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Killian AC, Carter AJ, Reed RD, Shelton BA, Qu H, McLeod MC, Orandi BJ, Cannon RM, Anderson D, MacLennan PA, Kumar V, Hanaway M, Locke JE. Greater community vulnerability is associated with poor living donor navigator program fidelity. Surgery 2022; 172:997-1004. [PMID: 35831221 PMCID: PMC9633042 DOI: 10.1016/j.surg.2022.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Community-level factors contribute to living donor kidney transplantation disparities but may also influence the interventions aimed to mitigate these disparities. The Living Donor Navigator Program was designed to separate the advocacy role from the patient in need of transplantation-friends/family are encouraged to participate as the patients' advocates to identify living donors, though some of the patients participate alone as self-advocates. Self-advocates have a lower living donor kidney transplantation likelihood compared to the patients with an advocate. We sought to evaluate the relationship between the patients' community-level vulnerability and living donor navigator self-advocacy as a surrogate for program fidelity. METHODS This single-center, retrospective study included 110 Living Donor Navigator participants (April 2017-June 2019). Program fidelity was assessed using the participants' advocacy status. Measures of community vulnerability were obtained from the Centers for Disease Control and Prevention Social Vulnerability Index. Modified Poisson regression was used to evaluate the association between community-level vulnerability and living donor navigator self-advocacy. RESULTS Of the 110 participants, 19% (n = 21) were self-advocates. For every 10% increase in community-level vulnerability, patients had 17% higher risk of self-advocacy (adjusted relative risk 1.17, 95% confidence interval: 1.03-1.32, P = .01). Living in areas with greater unemployment (adjusted relative risk: 1.18, 95% confidence interval: 1.04-1.33, P = .01), single-parent households (adjusted relative risk: 1.23, 95% confidence interval: 1.06-1.42, P = .006), minority population (adjusted relative risk: 1.30, 95% confidence interval: 1.04-1.55, P = .02), or no-vehicle households (adjusted relative risk: 1.17, 95% confidence interval: 1.02-1.35, P = .02) were associated with increased risk of self-advocacy. CONCLUSION Having a greater community-level vulnerability was associated with poor Living Donor Navigator Program fidelity. The potential barriers identified using the Social Vulnerability Index may direct resource allocation and program refinement to optimize program fidelity and efficacy for all participants.
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Affiliation(s)
- A Cozette Killian
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL. https://twitter.com/CozetteKale
| | - Alexis J Carter
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL. https://twitter.com/carteraj21
| | - Rhiannon D Reed
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL. https://twitter.com/rhiruns
| | - Brittany A Shelton
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Haiyan Qu
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - M Chandler McLeod
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Babak J Orandi
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Robert M Cannon
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Douglas Anderson
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Paul A MacLennan
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Vineeta Kumar
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Michael Hanaway
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Jayme E Locke
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL.
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Soltani S, Saraf-Bank S, Basirat R, Salehi-Abargouei A, Mohammadifard N, Sadeghi M, Khosravi A, Fadhil I, Puska P, Sarrafzadegan N. Community-based cardiovascular disease prevention programmes and cardiovascular risk factors: a systematic review and meta-analysis. Public Health 2021; 200:59-70. [PMID: 34700187 DOI: 10.1016/j.puhe.2021.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 08/16/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to summarise the effect of community-based intervention programmes on the prevention of cardiovascular disease (CVD) by reducing cardiometabolic risk factors. STUDY DESIGN This was a systematic review and meta-analysis. METHODS A systematic search in the PubMed database and screening of reference lists aimed to identify community-based CVD prevention programmes from inception up to April 2020. The mean differences and standard deviations for CVD risk factors, including blood pressure, lipid profile, blood glucose and body weight indices, were extracted and pooled using a random effects model. RESULTS Screening of 11,889 titles/abstracts and full texts resulted in 48 studies being included in this review. The meta-analysis showed that community-based programmes have led to considerable decreases in systolic blood pressure (weighted mean difference [WMD] = -2.90 mm Hg, 95% confidence interval [95% CI]: -3.63, -2.16), diastolic blood pressure (WMD = -2.21 mm Hg, 95% CI: -3.12, -1.29), serum levels of low-density lipoprotein cholesterol (LDL-C; WMD = -8.88 mg/dl, 95% CI: -12.84, -4.92), triglycerides (WMD = -8.40 mg/dl, 95% CI: -12.10, -4.70), total cholesterol (WMD = -2.96 mg/dl, 95% CI: -3.10, -2.81) and fasting blood glucose (WMD = -2.06 mg/dl, 95% CI: -3.02, -1.10). A moderate decrease in body weight was also found with community-based CVD prevention programmes. However, community-based CVD prevention programmes were not associated with any significant changes in serum levels of high-density lipoprotein. CONCLUSIONS The present study indicates that community-based strategies have successfully led to an improvement in CVD risk factors, particularly by reducing blood pressure, serum levels of LDL-C and triglycerides, obesity indices and blood glucose. The impact of these programmes on CVD is modified by the type of intervention and by different cultural and physical environments.
