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Charania NA, Tonumaipe'a D, Barbarich-Unasa TW, Iusitini L, Davis G, Pacheco G, Wilson D. Exploring the impact of the COVID-19 pandemic on perceptions of national scheduled childhood vaccines among Māori and Pacific caregivers, whānau, and healthcare professionals in Aotearoa New Zealand. Hum Vaccin Immunother 2024; 20:2301626. [PMID: 38205779 DOI: 10.1080/21645515.2023.2301626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
In Aotearoa New Zealand, there has been a marked decrease in the uptake of routine childhood vaccinations since the onset of the COVID-19 pandemic, particularly among Māori and Pacific children. This Māori and Pacific-centered research used an interpretive description methodology. We undertook culturally informed interviews and discussions with Māori and Pacific caregivers (n = 24) and healthcare professionals (n = 13) to understand their perceptions of routine childhood vaccines. Data were analyzed using reflexive thematic analysis and privileged respective Māori and Pacific worldviews. Four themes were constructed. "We go with the norm" reflected how social norms, health personnel and institutions promoted (and sometimes coerced) participants' acceptance of routine vaccines before the pandemic. "Everything became difficult" explains how the pandemic added challenges to the daily struggles of whānau (extended family networks) and healthcare professionals. Participants noted how information sources influenced disease and vaccine perceptions and health behaviors. "It needed to have an ethnic-specific approach" highlighted the inappropriateness of Western-centric strategies that dominated during the initial pandemic response that did not meet the needs of Māori and Pacific communities. Participants advocated for whānau-centric vaccination efforts. "People are now finding their voice" expressed renewed agency among whānau about vaccination following the immense pressure to receive COVID-19 vaccines. The pandemic created an opportune time to support informed parental vaccine decision-making in a manner that enhances the mana (authority, control) of whānau. Māori and Pacific-led vaccination strategies should be embedded in immunization service delivery to improve uptake and immunization experiences for whānau.
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Affiliation(s)
- Nadia A Charania
- Department of Public Health, Auckland University of Technology, Auckland, New Zealand
| | - Daysha Tonumaipe'a
- New Zealand Work Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Te Wai Barbarich-Unasa
- Taupua Waiora Centre for Māori Health Research, Auckland University of Technology, Auckland, New Zealand
| | - Leon Iusitini
- New Zealand Work Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Georgina Davis
- Taupua Waiora Centre for Māori Health Research, Auckland University of Technology, Auckland, New Zealand
| | - Gail Pacheco
- New Zealand Work Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Denise Wilson
- Taupua Waiora Centre for Māori Health Research, Auckland University of Technology, Auckland, New Zealand
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Abstract
How often a researcher is cited usually plays a decisive role in that person's career advancement, because academic institutions often use citation metrics, either explicitly or implicitly, to estimate research impact and productivity. Research has shown, however, that citation patterns and practices are affected by various biases, including the prestige of the authors being cited and their gender, race, and nationality, whether self-attested or perceived. Some commentators have proposed that researchers can address biases related to social identity or position by including a Citation Diversity Statement in a manuscript submitted for publication. A Citation Diversity Statement is a paragraph placed before the reference section of a manuscript in which the authors address the diversity and equitability of their references in terms of gender, race, ethnicity, or other factors and affirm a commitment to promoting equity and diversity in sources and references. The present commentary considers arguments in favor of Citation Diversity Statements, and some practical and ethical issues that these statements raise.
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Affiliation(s)
- Keisha S Ray
- McGovern Center For Humanities & Ethics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Perry Zurn
- Department of Philosophy and Religion, American University, Washington, Washington DC, USA
| | - Jordan D Dworkin
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Dani S Bassett
- Departments of Bioengineering, Electrical & Systems Engineering, Physics and Astronomy, Neurology, and Psychiatry, University of Pennsylvania; and the Santa Fe Institute, Philadelphia, Philadelphia, USA
| | - David B Resnik
- National Institutes of Health, National Institute of Environmental Health Sciences, New York, New York, USA
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Oscherwitz M, Lovell K, Markham D, Pichardo R, Feldman SR. Differential access to psoriasis biologic information in English and Spanish. JAAD Int 2024; 15:87-90. [PMID: 38495539 PMCID: PMC10940758 DOI: 10.1016/j.jdin.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Affiliation(s)
- Max Oscherwitz
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Katie Lovell
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dane Markham
- Mayo Clinic Alix School of Medicine, Jacksonville, Florida
| | - Rita Pichardo
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven R. Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Mak HW, Chiang V, Chan ET, Lee E, Yim JS, Lam DL, Li PH. Disparities in chronic spontaneous urticaria: Eligibility for drug reimbursement associated with clinical outcomes. J Allergy Clin Immunol Glob 2024; 3:100243. [PMID: 38585447 PMCID: PMC10997903 DOI: 10.1016/j.jacig.2024.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/07/2024] [Accepted: 01/13/2024] [Indexed: 04/09/2024]
Abstract
Background Chronic spontaneous urticaria (CSU) is an immunologic condition with an estimated prevalence of 0.1%. For CSU that is poorly controlled despite the use of antihistamines, omalizumab is the only treatment approved and recommended by international guidelines. Objective Our aim was to outline the impact of treatment accessibility on CSU outcomes in the real world. Methods Serial data on adult patients with CSU receiving care for at least 6 months at a dedicated, immunologist-led urticaria clinic at Grantham Hospital in Hong Kong between 2018 and 2023 were analyzed. Patients' clinicodemographic data, drug eligibility status (eligible for reimbursement or not), treatment step, and disease activity (weekly Urticaria Activity Score [UAS7]) were collected and compared according to drug eligibility status. Results This study included 238 patients, 80 (33.6%) of whom were eligible for reimbursement and 158 of whom were not. No significant clinicodemographic differences, including disease activity, were found at baseline. At latest follow-up, significantly more patients in the eligible group were receiving omalizumab (28.7% vs 5.7% [P < .001]), which is equivalent to a multivariate odds ratio of 9.35 (95% CI = 3.689-23.703 [P < .001]). The discrepancy persisted even in patients with moderate-to-severe CSU whose UAS7 was 16 or higher (40.6% [13 of 32] vs 10.2% [6 of 59]; P < .001). In addition, there was significantly less dose reduction (<300 mg every 4 weeks) in the eligible omalizumab users (4.3% vs 44.4% [P = .015]). Clinically, significantly greater improvements in UAS7 were reported by the eligible group (median change -8.0 vs -5.0 [P = .021]). Conclusion Patterns of management varied largely among patients with different drug eligibility statuses and led to disparities in health outcomes. More efforts to secure equitable access to guideline-based CSU care are warranted.
