiotic duration was 57.2 days and was similar for all patients. There were no significant differences in discharge disposition based on any of the factors identified with most of the patients (52.4%) being discharged to home. There was 1 mortality (2.4%). CONCLUSION Although there were no differences in outcomes based on nonclinical factors, African American men on public insurance bear a disproportionately high burden of SDE. Further investigation into the causes of this is warranted.
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Affiliation(s)
- Nirali Patel
- Department of Neurosurgery, Children's National Hospital, Washington , District of Columbia , USA
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Hennrick H, Miller E, Lai WW, Nelkin VC, Flores AM, Olson M, Kong D, Tan A. Effects of Implementing a Standardized Surveillance Program on Cardiac Neurodevelopmental Program Referral Completion. Pediatr Cardiol 2024; 45:821-828. [PMID: 38416202 DOI: 10.1007/s00246-024-03425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/20/2024] [Indexed: 02/29/2024]
Abstract
Differences in surveillance methods have resulted in significant variability in referral volumes and referral completion rates across cardiac neurodevelopmental programs, with frequent barriers to referral completion including high no-show rates, lack of education, and inaccessibility for underrepresented populations. The purpose of this study was to describe implementation of a standardized surveillance program and investigate impact on referral volume and completion over a two-year period. Between fiscal years 2021 and 2022, a surveillance program was implemented which standardized assessment of neurodevelopmental risk via a checklist as well as family education and referral procedures. All patients referred to the cardiac neurodevelopmental program during these two fiscal years were included in the analysis, and patient referrals were categorized as complete or incomplete (due to physician-related or patient-related factors). Referral completion rates between fiscal years were compared using two sample Z test of proportions, while associations between referral completion and demographic/anatomical variables were completed using chi-square tests of independence. Implementation of the formal surveillance program resulted in a 66.7% increase in referral volume. Proportions of both incomplete referrals (z = 2.00, p < 0.05) and incomplete referrals due to physician-related factors (z = 4.34, p < 0.01) were significantly lower after implementation. A significant association was found after implementation between referral completion and race/ethnicity (x2 = 14.08, p < 0.01) due to a significantly high proportion of completed referrals for patients identifying as Hispanic/Latino within the overall distribution of patients. This study describes the successful implementation of a standardized surveillance program, including improvements to referral volume and completion rate. Findings also support implementation of methods that emphasize physician surveillance methods and improve accessibility for historically marginalized groups at greatest risk for disparities in access and quality of care.
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Affiliation(s)
- Heather Hennrick
- Department of Psychology and Neuropsychology, Children's Hospital of Orange County, 1120 West La Veta Avenue, Suite 470, Orange, CA, 92868, USA
| | - Elizabeth Miller
- Heart Institute, Children's Hospital of Orange County, Orange, CA, USA
| | - Wyman W Lai
- Heart Institute, Children's Hospital of Orange County, Orange, CA, USA
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA
| | - Viannae Carmona Nelkin
- Department of Psychology and Neuropsychology, Children's Hospital of Orange County, 1120 West La Veta Avenue, Suite 470, Orange, CA, 92868, USA
| | - Ana-Mercedes Flores
- Department of Psychology and Neuropsychology, Children's Hospital of Orange County, 1120 West La Veta Avenue, Suite 470, Orange, CA, 92868, USA
| | - Marissa Olson
- Heart Institute, Children's Hospital of Orange County, Orange, CA, USA
| | - Dianne Kong
- Department of Psychology and Neuropsychology, Children's Hospital of Orange County, 1120 West La Veta Avenue, Suite 470, Orange, CA, 92868, USA
| | - Alexander Tan
- Department of Psychology and Neuropsychology, Children's Hospital of Orange County, 1120 West La Veta Avenue, Suite 470, Orange, CA, 92868, USA.
- Heart Institute, Children's Hospital of Orange County, Orange, CA, USA.
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Inanaga R, Toida T, Aita T, Kanakubo Y, Ukai M, Toishi T, Kawaji A, Matsunami M, Okada T, Munakata Y, Suzuki T, Kurita N. Trust, Multidimensional Health Literacy, and Medication Adherence among Patients Undergoing Long-Term Hemodialysis. Clin J Am Soc Nephrol 2024; 19:463-471. [PMID: 38127331 PMCID: PMC11020446 DOI: 10.2215/cjn.0000000000000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Basic health literacy and trust in physicians can influence medication adherence in patients receiving dialysis. However, how high-order health literacy is associated with medication adherence and how trust in physicians mediates this association remain unclear. We assessed the inter-relationships between health literacy, trust in physicians, and medication adherence. We investigated the mediating role of trust in physicians in the relationship between health literacy and medication adherence. METHODS This multicenter cross-sectional study included Japanese adults receiving outpatient hemodialysis at six dialysis centers. Multidimensional health literacy was measured using the 14-item Functional, Communicative, and Critical Health Literacy scale. Trust in physicians was measured using the five-item Wake Forest Physician Trust scale. Medication adherence was measured using the 12-item Adherence Starts with Knowledge scale. A series of general linear models were created to analyze the associations between health literacy and Adherence Starts Knowledge scores with and without trust in physicians. Mediation analysis was performed to determine whether trust in physicians mediated this association. RESULTS In total, 455 patients were analyzed. Higher functional and communicative health literacies were associated with less adherence difficulties (per 1-point higher: -1.79 [95% confidence interval (CI): -2.59 to -0.99] and -2.21 [95% CI: -3.45 to -0.96], respectively), whereas higher critical health literacy was associated with greater adherence difficulties (per 1-point higher: 1.69 [95% CI: 0.44 to 2.94]). After controlling for trust in physicians, the magnitude of the association between health literacies and medication adherence decreased. Trust in physicians partially mediated the association between functional or communicative health literacy and medication adherence (especially beliefs) and completely mediated the association between critical health literacy and medication adherence (especially behaviors). CONCLUSIONS Functional and communicative health literacies were positively associated with medication adherence, whereas critical health literacy was negatively associated with it. Each association was mediated by trust in physicians.