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Affiliation(s)
- S Soltani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - S Saraf-Bank
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - R Basirat
- Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A Salehi-Abargouei
- Nutrition and Food Security Research Center, Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - N Mohammadifard
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Khosravi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - I Fadhil
- Eastern Mediterranean NCD Alliance, Kuwait City, Kuwait
| | - P Puska
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - N Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Ma A, Comstock SE, Oyeside OA. Typologies of Sexual Health Vulnerability Predicting STI Preventive Behaviors Among Latinx Adults in the U.S.: A Latent Class Analysis Approach. J Immigr Minor Health 2021; 24:1288-1299. [PMID: 34655371 DOI: 10.1007/s10903-021-01293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/25/2022]
Abstract
Vulnerability to poor sexual health among U.S. Latinx populations is poorly understood, despite high STI rates. We examined how vulnerability typologies differ in their STI preventive behaviors. Using data from the 2016 National Health Interview Survey, we performed latent class analysis to test the association between sexual health vulnerability and HIV testing, hepatitis testing or vaccination, and HPV vaccination from a subsample of Latinx adults. Three classes emerged: Under-Employed Females with Health Care Access, Slightly Under-Employed Females with Some Health Care Access, and Employed Males without Health Care Access. Slightly Under-Employed Females with Some Health Care Access were associated with lack of HIV testing, hepatitis B and C testing, and HPV vaccination. Employed Males without Health Care Access were associated with lack of HIV testing and HPV vaccination. Sexual health vulnerability may be associated with certain STI preventive behaviors, which can inform and refine sexual health promotion programming.
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Affiliation(s)
- Alice Ma
- Department of Applied Health, Southern Illinois University Edwardsville, Campus Box 1126, Edwardsville, IL, 62026-1126, USA.
| | - Sara E Comstock
- Department of Applied Health, Southern Illinois University Edwardsville, Campus Box 1126, Edwardsville, IL, 62026-1126, USA
| | - Oluwadamilola A Oyeside
- Department of Applied Health, Southern Illinois University Edwardsville, Campus Box 1126, Edwardsville, IL, 62026-1126, USA
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Santos-Junior N, Braga JU, Maciel EMGDS. Cumulative Environmental Vulnerability Assessment in the Area of Influence of the Pecém Port Industrial Complex (Ceará, Brazil): A Spatial Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052404. [PMID: 33804547 PMCID: PMC7967749 DOI: 10.3390/ijerph18052404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 12/04/2022]
Abstract
The municipalities of Caucaia and São Gonçalo do Amarante are located in the metropolitan region of Fortaleza (CE) and are home to the Pecém Port Industrial Complex (PPIC). We know that economic development is not necessarily related to improvements in the quality of life of the population. Furthermore, the bonuses and burdens of this particular installation can occur unevenly. This study aimed to assess the cumulative environmental vulnerability of these municipalities. We used the cumulative environmental vulnerability assessment methodology to assess the population’s degree of vulnerability, considering census sectors as a spatial unit. This approach combines three indices: environmental risk index, social vulnerability index, and health index. Finally, we calculated the arithmetic mean of each indicator in each census sector. We built choropleth maps to assess the spatial distribution of environmental vulnerability. We found that many maps demonstrated high cumulative environmental vulnerability census sectors around the PPIC, while the Caucaia, located downtown, exhibited a substantial majority of the low cumulative environmental vulnerability census sectors. The district of Guararu, in Caucaia, was notable for having proportionally more census sectors with high health index values. Environmental vulnerability was heterogeneously distributed, and the most impoverished areas are also the most vulnerable.