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Affiliation(s)
- Hugo W.F. Mak
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Valerie Chiang
- Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong
| | - Elsie T.S. Chan
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Elaine Lee
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Jackie S.H. Yim
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Dorothy L.Y. Lam
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Philip H. Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Gallo Marin B, Oliva R, Anandarajah G. Exploring the Beliefs, Values, and Understanding of Quality End-of-Life Care in the Latino Community: A Spanish-Language Qualitative Study. Am J Hosp Palliat Care 2024; 41:508-515. [PMID: 37408485 DOI: 10.1177/10499091231188693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Context: Hospice services are underutilized by the Latino community in the United States. Previous research has identified that language is a key barrier contributing to disparities. However, very few studies have been conducted in Spanish to specifically explore other barriers to hospice enrollment or values related to end-of-life (EOL) care in this community. Here, we remove the language barrier in order to gain an in-depth understanding of what members of the diverse Latino community in one state in the USA considers high quality EOL and barriers to hospice. Methods: This exploratory semi-structured individual interview study of Latino community members was conducted in Spanish. Interviews were audio-recorded, transcribed verbatim and translated to English. Transcripts were analyzed by three researchers, using a grounded-theory approach to identify themes and sub-themes. Main Findings: Six major themes emerged: (1) concept of "a good death"-spiritual peace, family/community connection, no burdens left behind; (2) centrality of family; (3) lack of knowledge about hospice/palliative care; (4) Spanish language as critical; (5) communication style differences; and (6) necessity for cultural understanding. The central theme of "a good death" was closely linked to having the entire family physically and emotionally present. The four other themes represent interrelated, compounding barriers to achieving this "good death." Principal Conclusions: Healthcare providers and the Latino community can work together to decrease hospice utilization disparities by: actively involving family at every step; addressing misconceptions regarding hospice; conducting important conversations in Spanish; and improving provider skills in culturally sensitive care, including communication style.
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Affiliation(s)
| | - Rocío Oliva
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Gowri Anandarajah
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Hope Hospice and Palliative Care Rhode Island, Providence, RI, USA
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Zuchinali P, Béchard S, Remillard E, Souza Grigoletti S, Marier-Tétrault E, Jean-Charles L, Ribeiro PA, Tournoux F. Barriers to telemedicine for patients with heart failure: Who are the patients being left behind? J Telemed Telecare 2024; 30:747-750. [PMID: 35535410 DOI: 10.1177/1357633x221093428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Heart failure is associated with high rates of hospitalization, which are more prevalent in frail patients, impacting the quality of life and clinical outcomes. Telemedicine is considered cost-effective for improving patient self-management and hospitalization. However, socioeconomic deprivation and frailty could hinder access to virtual care. We investigated if frailty and socioeconomic factors were associated with telemedicine access among heart failure patients. For this cross-sectional analysis of Continuum study, 35 patients were allocated to the "able to use" group (had a smart device and were able to use it) or the "not able to use" group. Socioeconomic deprivation was determined according to the deprivation index. Frailty was assessed using the Fried criteria. The mean age was 69.9 ± 9 years, 74% were in New York Heart Association class II. A total of 14 patients (39%) were physically frail. Patients considered not able to use the app were more socioeconomically deprived (p = 0.011) and frail (p = 0.036). There was no correlation between frailty score and socioeconomic deprivation (r = 0.15, p = 0.411). Telemedicine use seems to be independently associated with frailty and socioeconomic deprivation in heart failure patients. More efforts should be made to foster the inclusion of vulnerable patients and improve global telemedicine access.
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Affiliation(s)
- Priccila Zuchinali
- Research Center of the Montreal University Hospital (CRCHUM), Montreal, QC, Canada
| | - Stéphanie Béchard
- Research Center of the Montreal University Hospital (CRCHUM), Montreal, QC, Canada
- Cardiology Division, Montreal University Hospital (CHUM), Montreal, QC, Canada
| | - Emilie Remillard
- Research Center of the Montreal University Hospital (CRCHUM), Montreal, QC, Canada
| | | | - Emmanuel Marier-Tétrault
- Research Center of the Montreal University Hospital (CRCHUM), Montreal, QC, Canada
- Cardiology Division, Montreal University Hospital (CHUM), Montreal, QC, Canada
| | - Loyda Jean-Charles
- Research Center of the Montreal University Hospital (CRCHUM), Montreal, QC, Canada
| | - Paula Ab Ribeiro
- Research Center of the Montreal University Hospital (CRCHUM), Montreal, QC, Canada
| | - François Tournoux
- Research Center of the Montreal University Hospital (CRCHUM), Montreal, QC, Canada
- Cardiology Division, Montreal University Hospital (CHUM), Montreal, QC, Canada
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Chowdhury D, Bansal N, Rasheed M, Saidi A, Stiver C, Laraja K, Ronai C, Baker Smith C, Johnson JN, Co-Vu J, Jain SS, Kipps AK, Sachdeva R, Bauser-Heaton H, Jone PN, Choueiter N, Ansong A, Sutton N, Lopez KN, Karamlou T, Fuller S, Snyder C, Taggart NW, Elliott P, Shaffer K, Williams R. Mind the Gap! Working Toward Gender Equity in Pediatric and Congenital Heart Disease: Present and Future. J Am Heart Assoc 2024:e032837. [PMID: 38639355 DOI: 10.1161/jaha.123.032837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Evidence from medicine and other fields has shown that gender diversity results in better decision making and outcomes. The incoming workforce of congenital heart specialists (especially in pediatric cardiology) appears to be more gender balanced, but past studies have shown many inequities. Gender-associated differences in leadership positions, opportunities presented for academic advancement, and recognition for academic contributions to the field persist. In addition, compensation packages remain disparate if evaluated based on gender with equivalent experience and expertise. This review explores these inequities and has suggested individual and institutional changes that could be made to recruit and retain women, monitor the climate of the institution, and identify and eliminate bias in areas like salary and promotions.
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Affiliation(s)
| | - Neha Bansal
- Division of Pediatric Cardiology Mount Sinai Kravis Children's Hospital New York NY USA
| | - Muneera Rasheed
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
| | - Arwa Saidi
- University of Florida Gainesville FL USA
| | - Corey Stiver
- The Heart Center, Nationwide Children's Hospital Columbus OH USA
| | - Kristin Laraja
- Division of Pediatric Cardiology, Department of Pediatrics University of Massachusetts Medical School Worcester MA USA
| | - Christina Ronai
- Department of Cardiology Boston Children's Hospital, Harvard Medical School Boston MA USA
| | | | - Jonathan N Johnson
- Department of Pediatrics, Division of Pediatric Cardiology Mayo Clinic Rochester MN USA
| | - Jennifer Co-Vu
- University of Florida Congenital Heart Center Gainesville FL USA
| | - Supriya S Jain
- New York Medical College-Maria Fareri Children's Hospital at Westchester Medical Center Valhalla NY USA
| | - Alaina K Kipps
- Division of Pediatric Cardiology Stanford School of Medicine Stanford CA USA
| | - Ritu Sachdeva
- Division of Pediatric Cardiology Children's Healthcare of Atlanta Atlanta GA USA
| | - Holly Bauser-Heaton
- Division of Pediatric Cardiology Children's Healthcare of Atlanta Atlanta GA USA
| | - Pei-Ni Jone
- Department of Pediatrics (Cardiology) Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Nadine Choueiter
- Division of Pediatric Cardiology Mount Sinai Kravis Children's Hospital New York NY USA
| | - Annette Ansong
- Division of Pediatric Cardiology Children's National Hospital Washington DC USA
| | - Nicole Sutton
- Children's Hospital at Montefiore, Albert Einstein College of Medicine Bronx NY USA
| | - Keila N Lopez
- Department of Pediatric Cardiology Baylor College of Medicine, Texas Children's Hospital Houston TX USA
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery Cleveland Clinic Children's Cleveland OH USA
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery Children's Hospital of Philadelphia Philadelphia PA USA
| | - Chris Snyder
- Division of Pediatric Cardiology UH Cleveland Medical Center Cleveland OH USA
| | - Nathaniel W Taggart
- Department of Pediatrics, Division of Pediatric Cardiology Mayo Clinic Rochester MN USA
| | | | - Kenneth Shaffer
- Dell Children's Medical Center University of Texas at Austin Dell Medical School Austin TX USA
| | - Roberta Williams
- Division of Pediatric Cardiology, Keck School of Medicine of USC Children's Hospital Los Angeles Los Angeles CA USA
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Cote SL, Nguyen A, Berry JL, Reid M, Chang J, Chen J, Nguyen A, Chang MY. Gender Disparities in Mentorship and Career Outcomes in Ophthalmology. J Womens Health (Larchmt) 2024. [PMID: 38634534 DOI: 10.1089/jwh.2023.0876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Background: Gender disparities in the field of ophthalmology have been increasingly recognized. Although mentorship has been proposed as a contributing factor, there are limited data on the differences in mentorship experiences by gender among ophthalmologists. Objective: The purpose of this study was to evaluate gender disparities in mentorship experiences among ophthalmologists, and the impact of mentorship disparities on career outcomes. Design: Prospective, cross-sectional study. Setting: Web-based survey distributed through ophthalmology listservs. Participants: Ophthalmologists and ophthalmologists-in-training who completed the survey. Exposure: Training and practicing in the field of ophthalmology. Main Outcome Measures: Mentorship score based on 10 items from a previously published scale of mentorship quality and self-reported career outcomes (income, job satisfaction, achievement of career goals, and support to achieve future career goals). Results: We received survey responses from 202 male and 245 female ophthalmologists. Female ophthalmologists reported significantly lower mentorship satisfaction and worse quality of mentorship (p < 0.03). Female ophthalmologists also reported significantly lower income, worse job satisfaction, and lower rates of goal achievement and support to achieve future goals; all of these career outcomes, except income level, were partly mediated by mentorship score (mediation effect ranged from 29% to 68%, p < 0.014). Conclusions and Relevance: Gender-based inequities in achievement of career goals and job satisfaction are partly mediated by disparities in mentorship. Therefore, focused mentorship of women in ophthalmology at all career stages is imperative to reduce these inequities.