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Affiliation(s)
- Ryohei Inanaga
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Nephrology, Shin-Yurigaoka General Hospital, Kanagawa, Japan
| | - Tatsunori Toida
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, Miyazaki, Japan
| | - Tetsuro Aita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of General Internal Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yusuke Kanakubo
- Tessyoukai Kameda Family Clinic Tateyama, Chiba, Japan
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
| | - Mamiko Ukai
- Tessyoukai Kameda Family Clinic Tateyama, Chiba, Japan
| | - Takumi Toishi
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Atsuro Kawaji
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Masatoshi Matsunami
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Tadao Okada
- Tessyoukai Kameda Family Clinic Tateyama, Chiba, Japan
| | - Yu Munakata
- Chikuseikai Munakata Clinic, Tokyo, Japan
- Munakata Clinic, Chiba, Japan
| | - Tomo Suzuki
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan
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Hernandez Alvarez A, Valentine L, Bustos VP, Foppiani J, Weidman AA, Foster L, Lee D, Escobar-Domingo MJ, Lee BT, Lin SJ. Racial and ethnic representation in united states plastic surgery clinical trials: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 91:430-437. [PMID: 38484437 DOI: 10.1016/j.bjps.2024.02.062] [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: 12/01/2023] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
In 1993, the National Institutes of Health Revitalization Act mandated increasing minority and women enrollment in clinical trials (CTs). This study aimed to investigate trends in race and ethnicity enrollment and reporting in US plastic and reconstructive surgery (PRS) CT. METHODS A comprehensive systematic review was performed. All CTs in PRS from 2012 to 2022 were included. To assess racial and ethnic representation within CTs, a random-effects meta-analysis of proportion was conducted to pool the prevalence of the binomial data. RESULTS A total of 3609 studies were initially identified in the search strategy, with 154 later classified as CTs in PRS. Only 36 met the eligibility criteria for reporting race and ethnicity and were included in the analysis. A total of 7281 participants were included: 446 (6.1%) males and 6835 (93.9%) females. From CTs that correctly reported race, the pooled prevalence of races were as follows: Whites 78% (95% confidence interval [CI] 73-82%), Black or African Americans 8% (95% CI 5-11%), Asians 1% (95% CI <1-2%), American Indians <1% (95% CI <1-<1%), and Pacific Islanders <1% (95% CI <1-<1%). From the studies that reported ethnicity correctly, the pooled prevalence of Hispanics was 7% (95% CI 5-9%), and Non-Hispanics was 12% (<1-38%). CONCLUSIONS Disparities in minority representation were present among PRS CTs. This suggests clear limitations in generalizing PRS CT results to the population. Efforts to decrease the gap in minority enrollment and accurately report race and ethnicity are needed in all fields, including plastic surgery.
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Affiliation(s)
| | - Lauren Valentine
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Valeria P Bustos
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jose Foppiani
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Allan A Weidman
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lacey Foster
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniela Lee
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Bernard T Lee
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Samuel J Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Jacobs J, Walsh JL, Valencia J, DiFranceisco W, Hirschtick JL, Hunt BR, Quinn KG, Benjamins MR. Associations Between Religiosity and Medical Mistrust: An Age-Stratified Analysis of Survey Data from Black Adults in Chicago. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01979-1. [PMID: 38514511 DOI: 10.1007/s40615-024-01979-1] [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: 11/06/2023] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
Medical mistrust is associated with poor health outcomes, ineffective disease management, lower utilization of preventive care, and lack of engagement in research. Mistrust of healthcare systems, providers, and institutions may be driven by previous negative experiences and discrimination, especially among communities of color, but religiosity may also influence the degree to which individuals develop trust with the healthcare system. The Black community has a particularly deep history of strong religious communities, and has been shown to have a stronger relationship with religion than any other racial or ethnic group. In order to address poor health outcomes in communities of color, it is important to understand the drivers of medical mistrust, which may include one's sense of religiosity. The current study used data from a cross-sectional survey of 537 Black individuals living in Chicago to understand the relationship between religiosity and medical mistrust, and how this differs by age group. Descriptive statistics were used to summarize data for our sample. Adjusted stratified linear regressions, including an interaction variable for age group and religiosity, were used to model the association between religiosity and medical mistrust for younger and older people. The results show a statistically significant relationship for younger individuals. Our findings provide evidence for the central role the faith-based community may play in shaping young peoples' perceptions of medical institutions.
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Affiliation(s)
- Jacquelyn Jacobs
- Sinai Urban Health Institute, Sinai Health System, 1500 S. Fairfield Ave, Chicago, IL, 60608, USA.
| | - Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jesus Valencia
- Sinai Urban Health Institute, Sinai Health System, 1500 S. Fairfield Ave, Chicago, IL, 60608, USA
| | - Wayne DiFranceisco
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jana L Hirschtick
- Advocate Aurora Research Institute, Advocate Health Center, Chicago, IL, USA
| | - Bijou R Hunt
- Sinai Infectious Disease Center, Sinai Health System, Chicago, IL, USA
| | - Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maureen R Benjamins
- Sinai Urban Health Institute, Sinai Health System, 1500 S. Fairfield Ave, Chicago, IL, 60608, USA
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Agarwal AK, Gonzales RE, Sagan C, Nijim S, Asch DA, Merchant RM, South EC. Perspectives of Black Patients on Racism Within Emergency Care. JAMA HEALTH FORUM 2024; 5:e240046. [PMID: 38457129 PMCID: PMC10924244 DOI: 10.1001/jamahealthforum.2024.0046] [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: 09/29/2023] [Accepted: 01/01/2024] [Indexed: 03/09/2024] Open
Abstract
Importance Numerous Black individuals experience racism persistently throughout their lives, with repercussions extending into health care settings. The perspectives of Black individuals regarding emergency department (ED) care, racism, and patient-centered approaches for dismantling structural racism remain less explored. Objective To qualitatively explore the perspectives and experiences of Black patients related to race, racism, and health care following a recent ED visit. Design, Setting, and Participants In this qualitative study, the audio from semistructured interviews of Black patients discharged from an academic urban ED between August 2021 to April 2022 were recorded, transcribed, and analyzed using thematic analysis. Main Outcomes and Measures The main outcomes encompassed the main themes from the analysis of the interviews with Black patients regarding their perspectives on race, racism, and clinical care. Results A total of 25 Black patients (20 [80%] female; mean [SD] age, 44.6 [12.9] years) discharged from the ED were interviewed. Three broad domains were identified: (1) racism in health care; (2) ED clinical care; and (3) recommendations for improvement. Within these domains, the first 2 were grouped into specific themes. Within the first domain, racism in health care, 7 themes were identified using thematic analysis: (1) a history of medical racism; (2) dismissiveness; (3) patient expectations on encountering racism; (4) medical mistrust; (5) health literacy; (6) postencounter outcomes, and (7) discrimination beyond but associated with race. Within the second theme, ED clinical care, 5 themes were identified using the same thematic analysis method: (1) discharge plan; (2) patient experience; (3) waiting room perceptions; (4) medication treatment; and (5) pain management. The third domain, recommendations for improvement, incorporated patient-generated suggestions for enhancing the Black patient experience. Conclusions and Relevance In this qualitative study, the fabric of clinical care delivery in the ED was intricately woven with Black patients' experiences of racism. Patients expressed a pervasive sense of mistrust, skepticism, and dismissiveness at the system level. Instances of racism were consistently highlighted by patients from their entry to the ED to discharge. These perspectives illuminate the pervasive nature of racism in clinical care, providing valuable insights for exploring patient-centered approaches to foster antiracist cultures in the ED and throughout the broader medical landscape.