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Affiliation(s)
- Norberto Santos-Junior
- Programa de Pós-Graduação em Saude Publica e Meio Ambiente, Escola Nacional de Saude Pública—FIOCRUZ 1, Rio de Janeiro 21041-210, Brazil;
| | - Jose Ueleres Braga
- Departamento de Epidemiologia e Metodos Quantitativos em Saude, Escola Nacional de Saude Pública—FIOCRUZ 2, Rio de Janeiro 21041-210, Brazil
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do estado do Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
- Correspondence: (J.U.B.); (E.M.G.d.S.M.); Tel.: +552122854139 (E.M.G.d.S.M.)
| | - Elvira Maria Godinho de Seixas Maciel
- Departamento de Epidemiologia e Metodos Quantitativos em Saude, Escola Nacional de Saude Pública—FIOCRUZ 2, Rio de Janeiro 21041-210, Brazil
- Correspondence: (J.U.B.); (E.M.G.d.S.M.); Tel.: +552122854139 (E.M.G.d.S.M.)
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Towards a universal concept of vulnerability: Broadening the evidence from the elderly to perinatal health using a Delphi approach. PLoS One 2019; 14:e0212633. [PMID: 30785926 PMCID: PMC6382270 DOI: 10.1371/journal.pone.0212633] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/06/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The concept 'vulnerability' is prevalent in the public domain, health care, social institutions and multidisciplinary research. Conceptual heterogeneity is present, hampering the creation of a common evidence-base of research achievements and successful policies. Recently an international expert group combined a specific literature review with a 2-stage Delphi procedure, arriving at a seemingly universal concept of vulnerability for the elderly with applications for research instruments. We replicated and extended this study, to generalize this result to health in general, and perinatal health in particular. METHODS Two independent expert panels (general health, perinatal health) repeated the Delphi-procedure, using an extended and updated literature review to derive statements on the concept and defining pathways of vulnerability. Additional views were collected on research tools. Consensus-by-design was explicitly avoided. Data collection and processing was independent. RESULTS Both panels showed surprising convergence on the pathways of vulnerability to health/ill-health, and their interaction. The agreed conceptual model describes a dynamic relation between health and ill-health and vulnerability. The 2 key pathways that link to vulnerability, are complementary, but not symmetrical as biological processes of maintaining health or obtaining better health are not reciprocal to recovery, so also not in terms of vulnerability impacts. An individual's degree of vulnerability is the net balance of risk effects and protective and healing factors (socially, biologically and in terms of health literacy and health care access). These factors can for measurement purposes (according to the panels: interview for exploration, checklists for population research) be grouped into 'material resources', 'taking responsibility for one's own health', 'risky activities and behaviors', and 'social support'. Supportive and transforming action can thus be undertaken. CONCLUSION A universal concept of vulnerability in the context of health was successfully derived after careful replication and extension of an international Delphi study on vulnerability among the elderly.
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Sudo K, Hamamoto Y. Health behaviors of foreign mothers in Japan regarding their young children and the factors that affect these behaviors: A qualitative study. Jpn J Nurs Sci 2019; 16:420-432. [PMID: 30688004 DOI: 10.1111/jjns.12251] [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: 04/06/2018] [Revised: 08/29/2018] [Accepted: 11/06/2018] [Indexed: 11/27/2022]
Abstract
AIM The number of foreign residents in Japan is increasing and these residents therefore should no longer be disregarded as members of Japanese society. The purpose of this study was to elucidate the health behaviors of foreign mothers in Japan regarding their children and the factors that affected these behaviors. METHODS A qualitative descriptive research design was used, involving a content analysis. Six focus group interviews were conducted with a total of 24 foreign mothers who were members of childrearing circles. RESULTS The health behaviors were classified as "Gathering information about child health management," "Preventing obstructions to child health care," "Perceiving the child's health condition," "Deciding to take the child to a healthcare facility," "Selecting adequate healthcare facilities," and "Managing at home when the child is sick." The factors that affected the health behaviors were classified as "Japanese culture and customs," "Child's health condition," "Culture and customs of the mother's native country," "Family," "Mother's health perception," "Healthcare facility and healthcare provider," "Friends," "Mother's health condition," "Internet," "Becoming accustomed to life in Japan," and "Japanese language ability." Gathering information, preventing obstructions to child health care, and perceiving the child's health condition were the most common behaviors. The main factors that affected the health behaviors were the culture and customs of both Japan and the mother's native country and the child's health condition. CONCLUSION It is recommended that healthcare professionals support foreign mothers to gather adequate and appropriate information regarding health, particularly child health, considering not only the culture and customs of the mother's native country, but also of the host country.