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Affiliation(s)
- Stephanie L Cote
- Division of Ophthalmology, The Vision Center at the Children's Hospital Los Angeles, Los Angeles, California, USA
- Roski Eye Center, University of Southern California, Los Angeles, California, USA
| | - Angeline Nguyen
- Division of Ophthalmology, The Vision Center at the Children's Hospital Los Angeles, Los Angeles, California, USA
- Roski Eye Center, University of Southern California, Los Angeles, California, USA
| | - Jesse L Berry
- Division of Ophthalmology, The Vision Center at the Children's Hospital Los Angeles, Los Angeles, California, USA
- Roski Eye Center, University of Southern California, Los Angeles, California, USA
| | - Mark Reid
- Division of Ophthalmology, The Vision Center at the Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Jessica Chang
- Roski Eye Center, University of Southern California, Los Angeles, California, USA
| | - Jenny Chen
- Kaiser Permanente, Oakland, California, USA
| | - Annie Nguyen
- Roski Eye Center, University of Southern California, Los Angeles, California, USA
| | - Melinda Y Chang
- Division of Ophthalmology, The Vision Center at the Children's Hospital Los Angeles, Los Angeles, California, USA
- Roski Eye Center, University of Southern California, Los Angeles, California, USA
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Tuot DS, Mukherjee A, Churape A, DeFries T, Su G, Khoong EC, Lyles C. Lessons From the Field From a Volunteer Telehealth Ambassador Program to Enhance Video Visits Among Low-Income Patients: Qualitative Improvement Study. JMIR Form Res 2024; 8:e49993. [PMID: 38619874 DOI: 10.2196/49993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 01/27/2024] [Accepted: 02/21/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND The prevalence of telehealth video use across the United States is uneven, with low uptake in safety-net health care delivery systems, which care for patient populations who face barriers to using digital technologies. OBJECTIVE This study aimed to increase video visit use in an urban safety-net delivery system. We piloted a telehealth ambassador program, in which volunteers offered technical support to patients with access to digital technologies to convert primary care visits already scheduled as telehealth audio-only visits to telehealth video visits. METHODS We used a descriptive approach to assess the feasibility, efficacy, and acceptability of the pilot telehealth ambassador program. Feasibility was quantified by the percentage of eligible patients who answered calls from telehealth ambassadors. Program efficacy was measured in two ways: (1) the percentage of patients with access to digital technology who interacted with the navigators and were successfully prepared for a telehealth video visit, and (2) the percentage of prepared patients who completed their scheduled video visits. Program acceptability was ascertained by a structured telephone survey. RESULTS Telehealth ambassadors attempted to contact 776 eligible patients; 43.6% (338/776) were reached by phone, among whom 44.4% (150/338) were provided digital support between March and May 2021. The mean call duration was 8.8 (range 0-35) minutes. Overall, 67.3% (101/150) of patients who received support successfully completed a telehealth video visit with their provider. Among the 188 patients who were contacted but declined video visit digital support, 61% (114/188) provided a reason for their decline; 42% (48/114) did not see added value beyond a telehealth audio-only visit, 20% (23/114) had insufficient internet access, and 27% (31/114) declined learning about a new technology. The acceptability of the telehealth ambassador program was generally favorable, although some patients preferred having in-real-time technology support on the day of their telehealth video visit. CONCLUSIONS This high-touch program reached approximately one-half of eligible patients and helped two-thirds of interested patients with basic video visit capability successfully complete a video visit. Increasing the program's reach will require outreach solutions that do not rely solely on phone calls. Routinely highlighting the benefits of video visits, partnering with community-based organizations to overcome structural barriers to telehealth use, and offering in-real-time technology support will help increase the program's efficacy.
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Affiliation(s)
- Delphine S Tuot
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
- Center for Innovation in Access and Quality at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francsico, CA, United States
| | - Aarya Mukherjee
- University of California, Berkeley, Berkeley, CA, United States
| | - Amanda Churape
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
- Center for Innovation in Access and Quality at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Triveni DeFries
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - George Su
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
- Center for Innovation in Access and Quality at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Elaine C Khoong
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francsico, CA, United States
| | - Courtney Lyles
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francsico, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, United States
- Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, CA, United States
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Hewitt J, Hamad N, Beecher C, Turner T, Chakraborty S. Poor reporting limited consideration of EDI in the Australian guidelines for the clinical care of people with COVID-19. J Clin Epidemiol 2024:111361. [PMID: 38631531 DOI: 10.1016/j.jclinepi.2024.111361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Actively addressing issues of equity, diversity and inclusion (EDI) in healthcare guidelines provides an important avenue ensure that individuals and communities receive high-quality health care that meets their needs. In 2020, the National Clinical Evidence Taskforce was charged with developing Australian living guidelines for COVID-19 (the Guidelines). It was intended that the Guidelines would consider the biological and social determinants of health underpinning evidence-based recommendations for of the treatment of COVID-19. The objective of this paper is to describe the evidence available on biological and social determinants of health that is reported in published trials of disease modifying therapies for COVID-19. STUDY DESIGN AND SETTING Published papers of randomised controlled trials that informed clinical recommendations (for and against drug therapies for COVID-19) in the Guidelines were reviewed retrospectively using a case series design. We extracted reported characteristics relating to biological and social determinants of health. These included: age, sex, gender, geographical location, ethnicity (including indigenous), disability, migrant status, income, education, employment, and social support. A descriptive analysis was conducted to illustrate the characteristics available for use in guideline development. RESULTS A total of 115 peer-reviewed papers describing randomised control trials of drug interventions for the treatment of COVID-19 were included. Biological and social determinants of health characteristics were poorly reported. Geographical location of the study was the only category reported in all papers. While age and sex were reported in most papers (n=109 and 108, respectively); ethnicity was reported in only one third of papers (n=40), social support was reported in only three papers and employment in one paper. No paper reported on gender, disability, migrant status, income or education. CONCLUSION Consideration of EDI issues is a crucial component of guideline development. Although these issues were widely recognised to impact on health outcomes from COVID-19, reporting of these characteristics was poor in COVID trials. Urgent action is needed to improve reporting of EDI characteristics if they are to be meaningfully considered in guideline processes, and health inequity be overcome.