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Affiliation(s)
- Anish K. Agarwal
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel E. Gonzales
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia
| | - Charlotte Sagan
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sally Nijim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - David A. Asch
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raina M. Merchant
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Eugenia C. South
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Justice, Penn Medicine, University of Pennsylvania, Philadelphia
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Katta MH, Shao CC, Jones B, Nehemiah A, Krouse R, Ko C, Chu DI. The role of telemedicine in building trust: An evolution of the patient-surgeon relationship. Am J Surg 2024; 229:186-187. [PMID: 38007368 DOI: 10.1016/j.amjsurg.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/27/2023] [Accepted: 11/08/2023] [Indexed: 11/27/2023]
Affiliation(s)
- Meghna H Katta
- University of Alabama at Birmingham Heersink School of Medicine, 1670 University Blvd, Birmingham, AL 35233, USA
| | - Connie C Shao
- University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, BDB 581, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Bayley Jones
- University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, BDB 581, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Ariel Nehemiah
- University of Pennsylvania Perelman School of Medicine, Department of Surgery, 3400 Spruce St # 4, Philadelphia, PA, 19104, USA
| | - Robert Krouse
- University of Pennsylvania Perelman School of Medicine, Department of Surgery, 3400 Spruce St # 4, Philadelphia, PA, 19104, USA
| | - Clifford Ko
- David Geffen School of Medicine at UCLA, Department of Surgery, 10833 Le Conte Ave #72, Los Angeles, CA, 90024, USA
| | - Daniel I Chu
- University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, BDB 581, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
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Thompson CL, Buchanan AH, Myers R, Weinberg DS. Integrating primary care, shared decision making, and community engagement to facilitate equitable access to multi-cancer early detection clinical trials. Front Oncol 2024; 13:1307459. [PMID: 38486933 PMCID: PMC10937460 DOI: 10.3389/fonc.2023.1307459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/06/2023] [Indexed: 03/17/2024] Open
Abstract
Effective implementation of cancer screening programs can reduce disease-specific incidence and mortality. Screening is currently recommended for breast, cervical, colorectal and lung cancer. However, initial and repeat adherence to screening tests in accordance with current guidelines is sub-optimal, with the lowest rates observed in historically underserved groups. If used in concert with recommended cancer screening tests, new biospecimen-based multi-cancer early detection (MCED) tests could help to identify more cancers that may be amendable to effective treatment. Clinical trials designed to assess the safety and efficacy of MCED tests to assess their potential for reducing cancer mortality are needed and many are underway. In the conduct of MCED test trials, it is crucial that participant recruitment efforts successfully engage participants from diverse populations experiencing cancer disparities. Strategic partnerships involving health systems, clinical practices, and communities can increase the reach of MCED trial recruitment efforts among populations experiencing disparities. This goal can be achieved by developing health system-based learning communities that build understanding of and trust in biomedical research; and by applying innovative methods for identifying eligible trial patients, educating potential participants about research trials, and engaging eligible individuals in shared decision making (SDM) about trial participation. This article describes how a developing consortium of health systems has used this approach to encourage the uptake of cancer screening in a wide range of populations and how such a strategy can facilitate the enrollment of persons from diverse patient and community populations in MCED trials.
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Affiliation(s)
- Cheryl L. Thompson
- Penn State Cancer Institute, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Adam H. Buchanan
- Department of Genomic Health, Geisinger, Danville, PA, United States
| | - Ronald Myers
- Division of Population Science Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - David S. Weinberg
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA, United States
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Foust JL, Taber JM. Injunctive social norms and perceived message tailoring are associated with health information seeking. J Behav Med 2024; 47:1-14. [PMID: 37119363 PMCID: PMC10148588 DOI: 10.1007/s10865-023-00413-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: 07/08/2022] [Accepted: 04/18/2023] [Indexed: 05/01/2023]
Abstract
Social norms messages may promote information seeking, especially when the norms refer to a group with which a person identifies. We hypothesized that tailored social norms messages would increase COVID-19 testing willingness and intentions. College students (n = 203, 75% female, 87% White) were randomly assigned to one of four conditions in a 2 (Descriptive norms: Relevant vs. Irrelevant to COVID-19 testing) x 2 (Tailoring: Specific vs. General group information) experimental design. Participants reported COVID-19 testing willingness and intentions, perceived injunctive norms, and identification and connectedness with the group in the message. Although neither the norm nor tailoring manipulation worked as intended, participants who perceived greater message tailoring and injunctive norms reported greater willingness and intentions, with no effect of perceived descriptive norms on either outcome. Tailored messages as well as messages promoting injunctive norms may promote information seeking across health contexts, thereby enabling more informed decisions.
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Affiliation(s)
- Jeremy L Foust
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA.
| | - Jennifer M Taber
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
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34
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Gonzalez VM, Stewart TJ. COVID-19 vaccine hesitancy among American Indian and Alaska native college students: the roles of discrimination, historical trauma, and healthcare system distrust. J Behav Med 2024; 47:123-134. [PMID: 37634151 DOI: 10.1007/s10865-023-00443-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
For American Indians and Alaska Native (AIAN) and other communities of color, experiences with discrimination and historical trauma may contribute to healthcare system distrust and negatively affect health care decisions, including vaccination. A saturated path analysis was conducted to examine the direct and indirect associations of thoughts regarding historical losses (of culture, language, and traditional ways) and AIAN racial discrimination with historical loss associated distress, healthcare system distrust, and COVID-19 vaccine hesitancy among AIAN college students (N = 391). Historical loss thoughts and experiences with racial discrimination were strongly associated with each other, and both were uniquely associated with greater historical loss associated distress. In turn, historical loss associated distress was associated with greater healthcare system distrust, which in turn was associated with greater likelihood of being COVID-19 vaccine hesitant. While further research is needed, the findings suggest that to address health disparities for AIAN people it is necessary to consider how to best overcome healthcare system distrust and factors that contribute to it, including historical trauma and contemporary experiences with discrimination.
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Affiliation(s)
- Vivian M Gonzalez
- Department of Psychology, University of Alaska Anchorage, 3211 Providence Drive, Anchorage, AK, 4464, 99508, USA.
| | - Tracy J Stewart
- Department of Psychology, University of Alaska Anchorage, 3211 Providence Drive, Anchorage, AK, 4464, 99508, USA
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35
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Ordaz OH, Croff RL, Robinson LD, Shea SA, Bowles NP. Belonging, endurance, and resistance: Black placemaking theory in primary care. Soc Sci Med 2024; 342:116509. [PMID: 38184964 PMCID: PMC10903339 DOI: 10.1016/j.socscimed.2023.116509] [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: 05/23/2023] [Revised: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 01/09/2024]
Abstract
Black-Americans continue to experience pervasive health disparities. Factors contributing to increased disease risk include a general mistrust of biomedical institutions among Black Americans. The purpose of this focus group study was to identify, among Black patients who regularly seek care from a primary provider, salient themes regarding barriers to 1) receiving quality primary care; and 2) adhering to medical recommendations. We examined transcripts of eight focus groups held remotely with 29 Black patients (aged 30-60 years) who had established primary care providers. Using grounded theory and an inductive thematic analysis of the transcripts, we identified three themes (belonging, endurance, and resistance) consistent with Black placemaking theory. Our findings suggest that reducing health disparities for Black Americans will require clinical initiatives that emphasize: 1) attention to social influences on health behavior and to features of medical institutions that mark them as White spaces (belonging); 2) recognition of, as well as sensitivity to, community awareness of the systemic and interpersonal barriers to health and safety that many Black adults endure; and 3) reframing avoidant (resistant) behaviors as protective strategies among Black patients. Examining primary care in this way-through the lens of Black placemaking theory-reveals how culturally meaningful approaches to harnessing the specialized knowledge and resilience that clearly exists among many Black communities can improve health care delivery.
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Affiliation(s)
- Omar H Ordaz
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Raina L Croff
- School of Medicine Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - LaTroy D Robinson
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Nicole P Bowles
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA.