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Affiliation(s)
- Kyoko Sudo
- National College of Nursing, Japan, Tokyo, Japan
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Corscadden L, Levesque JF, Lewis V, Strumpf E, Breton M, Russell G. Factors associated with multiple barriers to access to primary care: an international analysis. Int J Equity Health 2018; 17:28. [PMID: 29458379 PMCID: PMC5819269 DOI: 10.1186/s12939-018-0740-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 02/06/2018] [Indexed: 11/19/2022] Open
Abstract
Background Disparities in access to primary care (PC) have been demonstrated within and between health systems. However, few studies have assessed the factors associated with multiple barriers to access occurring along the care-seeking process in different healthcare systems. Methods In this secondary analysis of the 2016 Commonwealth Fund International Health Policy Survey of Adults, access was represented through participant responses to questions relating to access barriers either before or after reaching the PC practice in 11 countries (Australia, Canada, France, Germany, Norway, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and United States). The number of respondents in each country ranged from 1000 to 7000 and the response rates ranged from 11% to 47%. We used multivariable logistic regression models within each of eleven countries to identify disparities in response to the access barriers by age, sex, immigrant status, income and the presence of chronic conditions. Results Overall, one in five adults (21%) experienced multiple barriers before reaching PC practices. After reaching care, an average of 16% of adults had two or more barriers. There was a sixfold difference between nations in the experience of these barriers to access. Vulnerable groups experiencing multiple barriers were relatively consistent across countries. People with lower income were more likely to experience multiple barriers, particularly before reaching primary care practices. Respondents with mental health problems and those born outside the country displayed substantial vulnerability in terms of barriers after reaching care. Conclusion A greater understanding of the multiple barriers to access to PC across the stages of the care-seeking process may help to inform planning and performance monitoring of disparities in access. Variation across countries may reveal organisational and system drivers of access, and inform efforts to improve access to PC for vulnerable groups. The cumulative nature of these barriers remains to be assessed. Electronic supplementary material The online version of this article (10.1186/s12939-018-0740-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Corscadden
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, 4812, Australia. .,Bureau of Health Information, Level 11, 67 Albert Avenue, Chatswood, NSW, 2067, Australia.
| | - J F Levesque
- Bureau of Health Information, Level 11, 67 Albert Avenue, Chatswood, NSW, 2067, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia
| | - V Lewis
- Australian Institute for Primary Care & Ageing, La Trobe University, Melbourne, VIC, 3068, Australia
| | - E Strumpf
- Department of Economics and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 855 Sherbrooke St. West, Montreal, QC, H3A 2T7, Canada
| | - M Breton
- Department of community health, University of Sherbrooke, 150 Place Charles LeMoyne, Longueil, Québec, J4K 0A8, Canada
| | - G Russell
- General Practice Research, School of Primary and Allied Health Care, Monash University, 270 Ferntree Gull Rd Notting Hill, Melbourne, VIC, 3168, Australia
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Ejigu Tafere T, Afework MF, Yalew AW. Antenatal care service quality increases the odds of utilizing institutional delivery in Bahir Dar city administration, North Western Ethiopia: A prospective follow up study. PLoS One 2018; 13:e0192428. [PMID: 29420598 PMCID: PMC5805280 DOI: 10.1371/journal.pone.0192428] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 01/10/2018] [Indexed: 11/24/2022] Open
Abstract
Background In Ethiopia, more than 62% of pregnant women attend antenatal care at least once, yet only about one in four women give birth at health facility. This gap has fueled the need to investigate on the quality of ANC services at public health facilities and its link with the use of institutional delivery. Objective To assess the linkage between ANC quality and the use of institutional delivery among pregnant women attending ANC at public health facilities of BDR City Administration Methods A facility based prospective follow up study was conducted. and nine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit were enrolled.Women were followed from their first ANC visit until delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist. ANC service was considered as acceptable quality if women received ≥75th percentile of the essential ANC services. Generalized Estimating Equation (GEE) was carried out to control cluster effect among women who received ANC in the same facility. Results Among 823 pregnant women who completed follow up, only about one third (27.6%) received acceptable quality of ANC services. In one health facility syphilis test was not done at all for the last two years. The odds of giving birth at health institution among pregnant women who received acceptable ANC quality service was about 3.38 times higher than among pregnant women who received unacceptable ANC quality service (AOR = 3.38, 95% CI: 1.67, 6.83). Conclusion and recommendation In this study the quality of ANC service provision in public health facilities was compromised/low. Provision of quality ANC service had a great role in promoting institutional delivery. Therefore the local authorities at each level of health sector or the nongovernmental organizations working to improve maternal health need to provide training on focused antenatal care protocol for ANC providers.