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Affiliation(s)
- Jessie Hewitt
- National Clinical Evidence Taskforce, Australian Living Evidence Collaboration, Monash University, Australia
| | - Nada Hamad
- School of Clinical Medicine, University of New South Wales, Australia
| | - Claire Beecher
- National Clinical Evidence Taskforce, Australian Living Evidence Collaboration, Monash University, Australia
| | - Tari Turner
- National Clinical Evidence Taskforce, Australian Living Evidence Collaboration, Monash University, Australia
| | - Samantha Chakraborty
- National Clinical Evidence Taskforce, Australian Living Evidence Collaboration, Monash University, Australia.
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Little E, Barnes A, Power M. Predictors of fuel poverty and the equity of local fuel poverty support: secondary analysis of data from Bradford, England. Perspect Public Health 2024:17579139241245346. [PMID: 38616280 DOI: 10.1177/17579139241245346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
AIMS Addressing fuel poverty is a critical public health issue given its recent rise in prevalence across Europe. Although previous research identifies national risk markers of fuel poverty, evidence is lacking on whether these are consistent across local geographies, and the equity of local interventions. In the UK's current economic climate, it is more crucial than ever that services benefit households in greatest need. This study aimed to determine significant predictors of fuel poverty among households in Bradford, England, comparing them to national-level predictors, and evaluate if households possessing significant fuel poverty predictors were equitably referred to a local fuel poverty service (Warm Homes Healthy People, WHHP). METHODS A multivariate logistic regression model determined significant fuel poverty predictors in Bradford using household-level data from the Energy Saving Trust and the Low Income High Costs fuel poverty definition. Statistical testing highlighted significant differences in predictors of fuel poverty between households referred to WHHP and all Bradford households. RESULTS Significant (p < .05) predictors of fuel poverty included: living in an area with lower average household incomes and higher proportion of ethnic minority individuals, and living in a property with a lower energy efficiency rating. Households living in a detached or older property, and homeowners were more likely to be fuel poor. Differences in the direction of the relationship with fuel poverty were identified between some national and local predictors. Most predictors were significantly (p < .05) overrepresented among WHHP households, suggesting equitable service reach. Ethnic minorities, younger people, and multiperson households were underrepresented. CONCLUSIONS Local fuel poverty predictors were similar to many national-level predictors, but identified differences in the direction of the relationship between some national and local predictors reaffirm the value of locally focused research. WHHP successfully targeted households possessing key predictors, but should ensure that ethnic minorities, younger people, and multiperson households are equitably referred.
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Affiliation(s)
- E Little
- Public Health Registrar, Bradford Council, Bradford, UK
| | - A Barnes
- Senior Research Fellow, Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK
| | - M Power
- Research Fellow, Department of Health Sciences, University of York, York, UK
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12
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Chowdhury A, Saad Eddin A, Kim Hsieh S, Policeni FC. Review of Breast Imaging in Transgender and Gender-Diverse Patients: Gender-Affirming Care, Histopathologic Findings, Breast Cancer Risk, and Screening Recommendations. J Breast Imaging 2024:wbae016. [PMID: 38613363 DOI: 10.1093/jbi/wbae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Indexed: 04/14/2024]
Abstract
Gender diversity, especially pertaining to transgender and gender-diverse (TGD) populations, is often stigmatized. A small but not insignificant number of adults in the United States identify as TGD, including transgender, nonbinary, and other gender identities than cisgender. Accessing health care remains a significant challenge for TGD individuals because many health care systems adhere to a gender binary model and many TGD individuals experience negative interactions when interfacing with health care. There is also a scarcity of literature addressing their unique health care needs, limiting our current understanding of breast cancer risks and screening recommendations for TGD patients. This article reviews important considerations when providing care to TGD patients. It covers background information on gender identity and sexuality, explores gender-affirming care, discusses histopathologic findings of breast biopsy specimens, examines breast cancer risks, and presents current breast cancer screening recommendations for TGD patients. Education on TGD breast cancer risks and screening and creating a standardized screening protocol for TGD patients who may receive gender-affirming care through hormonal and surgical therapies could help improve their health care equity and access.
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Affiliation(s)
- Ajmain Chowdhury
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Su Kim Hsieh
- Department of Radiology, University of Iowa, Iowa City, IA, USA
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13
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Hudson S, Muspratt-Tucker N, Kudsk-Iversen S. On the ethics of removing Entonox® from labour ward: beyond carbon dioxide equivalents and seeking justice for patients and the planet. Anaesthesia 2024. [PMID: 38606766 DOI: 10.1111/anae.16296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Sarah Hudson
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nadia Muspratt-Tucker
- Department of Obstetrics and Gynaecology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Søren Kudsk-Iversen
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- University of Oxford, Oxford, UK
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14
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Sabatello M, Bakken S, Chung WK, Cohn E, Crew KD, Kiryluk K, Kukafka R, Weng C, Appelbaum PS. Return of polygenic risk scores in research: Stakeholders' views on the eMERGE-IV study. HGG Adv 2024; 5:100281. [PMID: 38414240 PMCID: PMC10950748 DOI: 10.1016/j.xhgg.2024.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 02/29/2024] Open
Abstract
Research on polygenic risk scores (PRSs) for common, genetically complex chronic diseases aims to improve health-related predictions, tailor risk-reducing interventions, and improve health outcomes. Yet, the study and use of PRSs in clinical settings raise equity, clinical, and regulatory challenges that can be greater for individuals from historically marginalized racial, ethnic, and other minoritized communities. As part of the National Human Genome Research Institute-funded Electronic Medical Records and Genomics IV Network, we conducted online focus groups with patients/community members, clinicians, and members of institutional review boards to explore their views on key issues, including PRS research, return of PRS results, clinical translation, and barriers and facilitators to health behavioral changes in response to PRS results. Across stakeholder groups, our findings indicate support for PRS development and a strong interest in having PRS results returned to research participants. However, we also found multi-level barriers and significant differences in stakeholders' views about what is needed and possible for successful implementation. These include researcher-participant interaction formats, health and genomic literacy, and a range of structural barriers, such as financial instability, insurance coverage, and the absence of health-supporting infrastructure and affordable healthy food options in poorer neighborhoods. Our findings highlight the need to revisit and implement measures in PRS studies (e.g., incentives and resources for follow-up care), as well as system-level policies to promote equity in genomic research and health outcomes.