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36
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Christensen M, Kartchner J, Giegengack M, Thompson AC. A Comparison of Black and Non-Black Patients in the Presentation and Treatment of Keratoconus. Clin Ophthalmol 2024; 18:259-267. [PMID: 38292854 PMCID: PMC10826705 DOI: 10.2147/opth.s447036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024] Open
Abstract
Purpose Patients with advanced keratoconus (KCN) are less likely to benefit from corneal cross-linking and may require a partial or full thickness keratoplasty. This study aimed to determine whether racial disparities exist in the clinical presentation and initial treatment recommendations for patients evaluated for KCN. Methods A single-center retrospective review was conducted on all patients who presented to the cornea department for initial evaluation of KCN between 2018 and 2020. Patients who had undergone prior corneal procedures or surgeries were excluded. Baseline sociodemographic and clinical information was collected and stratified according to black versus non-black race. Generalized estimating equations were used to examine the association between black race and presenting corrected distance visual acuity (CDVA), presence of corneal scarring, keratometry values, Belin ABCD score, and treatment recommendations. Multivariate models were adjusted for patient demographics. Results A total of 128 patients (251 eyes) were included in this study. In fully adjusted models, black individuals presented with significantly worse CDVA (p < 0.0001) and worse tomographic KCN staging according to the Belin ABCD criteria (p = 0.002) compared to non-blacks. Blacks were also more than four times as likely to present with a thinnest pachymetry <400 µm (p < 0.0001) and more than three times as likely to have corneal scarring (p = 0.001). Blacks were more than seven times more likely to have keratoplasty recommended as treatment than conservative management such as corneal cross-linking or contact lenses (p = 0.004). Conclusion Compared with their non-black counterparts, blacks presented with significantly more advanced KCN, which placed them at risk of requiring more invasive treatment plans. Future studies should investigate reasons for such late presentations and aim to mitigate disparities in the presentation and management of KCN.
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Affiliation(s)
| | - Jeffrey Kartchner
- Wake Forest University School of Medicine, Winston Salem, NC, USA
- Department of Surgical Ophthalmology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
- Arizona Eye Consultants, Tucson, AZ, USA
| | - Matthew Giegengack
- Wake Forest University School of Medicine, Winston Salem, NC, USA
- Department of Surgical Ophthalmology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Atalie C Thompson
- Wake Forest University School of Medicine, Winston Salem, NC, USA
- Department of Surgical Ophthalmology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
- Department of Gerontology and Geriatric Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
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37
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Zhao X, Hingle A, Shaw CC, Murphy A, Riddick BR, Davidson Mhonde RR, Taylor BG, Lamuda PA, Pollack HA, Schneider JA, Taxman FS. Endorsement of COVID-19 misinformation among criminal legal involved individuals in the United States: Prevalence and relationship with information sources. PLoS One 2024; 19:e0296752. [PMID: 38181012 PMCID: PMC10769018 DOI: 10.1371/journal.pone.0296752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/14/2023] [Indexed: 01/07/2024] Open
Abstract
Criminal legal system involvement (CLI) is a critical social determinant of health that lies at the intersection of multiple sources of health disparities. The COVID-19 pandemic exacerbates many of these disparities, and specific vulnerabilities faced by the CLI population. This study investigated the prevalence of COVID-19-related misinformation, as well as its relationship with COVID-19 information sources used among Americans experiencing CLI. A nationally representative sample of American adults aged 18+ (N = 1,161), including a subsample of CLI individuals (n = 168), were surveyed in February-March 2021. On a 10-item test, CLI participants endorsed a greater number of misinformation statements (M = 1.88 vs. 1.27) than non-CLI participants, p < .001. CLI participants reported less use of government and scientific sources (p = .017) and less use of personal sources (p = .003) for COVID-19 information than non-CLI participants. Poisson models showed that use of government and scientific sources was negatively associated with misinformation endorsement for non-CLI participants (IRR = .841, p < .001), but not for CLI participants (IRR = .957, p = .619). These findings suggest that building and leveraging trust in important information sources are critical to the containment and mitigation of COVID-19-related misinformation in the CLI population.
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Affiliation(s)
- Xiaoquan Zhao
- Department of Communication, George Mason University, Fairfax, Virginia, United States of America
| | - Aayushi Hingle
- Department of ELAP, Linguistics, & Communication Studies, Montgomery College, Takoma Park, Maryland, United States of America
| | - Cameron C. Shaw
- Schar School of Public Policy, George Mason University, Fairfax, Virginia, United States of America
| | - Amy Murphy
- Schar School of Public Policy, George Mason University, Fairfax, Virginia, United States of America
| | - Breonna R. Riddick
- Department of Communication, George Mason University, Fairfax, Virginia, United States of America
| | | | - Bruce G. Taylor
- NORC at the University of Chicago, Chicago, Illinois, United States of America
| | - Phoebe A. Lamuda
- NORC at the University of Chicago, Chicago, Illinois, United States of America
| | - Harold A. Pollack
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, Illinois, United States of America
| | - John A. Schneider
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, Illinois, United States of America
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Faye S. Taxman
- Schar School of Public Policy, George Mason University, Fairfax, Virginia, United States of America
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Murdock ME, Cruz GJ, Derby L, Ellis J, Kronish IM, Edmondson D, Birk JL. Health insurance, perceived threat, and posttraumatic stress after suspected acute coronary syndrome. Health Psychol 2024; 43:34-40. [PMID: 37917470 PMCID: PMC10841455 DOI: 10.1037/hea0001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Threat perceptions during evaluation for acute coronary syndrome (ACS) in the emergency department (ED) predict posttraumatic stress symptoms (PSS). It is unknown how health insurance status affects threat perceptions. We tested whether lacking health insurance is associated with higher threat perceptions and PSS in patients with suspected ACS in the ED and whether threat perceptions mediate associations between lack of health insurance and subsequent PSS. METHOD Patients in the Columbia University Irving Medical Center ED with suspected ACS enrolled in an observational cohort study of psychological and cardiovascular outcomes. A multivariable linear regression model tested health insurance status as the predictor of ED threat perceptions and PSS 1-month posthospitalization, adjusting for age, gender, education, Charlson Comorbidity Index, and Global Registry of Acute Coronary Events risk score. A bootstrapped mediation model tested health insurance status as the predictor, PSS 1-month posthospitalization as the outcome, and ED threat perceptions as the mediator, with the same covariates. RESULTS Of 1,741 patients with suspected ACS in the ED (Mage = 61.01 years, SD = 13.27; 47.1% women), a plurality identified as "Other" race (36.1%), Black (23.9%), and White (22.4%), and 10.3% of patients were uninsured. Lack of health insurance was associated with greater threat perceptions, b = -0.16, 95% CI [-0.26, -0.06], p = .002. Threat perceptions mediated the association between lack of health insurance and higher 1-month PSS, indirect effect = -1.04, 95% CI [-1.98, -0.17]. CONCLUSIONS Lacking health insurance may heighten threat perceptions during ACS evaluation, which may put patients at risk of developing PSS. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Margaret E. Murdock
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Gaspar J. Cruz
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Lilly Derby
- Department of Clinical Psychology, Rutgers University
| | - Julia Ellis
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Ian M. Kronish
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Donald Edmondson
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
| | - Jeffrey L. Birk
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center
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39
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Katzow MW, Steinway C, Zuzarte A, Chen J, Fishbein J, Jan S. Sociodemographic Disparities in Ambulatory Pediatric Telemedicine Utilization During COVID-19. Telemed J E Health 2024; 30:57-66. [PMID: 37579076 DOI: 10.1089/tmj.2023.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Objective: Few studies have examined sociodemographic disparities in ambulatory pediatric telemedicine utilization during the coronavirus disease 2019 pandemic. We aimed to (1) assess disparities in telemedicine visit completion during the first 6 weeks of the pandemic in 2020 and (2) determine if these disparities were significantly different from those present in 2019, when all visits occurred in person. Methods: We compared sociodemographic characteristics of patients with successful versus unsuccessful telemedicine visits from March 10, 2020 to April 18, 2020, using generalized linear mixed models. We performed the same analysis for in-person visits from the same period in 2019. We tested for differences across years using interaction terms in a combined 2019-2020 model. Results: Of 3,639 telemedicine visits scheduled, 3,033 (83.3%) were successful. In 2020, Black/African American race was significantly associated with lower odds of telemedicine visit success (odds ratio 0.65 [95% confidence interval 0.49-0.87]) compared with White race, after adjusting for age, gender, ethnicity, insurance type, visit timing, visit specialty, social vulnerability index, and internet access. In 2019, racial identity other than White was significantly associated with lower odds of in-person visit success than White, as was public insurance compared with private. In the full 2019-2020 model, in-person visits (2019) had lower odds of success than telemedicine visits (2020), and neither race, insurance type, nor any other sociodemographic characteristic had significant interactions with year. Conclusions: Racial disparities were evident in telemedicine utilization early in the pandemic; however, these disparities were not significantly different from those seen in 2019, when all visits were in person. Furthermore, telemedicine may improve access to care overall, despite having no significant impact on inequity. Efforts to eliminate racial disparities in ambulatory pediatric health care utilization are necessary across visit modalities.