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Affiliation(s)
- Tadese Ejigu Tafere
- School of Public Health (SPH), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | | | - Alemayehu Worku Yalew
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Healthcare Disparities in Outcomes of a Metropolitan Congenital Heart Surgery Center: The Effect of Clinical and Socioeconomic Factors. J Racial Ethn Health Disparities 2017; 5:410-421. [PMID: 28849382 DOI: 10.1007/s40615-017-0384-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study is to identify the impact of demographic, socioeconomic, and clinical factors on congenital heart surgery outcomes. STUDY DESIGN This retrospective cohort study included 234 congenital heart surgery patients from 2011 through 2015, in a racially/ethnically diverse metropolitan children's hospital. Outcomes included length of stay (LOS), age at first echocardiogram, length of mechanical ventilation, and incidence of complications. RESULTS Compared to others, black children underwent their first echocardiogram at a later age (median 23 versus 2 days, p = 0.014) and were more likely to be diagnosed with congenital heart disease in the emergency room (p = 0.026). Hispanic children were more likely to have major non-cardiac congenital anomalies (p = 0.045). Increased LOS during elective admissions was associated with higher surgical complexity (STAT category 4 and 5 Estimate 3.905 days, p = 0.001), compared to STAT category 1, and number of complications (Estimate = 2.306 days per complication, p < 0.001). Increased LOS in non-elective admissions was associated with the number of complex chronic conditions (Estimate = 15.446 days, p = 0.045) and the number of complications (Estimate = 11.591 days per complication, p < 0.001). However, in multivariate analysis, race and ethnicity was not associated with increased LOS or age at first echocardiogram. CONCLUSION In this diverse setting, race/ethnicity was not associated with increased LOS, age at first echocardiogram, length of ventilation, or complications. Surgical complexity, chronic conditions, and complications were associated with increased LOS. We discuss some interventions to reduce disparities in congenital heart surgery outcomes.
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Seo M, Begley C, Langabeer JR, DelliFraine JL. Barriers and disparities in emergency medical services 911 calls for stroke symptoms in the United States adult population: 2009 BRFSS Survey. West J Emerg Med 2015; 15:251-9. [PMID: 24926394 PMCID: PMC4043558 DOI: 10.5811/westjem.2013.9.18584] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 09/09/2013] [Accepted: 09/09/2013] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION This study examines barriers and disparities in the intentions of American citizens, when dealing with stroke symptoms, to call 911. This study hypothesizes that low socioeconomic populations are less likely to call 911 in response to stroke recognition. METHODS The study is a cross-sectional design analyzing data from the Centers for Disease Control's 2009 Behavioral Risk Factor Surveillance Survey, collected through a telephone-based survey from 18 states and the District of Columbia. The study identified the 5 most evident stroke-warning symptoms based on those given by the American Stroke Association. We conducted appropriate weighting procedures to account for the complex survey design. RESULTS A total of 131,988 respondents answered the following question: "If you thought someone was having a heart attack or a stroke, what is the first thing you would do?" A majority of those who said they would call 911 were insured (85.1%), had good health (84.1%), had no stroke history (97.3%), had a primary care physician (PCP) (81.4%), and had no burden of medical costs (84.9%). Those less likely to call 911 were found in the following groups: 65 years or older, men, other race, unmarried, less than or equal to high school degree, less than $25,000 family income, uninsured, no PCP, burden of medical costs, fair/poor health, previous history of strokes, or interaction between burden of medical costs and less than $50,000 family income (p<0.0001 by X(2) tests). The only factors significantly associated with "would call 911" were age, sex, race/ethnicity, marital status, and previous history of strokes. CONCLUSION Barriers and disparities exist among subpopulations of different socioeconomic statuses. This study suggests that some potential stroke victims could have limited access to EMS services. Greater effort targeting certain populations is needed to motivate citizens to call 911.