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Affiliation(s)
- Maya Sabatello
- Center for Precision Medicine and Genomics, Department of Medicine, Columbia University, New York, NY, USA; Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY, USA.
| | - Suzanne Bakken
- School of Nursing and Department of Biomedical Informatic, Columbia University, New York, NY, USA
| | - Wendy K Chung
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Elizabeth Cohn
- Northwell Health 600 Community Drive, Manhasset, NY, USA
| | - Katherine D Crew
- Department of Medicine and Epidemiology, Columbia University, New York, NY 10032, USA
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Rita Kukafka
- Departments of Biomedical Informatics and Sociomedical Sciences, Columbia University, New York, NY 10032, USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
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15
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Mohareb AM, Deukmejian M, Guerra Castillo C, Brown TS, LaRocque R, Taveras E, Sarin Gupta P. School-based mobile clinics to improve vaccine access: a cross-sectional study of COVID-19 vaccination. J Pediatric Infect Dis Soc 2024:piae032. [PMID: 38587478 DOI: 10.1093/jpids/piae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Amir M Mohareb
- Center for Global Health, Massachusetts General Hospital. Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital. Boston, MA, USA
- Department of Medicine, Harvard Medical School. Boston, MA, USA
| | | | | | - Tyler S Brown
- Section of Infectious Diseases, Boston Medical Center. Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Regina LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital. Boston, MA, USA
- Department of Medicine, Harvard Medical School. Boston, MA, USA
| | - Elsie Taveras
- Department of Medicine, Harvard Medical School. Boston, MA, USA
- Mass General Brigham. Boston, MA, USA
| | - Priya Sarin Gupta
- Department of Medicine, Harvard Medical School. Boston, MA, USA
- Mass General Brigham. Boston, MA, USA
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16
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Medina MS, Alvarez NA, Sucher BJ. Getting started writing a personal diversity statement. Am J Health Syst Pharm 2024:zxae098. [PMID: 38577876 DOI: 10.1093/ajhp/zxae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Indexed: 04/06/2024] Open
Abstract
In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Melissa S Medina
- The University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Nancy A Alvarez
- R. Ken Coit College of Pharmacy-Phoenix Campus, The University of Arizona, Phoenix, AZ, USA
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17
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Affiliation(s)
- Marie Chisholm-Burns
- Department of Surgery, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Richard N Formica
- Yale School of Medicine, Section of Nephrolog, New Haven, Connecticut, USA
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18
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Gerber W, Fields R, Guesela N, Nuhu KAI, Manika E. Beyond constructs and principles: addressing gender-related barriers to high, equitable immunization coverage. Front Glob Womens Health 2024; 5:1367590. [PMID: 38633243 PMCID: PMC11021583 DOI: 10.3389/fgwh.2024.1367590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
The global immunization community has only recently recognized that addressing gender-related barriers to vaccination is critical to improving equity and increasing protection against vaccine-preventable diseases. USAID's MOMENTUM Routine Immunization Transformation and Equity project aims to strengthen routine immunization programs to overcome entrenched obstacles to reaching zero-dose and under-immunized children while supporting the introduction of other new vaccines given over the life course. From the outset, the project recognized the need to mainstream gender into its global and country level work, incorporating gender considerations into all phases of the program cycle, from assessment to activity design, strategic communications, monitoring, evaluation, and continuous learning. Its gender mainstreaming efforts focus on five areas of improvement for immunization: service access and convenience; service quality and experience; communication and demand generation for immunization among caregivers (both women and men) and families; making services more responsive to agency and autonomy constraints of female caregivers; and the conditions and circumstances of health workers, who are mostly women. The authors describe approaches the project has applied to build capacity of its own global and country level staff to both recognize the gender dimensions inherent in common obstacles to immunization and ways to address them. Authors describe project activities carried out at global and country levels and share experience and challenges encountered in increasing recognition of gender barriers, moving from theory to practical action in addressing them, building capacity, and gauging the success of the work to date. The lessons learned are useful to colleagues working within the circumstances of time-limited and geography-specific projects whose main focus is to improve equity in immunization.
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Affiliation(s)
- Willow Gerber
- MOMENTUM Routine Immunization Transformation and Equity Project, JSI Research and Training Institute, Arlington, VA, United States
| | - Rebecca Fields
- MOMENTUM Routine Immunization Transformation and Equity Project, JSI, Arlington, VA, United States
| | - Neide Guesela
- MOMENTUM Routine Immunization Transformation and Equity Project, JSI Research and Training Institute, Maputo, Mozambique
| | - Khadijah A. Ibrahim Nuhu
- MOMENTUM Routine Immunization Transformation and Equity Project, JSI Research and Training Institute, Abuja, Nigeria
| | - Eugene Manika
- MOMENTUM Routine Immunization Transformation and Equity Project, PATH, Kinshasa, Democratic Republic of Congo
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19
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Yang T, Linn BS, Bennis J. Incorporating diversity, equity, and inclusion concepts in pharmacy education and experiential training. Am J Health Syst Pharm 2024; 81:275-278. [PMID: 37966508 DOI: 10.1093/ajhp/zxad279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
| | - Becky S Linn
- University of Wyoming School of Pharmacy Laramie, WY, USA
| | - Jane Bennis
- University of Wyoming School of Pharmacy Laramie, WY, USA
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20
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Denny MC, Rosendale N, Gonzales NR, Leslie-Mazwi TM, Middleton S. Addressing Disparities in Acute Stroke Management and Prognosis. J Am Heart Assoc 2024; 13:e031313. [PMID: 38529656 DOI: 10.1161/jaha.123.031313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/03/2024] [Indexed: 03/27/2024]
Abstract
There are now abundant data demonstrating disparities in acute stroke management and prognosis; however, interventions to reduce these disparities remain limited. This special report aims to provide a critical review of the current landscape of disparities in acute stroke care and highlight opportunities to use implementation science to reduce disparities throughout the early care continuum. In the prehospital setting, stroke symptom recognition campaigns that have been successful in reducing prehospital delays used a multilevel approach to education, including mass media, culturally tailored community education, and professional education. The mobile stroke unit is an organizational intervention that has the potential to provide more equitable access to timely thrombolysis and thrombectomy treatments. In the hospital setting, interventions to address implicit biases among health care providers in acute stroke care decision-making are urgently needed as part of a multifaceted approach to advance stroke equity. Implementing stroke systems of care interventions, such as evidence-based stroke care protocols at designated stroke centers, can have a broader public health impact and may help reduce geographic, racial, and ethnic disparities in stroke care, although further research is needed. The long-term impact of disparities in acute stroke care cannot be underestimated. The consistent trend of longer time to treatment for Black and Hispanic people experiencing stroke has direct implications on long-term disability and independence after stroke. A learning health system model may help expedite the translation of evidence-based interventions into clinical practice to reduce disparities in stroke care.