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Affiliation(s)
- Michelle W Katzow
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Center for Health Innovations and Outcomes Research, Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Caren Steinway
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Andrea Zuzarte
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
| | - Jack Chen
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
| | - Joanna Fishbein
- Biostatistics Unit, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Sophia Jan
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Center for Health Innovations and Outcomes Research, Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Strouf Motley H, Kerr B, Sklansky DJ, Eickhoff J, Moreno MA, Babal JC. Parent Perceptions of Trainees in Pediatric Care: Cross-Sectional Study. JMIR Form Res 2023; 7:e46631. [PMID: 38090789 PMCID: PMC10753426 DOI: 10.2196/46631] [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: 02/27/2023] [Revised: 10/22/2023] [Accepted: 11/20/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Clinical experience and progressive autonomy are essential components of medical education and must be balanced with patient comfort. While previous studies have suggested that most patients accept trainee involvement in their care, few studies have focused specifically on the views of parents of pediatric patients or examined groups who may not report acceptance. OBJECTIVE This study aims to understand parental profiles of resident and medical student involvement in pediatric care and to use latent class analysis (LCA) methodology to identify classes of responses associated with parent demographic characteristics. METHODS We used data from a national cross-sectional web-based survey of 3000 parents. The survey used a 5-point Likert scale to assess 8 measures of parent perceptions of residents and medical students. We included participants who indicated prior experience with residents or medical students. We compared responses about resident involvement in pediatric care with responses about student involvement, used LCA to identify latent classes of parent responses, and compared demographic features between the latent classes. RESULTS Of the 3000 parents who completed the survey, 1543 met the inclusion criteria for our study. Participants reported higher mean scores for residents than for medical students for perceived quality of care, comfort with autonomously performing an examination, and comfort with autonomously giving medical advice. LCA identified 3 latent classes of parent responses: Trainee-Hesitant, Trainee-Neutral, and Trainee-Supportive. Compared with the Trainee-Supportive and Trainee-Neutral classes, the Trainee-Hesitant class had significantly more members reporting age <30 years, household income < US $50,000, no college degree, and lesser desire to receive future care at a teaching hospital (all P<.05). CONCLUSIONS Parents may prefer greater clinical autonomy for residents than medical students. Importantly, views associated with the Trainee-Hesitant class may be held disproportionately by members of historically and currently socially marginalized demographic groups. Future studies should investigate underlying reasons for trainee hesitancy in these groups, including the possibility of mistrust in medicine.
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Affiliation(s)
- Haley Strouf Motley
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Bradley Kerr
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Daniel J Sklansky
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Jens Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Megan A Moreno
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Jessica C Babal
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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Carmona G, Sawant K, Hamasha R, Cross FL, Woolford SJ, Buyuktur AG, Burke Bailey S, Rowe Z, Marsh E, Israel B, Platt J. Use of the socio-ecological model to explore trusted sources of COVID-19 information in Black and Latinx communities in Michigan. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:389-400. [PMID: 37942823 PMCID: PMC10872920 DOI: 10.1080/17538068.2023.2277499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND Identifying trusted sources of health information and exploring what makes these sources trustworthy is an important aspect of public health. This exploration requires embracing the cultural differences in minoritized communities, which are often treated as homogeneous. This qualitative study identifies and analyze the sources of trusted COVID-19 information among Black and Latinx communities in Michigan and assesses the rationale underlying this trust. METHODS Interviews were conducted with 24 Black and 16 Latinx participants (n = 40) in four Michigan counties significantly impacted by COVID-19. The socio-ecological model was applied as an analytical framework for understanding the entities considered trusted sources of information. Within each level of the model, the dimensions of trustworthiness most salient for participants were identified. RESULTS We found that sources of information came from all levels of the model, including interpersonal (COVID-19 survivors, church representatives, friends, relatives), organizational (employers, healthcare providers, traditional news reports), social media (hybrid source), community (members and groups), and public policy (county health department, federal and state government). Furthermore, participants determined whether they could trust information about COVID-19 by cross-referencing multiple resources. We identified competence, confidence, communication, and system trust as the dimensions of trustworthiness most often reported by participants. CONCLUSIONS Our research suggests public health communications should engage in cross-referencing practices, providing information from sources at all levels of interaction, cultural competency, and awareness of historical/structural inequities. These efforts would be further strengthened by attending to needs for both factual information as well as care and personal connection.