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Affiliation(s)
- Munseok Seo
- Management, Policy and Community Health Division, University of Texas Health Science Center, Houston, Texas
| | - Charles Begley
- Management, Policy and Community Health Division, University of Texas Health Science Center, Houston, Texas
| | - James R Langabeer
- Management, Policy and Community Health Division, University of Texas Health Science Center, Houston, Texas
| | - Jami L DelliFraine
- Virginia Commonwealth University, Department of Health Administration, Richmond, Virginia
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Karlén J, Ludvigsson J, Hedmark M, Faresjö Å, Theodorsson E, Faresjö T. Early psychosocial exposures, hair cortisol levels, and disease risk. Pediatrics 2015; 135:e1450-7. [PMID: 25941311 DOI: 10.1542/peds.2014-2561] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Early psychosocial exposures are increasingly recognized as being crucial to health throughout life. A possible mechanism could be physiologic dysregulation due to stress. Cortisol in hair is a new biomarker assessing long-term hypothalamic-pituitary-adrenal axis activity. The objective was to investigate whether early-life adverse psychosocial circumstances influence infant cortisol levels in hair and health outcomes in children prospectively until age 10. METHODS A cohort study in the general community using a questionnaire covering 11 psychosocial items in the family during pregnancy and the cumulative incidence of diagnoses until age 10 years in 1876 children. Cortisol levels in hair were measured by using a radioimmunoassay in those with sufficient hair samples at age 1, yielding a subsample of n = 209. RESULTS Children with added psychosocial exposures had higher infant cortisol levels in hair (B = 0.40, P < .0001, adjusted for gender and size for gestational age) in a cumulative manner and were significantly more often affected by 12 of the 14 most common childhood diseases, with a general pattern of increasing odds ratios. CONCLUSIONS The findings support the model of physiologic dysregulation as a plausible mechanism by which the duration and number of early detrimental psychosocial exposures determine health outcomes. The model indicates that the multiplicity of adversities should be targeted in future interventions and could help to identify children who are at high risk of poor health. Furthermore, given the prolonged nature of exposure to a stressful social environment, the novel biomarker of cortisol in hair could be of major importance.
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Affiliation(s)
- Jerker Karlén
- Division of Community Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, and
| | | | - Max Hedmark
- Division of Community Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, and
| | - Åshild Faresjö
- Division of Community Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, and
| | - Elvar Theodorsson
- Clinical Chemistry, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Tomas Faresjö
- Division of Community Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, and
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Abstract
BACKGROUND Although cardiovascular health has been improving for many Americans, this is not true of those in "vulnerable populations." To address this growing disparity, communities and researchers have worked for decades, and as a result of their work, a growing body of literature supports the use of community engagement as a component of successful interventions. However, little literature synthesizes community-based interventions that address this disparity among a wide range of vulnerable populations. OBJECTIVE This article provides a critical review of community-based cardiovascular disease interventions to improve cardiovascular health behaviors and factors among vulnerable populations based on the American Heart Association's 7 metrics of ideal cardiovascular health. METHODS In February 2011, 4 databases (PubMed, PsychInfo, CINAHL, and Scopus) were searched using the following keywords: vulnerable populations OR healthcare disparities AND cardiovascular disease AND clinical trials OR public health practice AND English. RESULTS This search strategy resulted in the retrieval of 7120 abstracts. Each abstract was reviewed by at least 2 authors, and eligibility for the systematic review was confirmed after reading the full article. Thirty-two studies met eligibility criteria. Education was the most common intervention (41%), followed by counseling or support (38%) and exercise classes (28%). Half of the interventions were multicomponent. Healthcare providers were the most frequent interventionists. Interventions aimed at decreasing blood pressure were the most promising, whereas behavior change interventions were the most challenging. Almost all of the interventions were at the individual level and were proof-of-concept or efficacy trials. CONCLUSIONS This analysis provides a step toward understanding the current literature on cardiovascular interventions for vulnerable population. The next step should be integrating the identified successful interventions into larger health systems and/or social policies.