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Affiliation(s)
- M Carter Denny
- Department of Neurology Georgetown University School of Medicine Washington DC USA
- Department of Neurology, MedStar Health Washington DC USA
| | - Nicole Rosendale
- Department of Neurology University of California San Francisco San Francisco CA USA
- Weill Institute for Neurosciences, University of California San Francisco San Francisco CA USA
| | - Nicole R Gonzales
- Department of Neurology University of Colorado Anschutz Medical Campus Aurora CO USA
| | | | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University Darlinghurst Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University Darlinghurst Australia
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21
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Isaac S, Mirzaei A, McLachlan AJ, Chaar BB. Conscientious objection - a cross-sectional, vignette-based, mixed methods exploration of Australian pharmacists' perspectives. J Pharm Policy Pract 2024; 17:2323086. [PMID: 38572377 PMCID: PMC10989204 DOI: 10.1080/20523211.2024.2323086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Background: Conscientious objection (CO) in healthcare is a controversial topic. Some perceive CO as freedom of conscience, others believe their professional duty-of-care overrides personal-perspectives. There is a paucity of literature pertaining to pharmacists' perspectives on CO. Aim: To explore Australian pharmacists' decision-making in complex scenarios around CO and reasons for their choices. Method: A cross-sectional, qualitative questionnaire of pharmacists' perspectives on CO. Vignette-based questions were about scenarios related to medical termination, emergency contraception, IVF surrogacy for a same-sex couple and Voluntary Assisted Dying (VAD) Results: Approximately half of participants (n = 223) believed pharmacists have the right to CO and most agreed to supply prescriptions across all vignettes. However, those who chose not to supply (n = 20.9%), believed it justifiable, even at the risk of patients failing to access treatment. Strong self-reported religiosity had a statistically significant relationship with decisions not to supply for 3 of 4 vignettes. Three emergent themes included: ethical considerations, the role of the pharmacist and training and guidance. Conclusion: This exploratory study revealed perspectives of Australian pharmacists about a lack of guidance around CO in pharmacy. Findings highlighted the need for future research to investigate and develop further training and professional frameworks articulating steps to guide pharmacists around CO.
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Affiliation(s)
- Sami Isaac
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ardalan Mirzaei
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Andrew J. McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Betty B. Chaar
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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22
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Naidu T, Gingell G, Zaidi Z. Decolonial framework for applying reflexivity and positionality in global health research. Glob Health Promot 2024:17579759241238016. [PMID: 38566278 DOI: 10.1177/17579759241238016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Contemporary research practices link to colonial and imperialist knowledge creation and production and may promote harmful perspectives on marginalized and oppressed groups. We present a framework for a decolonial approach to research in global health and health promotion applicable across research settings. This framework is aimed at anticipating and alleviating potentially harmful practices inherent in dominant research methods. The framework focuses from a macro- and micro-level perspective on three critical dyads: 'context' and 'accountability'; 'researcher identity' and 'positionality'; and 'procedural ethics' and 'ethics in practice' considerations. We present guidance for how to consider reflexivity and positionality as they apply in this framework in global health and health promotion research practice.
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Affiliation(s)
| | | | - Zareen Zaidi
- George Washington University Medical Faculty Associates, Washington, USA
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23
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Samuels-Kalow ME, Chary AN, Ciccolo G, Apro A, Danaher F, Lambert R, Camargo CA, Zachrison KS. Barriers and facilitators to pediatric telehealth use in English- and Spanish-speaking families: A qualitative study. J Telemed Telecare 2024; 30:527-537. [PMID: 35072550 DOI: 10.1177/1357633x211070725] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND With the rapid increase in telehealth use during the COVID-19 pandemic, concerns have been raised about the potential for exacerbating existing healthcare disparities in marginalized populations. While eliminating barriers such as transportation and time constraints, telehealth may introduce barriers related to technology access. With little known about the patient experience accessing telehealth during the COVID-19 pandemic, this study seeks to understand the barriers and facilitators to telehealth use as well as interventions that may address them. METHODS We conducted qualitative interviews with parents of pediatric patients of a primary care clinic in a diverse community during the study period of March-May 2021. The interviews explored barriers and facilitators to telehealth during the COVID-19 pandemic. Interviews were balanced across language (Spanish and English) as well as across visit type (in-person vs. telehealth). Recruitment, collection of demographic information, and interviews were conducted by telephone. The conversations were recorded and transcribed. Once thematic saturation was achieved, the data were analyzed using a modified grounded theory approach. RESULTS Of the 33 participants, 17 (52%) spoke English and 16 (48%) spoke Spanish. A total of 17 (52%) had experienced a telehealth encounter as their first visit during the study period while 16 (48%) had an in-person visit. Five themes were identified: (1) a recognition of differences in technological knowledge and access, (2) situational preferences for telehealth versus in-person visits, (3) avoidance of COVID-19 exposure, (4) convenience, and (5) change over time. English-speaking patients expressed greater ease with and a preference for telehealth, while Spanish-speaking participants expressed more technological difficulty with telehealth and a preference for in-person visits. Suggested interventions included informational tutorials such as videos before the visit, technical support, and providing families with technological devices. CONCLUSION In this study, we examined patient and family perspectives on pediatric telehealth during the COVID-19 pandemic. Implementation of the suggested interventions to address barriers to telehealth use is essential to prevent further exacerbation of health disparities already experienced by marginalized populations.
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Affiliation(s)
- Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anita N Chary
- Department of Emergency Medicine, Center for Innovations in Quality, Effectiveness and Safety, Baylor College of Medicine, Houston, TX, USA
| | - Gia Ciccolo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashley Apro
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Fiona Danaher
- Department of Pediatrics, Division of Global Health, and Center for Immigrant Health, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Rebecca Lambert
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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24
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Cullen T, Griffith M, Damodaran A, Lewis E, McMillan F, Sammel A, Honeysette R, Biles B, Beadman K, Nathan S. The First Nations experience of accessing rheumatology services in a metropolitan hospital: A qualitative study. Health Expect 2024; 27:e14049. [PMID: 38623822 PMCID: PMC11019439 DOI: 10.1111/hex.14049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE First Nations Australians experience a higher burden and severity of Rheumatic Disease with poorer outcomes than the general population. Despite a widely acknowledged need to improve health outcomes, there has been minimal research assessing existing models of care from a First Nations perspective in Australia. The objective of this study was to describe First Nations experiences and barriers and enablers to accessing a hospital-based adult Rheumatology service in Sydney. METHODS A qualitative study using semi-structured interviews was undertaken. Patients who self-identified as First Nations attending the Prince of Wales Hospital Rheumatology Clinic in 2021 were invited to participate. Interviews were conducted face-to-face or by telephone using culturally-appropriate Yarning methods with an Aboriginal Health Worker (AHW) at the request of participants. Thematic analysis was done in consultation with an Aboriginal Reference Group (ARG). RESULTS Four categories, which encapsulated 11 themes were identified. Participants reported barriers to care such as logistics of the referral process, not feeling culturally safe because of uncomfortable clinic environments and health worker behaviours, inadequate cultural support and community perceptions of the specialty. Enabling factors included family member involvement, AHW support and telehealth consultation. CONCLUSION The current model of care perpetuates access challenges for First Nations Australians within rheumatology. Barriers to care include the delayed referral process, limited cultural responsivity in the clinic environment and poor cross-cultural communication. There is a need for models of care that are co-designed with First Nations Peoples to address these barriers. PATIENT AND PUBLIC CONTRIBUTION Participants were First Nations Australians with lived experience attending the rheumatology clinic. All interviewees were offered the opportunity to review their transcripts to ensure trustworthiness of the data. Preliminary thematic analysis was conducted in partnership with the AHW who has over 20 years experience. Following preliminary coding, a list of themes were presented to the ARG for iterative discussion and refinement. The ARG provided community representation and ensured that First Nations voices were privileged in the analysis. It's intended that the findings of this study will support the upcoming co-design of a First Nations health service for Rheumatology patients.