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Affiliation(s)
- Gloria Carmona
- Department of Learning Health Sciences, Medical School, University of Michigan, Michigan, USA
| | | | | | | | - Susan J Woolford
- Department of Pediatrics University of Michigan, Susan B Meister Child Health Evaluation and Research Center
| | - Ayse G Buyuktur
- Michigan Institute for Clinical & Health Research, University of Michigan
| | - Sarah Burke Bailey
- Michigan Institute for Clinical & Health Research, University of Michigan
| | | | - Erica Marsh
- Department of Obstetrics and Gynecology, University of Michigan Medical School
| | - Barbara Israel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan
| | - Jodyn Platt
- Department of Learning Health Sciences, Medical School, University of Michigan, Michigan, USA
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Patel A, Lebron VM, Pabalan A, Schueler SA, El-Bayoumi J, Onumah C, Borum ML. Engaging the community on colorectal cancer screening: Additional factors identified by African Americans as potential barriers during focus groups. J Natl Med Assoc 2023; 115:580-583. [PMID: 37852880 DOI: 10.1016/j.jnma.2023.09.010] [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: 08/13/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE African-Americans have the highest rate of colorectal cancer deaths. Adherence to colorectal cancer screening guidelines can improve outcomes. The objective of this study was to evaluate physician trust and barriers to screening utilizing a unique bi-directional learning focus group involving African-American adults and health care learners. METHODS A focus group of African-American adults from a community church and university health care learners was conducted to identify colon cancer screening barriers. Health care learners were medical students, resident physicians and gastroenterology fellows. Pre-focus group surveys, including the Wake Forest Physician Trust Scale (WFPTS) and a colon cancer screening knowledge survey, were administered. Audio recording of the focus group was transcribed with subsequent thematic analysis. A post-focus group survey evaluated the colorectal cancer screening barriers identified during the focus group. Analysis of pre- and post- focus group surveys was performed using Fisher Exact test with significance set at p<0.05. RESULTS The focus group consisted of 18 members (7 African-American community members, 11 non-African American health care learners). WFPTS revealed that 83% (86% community members, 82% health care learners; p = 1.0) strongly agree / agree that their physician would advocate for their health. 77% (86% community members, 73% health care learners; p = 1.0) strongly agree / agree that they trusted their physician. 100% recognized that colon cancer screening is recommended. The focus group identified lack of awareness (81%), colonoscopy preparation (81%), trust in physician (60%), lack of insurance coverage (56%), transportation (56%), colonoscopy wait time (50%), insufficient physician discussion (50%) and fear of procedure or cancer (35%) as screening barriers. Post-focus group surveys revealed that community members more frequently identified racial disparity in health care (p = 0.0474), physician respect toward patients (p = 0.0128) and insufficient physician discussion (p = 0.0006) as screening barriers. CONCLUSIONS Focus group discussion identified multiple barriers for colorectal cancer screening. Notably, differences in the perceptions of African-American community members and non-African-American health care learners about racial disparity in health care, physician respect toward patients and insufficient physician discussion were revealed. The integration of bi-directional focus group learning can be considered as a potential strategy to assist in the development of focused screening interventions.
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Affiliation(s)
- Ankit Patel
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Valeria Martinez Lebron
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Ana Pabalan
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Samuel A Schueler
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington DC, USA
| | - Jehan El-Bayoumi
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Chavon Onumah
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Marie L Borum
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington DC, USA.
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Gaba H, Shamaskin-Garroway AM, Pierson WE, Berliant MN. Racial and Ethnic Differences in Patient-Reported Acceptability of Adverse Childhood Experience (ACE) Screening in Adult Primary Care. J Racial Ethn Health Disparities 2023; 10:3107-3114. [PMID: 36469290 DOI: 10.1007/s40615-022-01484-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/27/2022] [Accepted: 11/27/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Given the dose-response relationship between adverse childhood experiences (ACEs) and worse health outcomes, there has been a growing push for routine ACE screening in healthcare settings. OBJECTIVE This study explored differences in patient-reported acceptability of ACE screening among adult primary care patients. PARTICIPANTS AND SETTING Participants were adult primary care patients at an academic safety-net internal medicine clinic. Of the 136 patients who elected to participate in this study, 131 (96%) submitted completed surveys. METHODS Adult primary care patients at an academic safety-net internal medicine clinic completed an ACE screener and follow-up survey assessing their reported acceptability of ACE screening. Patients were also asked to specify their race, ethnicity, gender, and age. Chi-square analysis and Fisher's exact tests were used to examine associations between variables. RESULTS Among 131 patients, 37% reported 4 or more ACEs. Black/African American patients and Hispanic/Latinx patients were overrepresented in the high ACE score (4 +) group (p < 0.05). Over one in three of all patients did not find ACE screening to be an acceptable part of their primary care. After a Bonferroni adjustment, patient-reported acceptability was not statistically associated with patients' ACE score or patients' race, ethnicity, gender, or age. Notably, however, in our small sample of Native American and Hispanic/Latino patients, over half did not find ACE screening to be acceptable. CONCLUSIONS There is insufficient evidence to conclude that patients find ACE screening to be an acceptable part of their primary care. Our study is the first to explore how patient-reported acceptability may vary with patient demographics. While our findings revealed no significant associations between patient demographics and acceptability, trends observed within our study suggest that future studies with larger and more representative samples are needed. We consider routine ACE screening to be unsubstantiated and premature, and instead encourage the development of comprehensive trauma-informed practices for which a disclosure of childhood adversity is not necessary.
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Affiliation(s)
- Harshita Gaba
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
| | - Andrea M Shamaskin-Garroway
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - William E Pierson
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Marc N Berliant
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
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Jiao L, Wachinger J, Dasch S, Bärnighausen T, McMahon SA, Chen S. Calculation, knowledge, and identity: Dimensions of trust when making COVID-19 vaccination choices in China. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 4:100288. [PMID: 37334196 PMCID: PMC10232919 DOI: 10.1016/j.ssmqr.2023.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023]
Abstract
Vaccine hesitancy threatens the response to the COVID-19 pandemic and to other infectious disease outbreaks globally. Fostering trust has been highlighted as a critical factor in addressing vaccine hesitancy and expanding vaccine coverage, but qualitative exploration of trust in the context of vaccination remains limited. We contribute to filling this gap by providing a comprehensive qualitative analysis of trust in the context of COVID-19 vaccination in China. We conducted 40 in-depth interviews with Chinese adults in December 2020. During data collection, trust emerged as a highly salient topic. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed with a combination of inductive and deductive coding. Following established trust literature, we differentiate between three types of trust - calculation-based trust, knowledge-based trust, and identity-based trust - which we grouped across components of the health system, as informed by the WHO's building blocks. Our results highlight how participants attributed their level of trust in COVID-19 vaccines to their trust in the medical technology itself (based on assessing risks and benefits or previous vaccination experiences), the service delivery and health workforce (informed by past experiences with health providers and their role throughout the pandemic), and leadership and governance (drawing on notions of government performance and patriotism). Reducing negative impact from past vaccine controversies, increasing the credibility of pharmaceutical companies, and fostering clear communication are identified as important channels for facilitating trust. Our findings emphasize a strong need for comprehensive information on COVID-19 vaccines and increased promotion of vaccination by credible figures.
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Affiliation(s)
- Lirui Jiao
- Columbia University Mailman School of Public Health, New York, USA
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Selina Dasch
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Department of Global Health and Population, Harvard School of Public Health, Massachusetts, USA
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Simiao Chen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Anderson A. "Messengers matter": Assessing the impact of racially concordant care on vaccine hesitation. Soc Sci Med 2023; 338:116335. [PMID: 37913746 DOI: 10.1016/j.socscimed.2023.116335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
With the rise in COVID-related deaths among the unvaccinated, understanding coronavirus vaccine hesitancy is critical to maintaining public health. Previous research has shown that sociodemographic factors, such as race, are essential for understanding vaccine hesitancy; yet, the specific factors driving racial disparities in vaccination continue to be a matter of intense debate. This study uses a novel survey experiment to uncover the linkages between race, physician trust, and vaccine hesitancy. Using a standard prompt on the release of the COVID-19 vaccine, it tests whether patient-physician race concordance affects the likelihood of vaccine uptake among US citizens. Analyses reveal that racially concordant care has a negligible effect on vaccine hesitancy, but does ameliorate other harmful beliefs regarding one's likelihood of experiencing discrimination and racism in healthcare more generally. These findings suggest that increasing diversity in the medical field should be paired with efforts to address systemic inequalities to promote increased vaccination.