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McKernan SC, Kuthy RA, Momany ET, McQuistan MR, Hanley PF, Jones MP, Damiano PC. Geographic accessibility and utilization of orthodontic services among Medicaid children and adolescents. J Public Health Dent 2013; 73:56-64. [PMID: 23289856 DOI: 10.1111/jphd.12006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 11/09/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe rates of Medicaid-funded services provided by orthodontists in Iowa to children and adolescents, identify factors associated with utilization, and describe geographic barriers to care. METHODS We analyzed enrollment and claims data from the Iowa Medicaid program for a 3-year period, January 2008 through December 2010. Descriptive, bivariate, and multivariable logistic regression analyses were performed with utilization of orthodontic services as the main outcome variable. Service areas were identified by small area analysis in order to examine regional variability in utilization. RESULTS The overall rate of orthodontic utilization was 3.1 percent. Medicaid enrollees living in small towns and rural areas were more likely to utilize orthodontic services than those living in urban areas. Children who had an oral evaluation by a primary care provider in the year prior to the study period were more likely to receive orthodontic services. Service areas with lower population density and greater mean travel distance to participating orthodontists had higher utilization rates than smaller, more densely populated areas. CONCLUSIONS Rural residency and increased travel distances do not appear to act as barriers to orthodontic care for this population. The wide variability of utilization rates seen across service areas may be related to workforce supply in the form of orthodontists who accept Medicaid-insured patients. Referrals to orthodontists from primary care dentists may improve access to specialty care for Medicaid enrollees.
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Affiliation(s)
- Susan C McKernan
- Department of Preventive and Community Dentistry, College of Dentistry, Public Policy Center, University of Iowa, Iowa City, IA 52242, USA
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Lebrun LA, Shi L, Chowdhury J, Sripipatana A, Zhu J, Sharma R, Hayashi AS, Daly CA, Tomoyasu N, Nair S, Ngo-Metzger Q. Primary care and public health activities in select US health centers: documenting successes, barriers, and lessons learned. Am J Public Health 2012; 102 Suppl 3:S383-91. [PMID: 22690975 DOI: 10.2105/ajph.2012.300679] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined primary care and public health activities among federally funded health centers, to better understand their successes, the barriers encountered, and the lessons learned. METHODS We used qualitative and quantitative methods to collect data from 9 health centers, stratified by administrative division, urban-rural location, and race/ethnicity of patients served. Descriptive data on patient and institutional characteristics came from the Uniform Data System, which collects data from all health centers annually. We administered questionnaires and conducted phone interviews with key informants. RESULTS Health centers performed well on primary care coordination and community orientation scales and reported conducting many essential public health activities. We identified specific needs for integrating primary care and public health: (1) more funding for collaborations and for addressing the social determinants of health, (2) strong leadership to champion collaborations, (3) trust building among partners, with shared missions and clear expectations of responsibilities, and (4) alignment and standardization of data collection, analysis, and exchange. CONCLUSIONS Lessons learned from health centers should inform strategies to better integrate public health with primary care.
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Affiliation(s)
- Lydie A Lebrun
- Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD 20857, USA.
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Lebrun LA, Shi L, Chowdhury J, Sripipatana A, Zhu J, Sharma R, Hayashi AS, Daly CA, Tomoyasu N, Nair S, Ngo-Metzger Q. Primary care and public health activities in select U.S. health centers: documenting successes, barriers, and lessons learned. Am J Prev Med 2012; 42:S191-202. [PMID: 22704437 DOI: 10.1016/j.amepre.2012.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 03/29/2012] [Accepted: 03/29/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The goal of the current study was to examine primary care and public health activities among federally funded health centers, to better understand their successes, barriers encountered, and lessons learned. METHODS Qualitative and quantitative methods were used to collect data from nine health centers, stratified by administrative division, urban-rural location, and race/ethnicity of patients served. Descriptive data on patient and institutional characteristics came from the Uniform Data System, which collects data from all health centers annually. Questionnaires were administered and phone interviews were conducted with key informants. RESULTS Health centers performed well on primary care coordination and community orientation scales and reported conducting many essential public health activities. Specific needs were identified for integrating primary care and public health: (1) more funding for collaborations and for addressing the social determinants of health, (2) strong leadership to champion collaborations, (3) trust-building among partners, with shared missions and clear expectations of responsibilities, and (4) alignment and standardization of data collection, analysis, and exchange. CONCLUSIONS Lessons learned from health centers should inform strategies to better integrate public health with primary care.