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Affiliation(s)
- Taylor Cullen
- School of Population Health, Faculty of Medicine and Health, UNSWSydneyAustralia
- Department of RheumatologyPrince of Wales HospitalSydneyAustralia
| | - Miki Griffith
- Aboriginal and Torres Strait Islander Community ServicesPrince of Wales HospitalSydneyAustralia
| | - Arvin Damodaran
- Department of RheumatologyPrince of Wales HospitalSydneyAustralia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSWSydneyAustralia
| | - Ebony Lewis
- School of Population Health, Faculty of Medicine and Health, UNSWSydneyAustralia
| | - Faye McMillan
- School of Population Health, Faculty of Medicine and Health, UNSWSydneyAustralia
- School of Public HealthUniversity of TechnologySydneyAustralia
| | - Anthony Sammel
- Department of RheumatologyPrince of Wales HospitalSydneyAustralia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSWSydneyAustralia
| | - Rhiana Honeysette
- Aboriginal and Torres Strait Islander Community ServicesPrince of Wales HospitalSydneyAustralia
| | - Brett Biles
- School of Population Health, Faculty of Medicine and Health, UNSWSydneyAustralia
| | | | - Sally Nathan
- School of Population Health, Faculty of Medicine and Health, UNSWSydneyAustralia
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25
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Buresh M, Buchheit BM, Wason K, Northup R, Bratberg J, Finnell DS. Advocacy for Equity Around Evidence-Based Treatments: Overview and Proceedings of the AMERSA 2023 Conference. Subst Use Addctn J 2024; 45:156-162. [PMID: 38288714 DOI: 10.1177/29767342241228101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
This commentary provides an overview of the 2023 Association of Multidisciplinary Education and Research in Substance use and Addiction (AMERSA) annual conference: Advocacy for Equity Around Evidence-Based Treatments, held from November 1 to 4, 2023, in Washington, DC. The conference featured 9 interactive workshops, 106 oral abstract presentations, and 130 posters. From the preconference workshop to plenary sessions, paper, and poster presentations, there was a focus on addressing imbalanced social systems and structures underlying disparities. In the face of increasing drug overdose deaths, diminished access to prevention, intervention, treatment, and recovery supports for racial and ethnic minorities, there is a pressing need for advocacy for equity around evidence-based treatments.
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Affiliation(s)
- Megan Buresh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bradley M Buchheit
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kristin Wason
- Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, USA
| | | | - Jeffrey Bratberg
- University of Rhode Island College of Pharmacy, Kingston, RI, USA
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Gwata D, Ventriglio A, Hughes P, Deahl M. Structural inequalities, knife crime: A qualitative study. Int J Soc Psychiatry 2024:207640231221092. [PMID: 38557268 DOI: 10.1177/00207640231221092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The importance and impact of youth violence is increasingly being recognised and is a cause of international concern. In the UK, youth violence, specifically knife crime, is on the increase and has resulted in the deaths of many young people. In order to explore the impact of knife crimes on mental health and wellbeing of individuals, a number of focus groups were conducted with 24 professionals from multiple agencies. Qualitative analysis showed various emerging themes, which included ineffective mental health systems, structural violence and inequalities, policing, safety and community engagement, vulnerability and resilience in minority communities. Equity in mental health services, further development and roll-out of public mental health approaches and training accompanied by sufficient resources is needed.
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Affiliation(s)
| | | | | | - Martin Deahl
- Institute of Psychiatry, Kings College, London, UK
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Sowa NA, Zeng X. Factors Associated with Reliance on Audio-Only Technology (Telephone) for Completion of Telepsychiatry Visits. Telemed J E Health 2024; 30:e1034-e1048. [PMID: 37883647 DOI: 10.1089/tmj.2023.0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Introduction: The ability to access telepsychiatry through audio-video technology versus audio-only (telephone) technology potentially leads to inequitable outcomes. This study examines the characteristics of patients who relied on the telephone to complete outpatient telepsychiatry visits in a large health system. Methods: This is a retrospective analysis of all telepsychiatry outpatient visits conducted from May 1, 2020, to December 31, 2021. Demographic, clinical, and socioeconomic factors were extracted from the electronic health record. Two-sample t tests were used for continuous variables and χ2 tests for categorical variables for bivariate analyses. Multiple logistic regression was used to examine the association between only telephone visits and all input variables. Results: Eight hundred ninety-four (8.9%) patients completed all visits only by telephone during the study period. In bivariate analyses, factors associated with telephone-only visits included male sex, non-English primary language, Black race, unmarried status, non-Hispanic ethnicity, older age, Medicare enrollment, uninsured status, and higher social vulnerability index (SVI). Psychiatric diagnoses associated with only telephone visits included substance use disorders and psychotic disorders. In multivariate analyses, factors associated with higher odds of only telephone visits included older age, inactive patient portal, comorbid diabetes, higher SVI, and higher broadband adoption. Psychiatric diagnoses associated with higher odds of completing only telephone visits included psychotic disorders, substance use disorders, or intellectual/developmental disabilities. Conclusions: Several patient-level factors are associated with a reliance on the telephone to complete telepsychiatry appointments.
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Affiliation(s)
- Nathaniel A Sowa
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Xiaoming Zeng
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Mussallem A, Panko TL, Contreras JM, Plegue MA, Dannels WA, Roman G, Hauser PC, McKee MM. Making virtual health care accessible to the deaf community: Findings from the telehealth survey. J Telemed Telecare 2024; 30:574-578. [PMID: 35075938 DOI: 10.1177/1357633x221074863] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To reduce COVID-19 exposure risk, virtual visits became widely adopted as a common form of healthcare delivery for the general population. It is unknown how this affected the deaf population, a sociolinguistic minority group that continues to face communication and healthcare barriers. The survey's objective was to describe the deaf participants' experiences with telehealth visits. METHODS A 28-item online survey, available in American Sign Language and English, was developed and disseminated between November 2020 and January 2021. Ninety-nine deaf participants responded. Descriptive statistics were performed to assess the participant's virtual health care use, experiences, and communication approaches. RESULTS Seventy-five percent of respondents used telehealth at least once in the past 12 months (n = 74; age = 37.6 ± 14.5 years). Of those who used telehealth, nearly two-thirds experienced communication challenges (65.3%; n = 49). Half of the participants reported having to connect via a video relay service that employs interpreters who maintain general certification instead of a remote interpreter with specialized health care interpreting certifications for video visits with their health care providers (n = 37) and a third of participants reported needing to use their residual hearing to communicate with their providers (n = 25). CONCLUSION Standard protocols for health care systems and providers are needed to minimize the burden of access on deaf patients and ensure virtual visits are equitable. It is recommended these visits be offered on Health Insurance Portability and Accountability Act-compliant platforms and include multi-way video to allow for the inclusion of remote medical interpreters and/or real-time captionists to ensure effective communication between the provider and the deaf patient occurs.
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Affiliation(s)
- Ashley Mussallem
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Tiffany L Panko
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Jessica M Contreras
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Wendy A Dannels
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Gretchen Roman
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
| | - Peter C Hauser
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Baranowski M, Webb N, Slater J. What's the big IDEA? Incorporating inclusion, diversity, equity, and access (IDEA) in population health nutrition research and practice. Appl Physiol Nutr Metab 2024; 49:560-565. [PMID: 38318810 DOI: 10.1139/apnm-2023-0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Historically, the constructs of inclusion, diversity, equity, and access (IDEA) have not been sufficiently considered or included in population health nutrition research and practice. Consequently, current nutrition assessment benchmarks and knowledge translation tools may not accurately or adequately reflect diversity in the Canadian population or produce meaningful dietary guidance. The purpose of this current opinion paper is to introduce the population health nutrition research and practice framework and explore the current application of IDEA within this framework. Recommendations are offered to incorporate the constructs of IDEA along the continuum of future nutrition research and services to improve population nutritional health.