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Affiliation(s)
- Ashley Anderson
- University of North Carolina at Chapel Hill, 205 South Building, Chapel Hill, NC, 27599, USA.
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Hamid M, Gill J, Okoh P, Yanga N, Gupta V, Zhang JC, Singh N, Matelski J, Boakye P, James CE, Waterman A, Mucsi I. Knowledge About Renal Transplantation Among African, Caribbean, and Black Canadian Patients With Advanced Kidney Failure. Kidney Int Rep 2023; 8:2569-2579. [PMID: 38106596 PMCID: PMC10719606 DOI: 10.1016/j.ekir.2023.09.018] [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: 12/26/2022] [Revised: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Variable transplant-related knowledge may contribute to inequitable access to living donor kidney transplant (LDKT). We compared transplant-related knowledge between African, Caribbean, and Black (ACB) versus White Canadian patients with kidney failure using the Knowledge Assessment of Renal Transplantation (KART) questionnaire. Methods This was a cross-sectional cohort study. Data were collected from a cross-sectional convenience sample of adults with kidney failure in Toronto. Participants also answered an exploratory question about their distrust in the kidney allocation system. Clinical characteristics were abstracted from medical records. The potential contribution of distrust to differences in transplant knowledge was assessed in mediation analysis. Results Among 577 participants (mean [SD] age 57 [14] years, 63% male), 25% were ACB, and 43% were White Canadians. 45% of ACB versus 26% of White participants scored in the lowest tertile of the KART score. The relative risk ratio to be in the lowest tertile for ACB compared to White participants was 2.22 (95% confidence interval [CI]: 1.11, 4.43) after multivariable adjustment. About half of the difference in the knowledge score between ACB versus White patients was mediated by distrust in the kidney allocation system. Conclusion Participants with kidney failure from ACB communities have less transplant-related knowledge compared to White participants. Distrust is potentially contributing to this difference.
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Affiliation(s)
- Marzan Hamid
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Stanford University School of Medicine, Stanford, California, USA
| | - Jasleen Gill
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Princess Okoh
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nawang Yanga
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Vardaan Gupta
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jing Chen Zhang
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Navneet Singh
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John Matelski
- Biostatistical Research Unit, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Priscilla Boakye
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Carl E. James
- Jean Augustine Chair in Education, Community & Diaspora, Faculty of Education, York University, Toronto, Ontario, Canada
| | - Amy Waterman
- Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Istvan Mucsi
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Watson KS, Tossas KY, San Miguel Y, Gastala N, San Miguel LG, Grumeretz S, Henderson V, Winn R, Jimbo M, Naylor KB, Gregory ME, Molina Y, Hughes AM. Mi-CARE: Comparing Three Evidence-Based Interventions to Promote Colorectal Cancer Screening among Ethnic Minorities within Three Different Clinical Contexts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7049. [PMID: 37998280 PMCID: PMC10671818 DOI: 10.3390/ijerph20227049] [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: 09/13/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Multiple evidence-based interventions (EBIs) have been developed to improve the completion of colorectal cancer (CRC) screening within Federally Qualified Health Centers (FQHCs) and other safety net settings in marginalized communities. Little effort has been made, however, to evaluate their relative effectiveness across different clinical contexts and populations. To this end, we tested the relative effectiveness of three EBIs (mailed birthday cards, lay navigation, and provider-delivered education) among a convenience sample of 1252 patients (aged 50-75 years old, who were due for CRC screening and scheduled for a visit at one of three clinics within a network of Federally Qualified Health Centers (FQHCs) in the United States. To be eligible for the study, patients had to identify as African American (AA) or Latino American (LA). We compared the effects of the three EBIs on CRC screening completion using logistic regression. Overall, 20% of the study population, an increase from a baseline of 13%, completed CRC screening. Clinical demographics appeared to influence the effectiveness of the EBIs. Mailed birthday reminders appeared to be the most effective within the multi-ethnic clinic (p = 0.03), provider-delivered education within the predominantly LA clinic (p = 0.02), and lay navigation within the predominantly AA clinic (p = 0.03). These findings highlight the importance of understanding clinical context when selecting which evidence-based interventions to deploy.
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Affiliation(s)
- Karriem S. Watson
- National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA;
| | - Katherine Y. Tossas
- VCU Massey Comprehensive Cancer Center, 417 N 11th St., Richmond, VA 23219, USA; (K.Y.T.); (R.W.)
| | - Yazmin San Miguel
- Abbott Laboratories, 100 Abbott Park Road, Abbott Park, IL 60064, USA;
| | - Nicole Gastala
- Hospital & Health Sciences Systems Mile Square Health Center, University of Illinois, 1220 S Wood St. M/C 698; Chicago, IL 60612, USA;
| | - Liliana G. San Miguel
- Department of Community Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W Taylor Street, Chicago, IL 60612, USA; (L.G.S.M.); (Y.M.)
| | - Scott Grumeretz
- Cancer Center, University of Illinois, SRH MC 709, 818 South Wolcott Avenue, Chicago, IL 60612, USA;
| | - Vida Henderson
- Fred Hutchinson Cancer Center, 1100 Fairview Ave. N. M3-B232, Seattle, WA 98109, USA;
| | - Robert Winn
- VCU Massey Comprehensive Cancer Center, 417 N 11th St., Richmond, VA 23219, USA; (K.Y.T.); (R.W.)
| | - Masahito Jimbo
- Department of Family and Community Medicine, College of Medicine, University of Illinois Chicago, 1919 W. Taylor Street, MC 663, Chicago, IL 60612, USA;
| | - Keith B. Naylor
- Department of Clinical Medicine, Division of Gastroenterology and Hepatology, College of Medicine, University of Illinois Chicago, 840 S. Wood St., 718E CSB (MC 716), Chicago, IL 60612, USA;
| | - Megan E. Gregory
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL 32611, USA;
| | - Yamilé Molina
- Department of Community Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W Taylor Street, Chicago, IL 60612, USA; (L.G.S.M.); (Y.M.)
| | - Ashley M. Hughes
- Department of Biomedical and Health Information Sciences, School of Applied Health Sciences, University of Illinois Chicago, 1919 W. Taylor Street MC 530, Chicago, IL 60612, USA
- Center for Innovation for Chronic, Complex Healthcare, Edward Hines JR VA Hospital, 5000 South 5th Avenue, Bldg 1, Hines, IL 60141, USA
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Palla JB, Laguna TA. Health inequities in the modulator era. Curr Opin Pulm Med 2023; 29:626-633. [PMID: 37611037 DOI: 10.1097/mcp.0000000000001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW To discuss the existing health inequities in people with cystic fibrosis (CF) and how the recent development of cystic fibrosis transmembrane regulator (CFTR) modulators may impact these inequities. RECENT FINDINGS People with CF (pwCF) from low socioeconomic status (SES) have more pulmonary exacerbations, worse nutritional status, lower pulmonary function, and an increased mortality rate with less access to lung transplantation. pwCF who identify as racial and ethnic minorities have earlier mortality, lower lung function, are less likely to be detected on newborn screening resulting in a delayed diagnosis, are underrepresented in clinic trials, and less likely to be eligible for a CFTR modulator. Female sex is associated with more pulmonary exacerbations and earlier mortality. Sexual gender minorities are a vulnerable population with worse health outcomes, and more research is needed in CF. CFTR modulators are inaccessible to low to middle-income countries due to significant cost burden. SUMMARY People with CF from low SES, racial and ethnic minorities, female sex, and sexual gender minorities face health inequities. CFTR modulator use will further widen existing health inequities given the unequal access to modulators based on nonqualifying genetics and exorbitant cost restricting use both on an individual and global level.