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Affiliation(s)
- Lydie A Lebrun
- Bureau of Primary Health Care, Health Resources and Services Administration, DHHS, Rockville, Maryland 20857, USA.
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Wewers ME, Salsberry PJ, Ferketich AK, Ahijevych KL, Hood NE, Paskett ED. Risk factors for smoking in rural women. J Womens Health (Larchmt) 2012; 21:548-56. [PMID: 22360694 PMCID: PMC3388498 DOI: 10.1089/jwh.2011.3183] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study examined the association between social, demographic, and psychologic factors and smoking status among Appalachian Ohio women. A secondary aim examined whether specific factors could be identified and segmented for future tailored treatment of tobacco dependence. METHODS A cross-sectional survey (n=570) obtained information about social, demographic, and psychologic factors and smoking. Logistic regression described associations between these characteristics and smoking status. Chi-square automatic interaction detection (CHAID) analyses identified subgroups at risk for smoking. RESULTS Fifty-two percent never smoked, with 20.5% and 27.5% categorized as former and current smokers, respectively. Women with low adult socioeconomic position (SEP) were more likely to smoke (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.74-5.34) compared to high SEP women. Other factors associated with current smoking included age 31-50 (OR 2.30, 95% CI 1.22-4.33), age 18-30 (OR 3.29, 95% CI 1.72-5.34), Center for Epidemiologic Studies Depression scale (CES-D) score≥16 (OR 1.99, 95% CI 1.31-3.05), and first pregnancy at age<20 (OR 1.74, 95% CI 1.14-2.66). The prevalence of smoking was 50% among those with four or more risk factors compared to 10% for those reporting no risk factors. CHAID analyses identified low adult SEP and depressive symptoms as the combination of risk factors most strongly associated with smoking; 49.3% of women in this subgroup currently smoked. CONCLUSIONS Low SEP in adulthood, maternal circumstances, and depressive symptoms are associated with current smoking. Tailored cessation interventions that address these risk factors should be developed and further evaluated in an attempt to reduce disparities in smoking prevalence among this vulnerable group of women.
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Affiliation(s)
- Mary Ellen Wewers
- College of Public Health, The Ohio State University, Columbus, Ohio 43210, USA.
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Abstract
AIM This article is a report of the analysis of the concept of vulnerability and its relationship to oral health in early childhood. BACKGROUND Poor oral health is a continued problem for children worldwide. Vulnerability increases the probability of poor oral health outcomes. The lack of clarity of the concept of vulnerability creates difficulty in understanding this multi-factoral condition. DATA SOURCES Data source included 34 articles covering the period 2000-2009 from a variety of disciplines, including nursing, dentistry, medicine and public health. METHODS The concept analysis was conducted using Rodgers' evolutionary method. The literature was analysed and a social ecology model was used to frame the discussion, recognizing family and community influences on children's oral health. RESULTS The context of oral health in early childhood contributes to the changes in the concept vulnerability. The attributes are closely related to family and community factors and identified as limited parental income, parental education, community-based services and fluoride; and exposure to poor parental habits, parental neglect and harmful toxins. The primary antecedent is identified as a form of limited protection from exposure to various circumstances. CONCLUSION Children with limited protection have increased vulnerability and greater probability of poor health outcomes. Nurses who understand the concept of vulnerability related to oral health and can identify factors that create protection and are capable of decreasing vulnerability through parent education, community awareness and policy changes that support children and families.
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Affiliation(s)
- Deborah J Mattheus
- School of Nursing and Dental Hygiene, University of Hawaii, Honolulu, Hawaii, USA.
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