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Affiliation(s)
- John B Palla
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Theresa A Laguna
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
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Jin HA, McMillan CT, Yannatos I, Fisher L, Rhodes E, Jacoby SF, Irwin DJ, Massimo L. Racial Differences in Clinical Presentation in Individuals Diagnosed With Frontotemporal Dementia. JAMA Neurol 2023; 80:1191-1198. [PMID: 37695629 PMCID: PMC10495924 DOI: 10.1001/jamaneurol.2023.3093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/18/2023] [Indexed: 09/12/2023]
Abstract
Importance Prior research suggests there are racial disparities in the presentation of dementia, but this has not been investigated in the context of frontotemporal dementia (FTD). Objective To explore racial disparities in dementia severity, functional impairment, and neuropsychiatric symptoms in individuals with a diagnosis of FTD. Design, Setting, and Participants This exploratory cross-sectional study of National Alzheimer's Coordinating Center (NACC) data collected between June 2005 to August 2021 evaluated Asian, Black, and White individuals with a diagnosis of FTD (behavioral variant FTD or primary progressive aphasia). Excluded were races with limited data, including American Indian or Alaska Native (n = 4), Native Hawaiian or other Pacific Islander (n = 3), other (n = 13), and unknown (n = 24), and participants with symptom duration more than 4 SDs above the mean. Main Outcomes and Measures Racial differences at initial NACC visit were examined on Clinical Dementia Rating Dementia Staging Instrument plus NACC Frontotemporal Lobar Degeneration Behavior & Language Domains (FTLD-CDR), Functional Assessment Scale, and Neuropsychiatric Inventory using regression models. Matching was also performed to address the imbalance between racial groups. Results The final sample comprised 2478 individuals, of which 59 (2.4%) were Asian, 63 (2.5%) were Black, and 2356 (95.1%) were White. The mean (SD) age at initial visit was 65.3 (9.4) years and symptom duration at initial visit was 67.5 (35.6) months. Asian and Black individuals were considerably underrepresented, comprising a small percent of the sample. Black individuals had a higher degree of dementia severity on FTLD-CDR (β = 0.64; SE = 0.24; P = .006) and FTLD-CDR sum of boxes (β = 1.21; SE = 0.57; P = .03) and greater functional impairment (β = 3.83; SE = 1.49; P = .01). There were no differences on FTLD-CDR and Functional Assessment Scale between Asian and White individuals. Black individuals were found to exhibit a higher frequency of delusions, agitation, and depression (delusions: odds ratio [OR], 2.18; 95% CI, 1.15-3.93; P = .01; agitation: OR, 1.73; 95% CI, 1.03-2.93; P = .04; depression: OR, 1.75; 95% CI, 1.05-2.92; P = .03). Asian individuals were found to exhibit a higher frequency of apathy (OR, 1.89; 95% CI, 1.09-3.78; P = .03), nighttime behaviors (OR, 1.72; 95% CI, 1.01-2.91; P = .04), and appetite/eating (OR, 1.99; 95% CI, 1.17-3.47; P = .01) compared to White individuals. Conclusions and Relevance This exploratory study suggests there are racial disparities in dementia severity, functional impairment, and neuropsychiatric symptoms. Future work must address racial disparities and their underlying determinants as well as the lack of representation of racially minoritized individuals in nationally representative dementia registries.
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Affiliation(s)
- Hannah A. Jin
- Penn Frontotemporal Degeneration Center, Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia
| | - Corey T. McMillan
- Penn Frontotemporal Degeneration Center, Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia
| | - Isabel Yannatos
- Penn Frontotemporal Degeneration Center, Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia
| | - Lauren Fisher
- Penn Frontotemporal Degeneration Center, Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia
| | - Emma Rhodes
- Penn Frontotemporal Degeneration Center, Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia
| | - Sarah F. Jacoby
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia
| | - David J. Irwin
- Penn Frontotemporal Degeneration Center, Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia
| | - Lauren Massimo
- Penn Frontotemporal Degeneration Center, Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia
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Ohayagha C, Perrin PB, Arango-Lasprilla JC, Jones SCT. Influence of Foreign Versus US Nativity on the Trajectory of Functional Independence Over the 10 Years After Traumatic Brain Injury: A Model Systems Study. J Head Trauma Rehabil 2023; 38:E394-E403. [PMID: 36854103 DOI: 10.1097/htr.0000000000000858] [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: 03/02/2023]
Abstract
OBJECTIVE Although racial/ethnic disparities have been documented in numerous outcomes after traumatic brain injury (TBI), research has yet to explore differences in rehabilitation outcomes based upon nativity (foreign-born vs US-born individuals). The purpose of this study was to compare the functional outcomes over the first 10 years after TBI for individuals born in the United States with those who were foreign-born. SETTING/PARTICIPANTS A sample of 10 695 individuals in the TBI Model Systems database with a coding for country of birth the United States ( n = 9435) versus other than the United States ( n = 1260) was used. DESIGN/MAIN MEASURES Outcome measures at 1, 2, 5, and 10 years after TBI included the Motor and Cognitive subscales of the Functional Independence Measure and the Supervision Rating Scale. RESULTS Foreign-born individuals exhibited lower motor functional independence trajectories than those born in the United States, even after controlling for demographic and injury-related covariates. However, foreign-born individuals generally showed a stronger upward quadratic trajectory in motor functional independence with the greatest gains between the 5- and 10-year time points, whereas those born in the United States improved more quickly but then plateaued between the 5- and 10-year time points; these differential effects over time dissipated with the addition of demographic and injury-related covariates. Foreign-born individuals also exhibited lower cognitive functional independence trajectories, as well as greater supervision needs trajectories, than those born in the United States, even after controlling for demographic and injury-related covariates. CONCLUSION These findings dovetail with literature suggesting that racially/ethnically diverse groups exhibit reduced functional independence after TBI. The findings may also suggest potential systematic barriers such as healthcare access and language barriers that may influence the frequency, rate, and quality of care received. The results highlight the importance of uncovering cultural distinctions and can aid in facilitating research examining foreign nativity-based disparities following TBI.
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Affiliation(s)
- Chimdindu Ohayagha
- Virginia Commonwealth University, Richmond (Ms Ohayagha and Drs Arango-Lasprilla and Jones); University of Virginia, Charlottesville (Dr Perrin); and Central Virginia Veterans Affairs Health Care System, Richmond (Dr Perrin)
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