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Affiliation(s)
- Maria Baranowski
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Nikki Webb
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Joyce Slater
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
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Sobhy MM, Brand M, Henshall K, MacCormick AD. Investigating major trauma in Māori youth at Te Whatu Ora Counties Manukau. ANZ J Surg 2024; 94:580-584. [PMID: 38486439 DOI: 10.1111/ans.18948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/25/2024] [Accepted: 03/06/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The Ninth Perioperative Mortality Review Committee (POMRC) report found the likelihood of death was over three times higher in Māori youth compared to non-Māori (age: 15-18 years) in the 30-days following major trauma. The aim of our study is to investigate variations in care provided to Māori youth presenting to Te Whatu Ora Counties Manukau (TWO-CM) with major trauma, to inform policies and improve care. METHODS This was a retrospective, observational study of 15-18-year-olds admitted to Middlemore Hospital from January 2018 to December 2021 following major trauma (Injury Severity Score (ISS) >12 or with (ISS) <12 who died). Data were obtained from the New Zealand Trauma Registry (NZTR). Six key performance indicators were studied against hospital guidelines/international consensus: Deaths, Cause-of-death, trauma call, RedBlanket activations, time-to-computed tomography (CT), and time-to-operating theatre (OT). RESULTS Of 77 patients, five deaths occurred, four non-Māori, and one Māori (P = 0.645). Five trauma calls were not activated (P = 0.642). There was no statistically significant difference for both median time to CT (P = 0.917) and time to CT for patients with GCS >13 (P = 0.778) between Māori and non-Māori. Five patients did not meet guidelines for time-to-OT (three non-Māori and two Māori) (P = 0.377). CONCLUSION No statistically significant variations in care were present for Māori youth presenting with major trauma, these findings did not match the national trend.
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Affiliation(s)
- Mira M Sobhy
- Department of Surgery, Te Waipapa Taumata Rau (University of Auckland), Tāmaki Makaurau, Aotearoa, New Zealand
- Dunedin School of Medicine, Ōtākou Whakaihu Waka (University of Otago), Dunedin, Aotearoa, New Zealand
| | - Maria Brand
- Department of Surgery, Te Waipapa Taumata Rau (University of Auckland), Tāmaki Makaurau, Aotearoa, New Zealand
- Department of Surgery, Te Whatu Ora Counties Manukau, Auckland, Aotearoa, New Zealand
| | - Kevin Henshall
- Department of Surgery, Te Whatu Ora Counties Manukau, Auckland, Aotearoa, New Zealand
| | - Andrew D MacCormick
- Department of Surgery, Te Waipapa Taumata Rau (University of Auckland), Tāmaki Makaurau, Aotearoa, New Zealand
- Department of Surgery, Te Whatu Ora Counties Manukau, Auckland, Aotearoa, New Zealand
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Williams CP, Deng L, Caston NE, Gallagher K, Angove R, Pisu M, Azuero A, Arend R, Rocque GB. Understanding the financial cost of cancer clinical trial participation. Cancer Med 2024; 13:e7185. [PMID: 38629264 PMCID: PMC11022148 DOI: 10.1002/cam4.7185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/14/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Though financial hardship is a well-documented adverse effect of standard-of-care cancer treatment, little is known about out-of-pocket costs and their impact on patients participating in cancer clinical trials. This study explored the financial effects of cancer clinical trial participation. METHODS This cross-sectional analysis used survey data collected in December 2022 and May 2023 from individuals with cancer previously served by Patient Advocate Foundation, a nonprofit organization providing social needs navigation and financial assistance to US adults with a chronic illness. Surveys included questions on cancer clinical trial participation, trial-related financial hardship, and sociodemographic data. Descriptive and bivariate analyses were conducted using Cramer's V to estimate the in-sample magnitude of association. Associations between trial-related financial hardship and sociodemographics were estimated using adjusted relative risks (aRR) and corresponding 95% confidence intervals (CI) from modified Poisson regression models with robust standard errors. RESULTS Of 650 survey respondents, 18% (N = 118) reported ever participating in a cancer clinical trial. Of those, 47% (n = 55) reported financial hardship as a result of their trial participation. Respondents reporting trial-related financial hardship were more often unemployed or disabled (58% vs. 43%; V = 0.15), Medicare enrolled (53% vs. 40%; V = 0.15), and traveled >1 h to their cancer provider (45% vs. 17%; V = 0.33) compared to respondents reporting no hardship. Respondents who experienced trial-related financial hardship most often reported expenses from travel (reported by 71% of respondents), medical bills (58%), dining out (40%), or housing needs (40%). Modeling results indicated that respondents traveling >1 h vs. ≤30 min to their cancer provider had a 2.2× higher risk of financial hardship, even after adjusting for respondent race, income, employment, and insurance status (aRR = 2.2, 95% CI 1.3-3.8). Most respondents (53%) reported needing $200-$1000 per month to compensate for trial-related expenses. Over half (51%) of respondents reported less willingness to participate in future clinical trials due to incurred financial hardship. Notably, of patients who did not participate in a cancer clinical trial (n = 532), 13% declined participation due to cost. CONCLUSION Cancer clinical trial-related financial hardship, most often stemming from travel expenses, affected almost half of trial-enrolled patients. Interventions are needed to reduce adverse financial participation effects and potentially improve cancer clinical trial participation.
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Affiliation(s)
| | - Luqin Deng
- University of Alabama at BirminghamBirminghamAlabamaUSA
| | | | | | | | - Maria Pisu
- University of Alabama at BirminghamBirminghamAlabamaUSA
| | - Andres Azuero
- University of Alabama at BirminghamBirminghamAlabamaUSA
| | - Rebecca Arend
- University of Alabama at BirminghamBirminghamAlabamaUSA
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Tsuchida RE, Mbele N, Chopra Z, Moll J, Burkhardt JC, Hekman DJ, Perry MA. Identifying the prevalence and characteristics of diversity, equity, and inclusion leaders in academic emergency medicine. AEM Educ Train 2024; 8:e10965. [PMID: 38525368 PMCID: PMC10955607 DOI: 10.1002/aet2.10965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/26/2024]
Abstract
Objectives Our study aims to better understand and describe the current state of diversity, equity, and inclusion (DEI) leadership in emergency medicine (EM) by identifying the prevalence of department DEI leadership positions, their demographics, and their job duty characteristics. Methods We disseminated an electronic survey from April to July 2022 to Society for Academic Emergency Medicine (SAEM) Association of Academic Chairs of Emergency Medicine, Academy for Diversity and Inclusion in Emergency Medicine, and the Equity and Inclusion Committee to identify department DEI leads. From July to August 2022, a 45-question survey was sent to all identified DEI leaders on individual characteristics, DEI experience, and DEI lead job description. Results We received a response from 79 out of 120 academic EM departments identified (65.8%). Of the responding institutions, 59 (74.7%) reported a DEI leader. A total of 74.6% of these DEI leaders responded at least partially to our survey and 57.6% responded in full. The most common titles were vice/associate chair of DEI (34.4%), director of DEI (28.1%), and DEI committee chair (18.8%). Most respondents (84.4%) were the inaugural DEI lead in their department and 84.4% of respondents did not have a formal DEI role in their department previously. On average, respondents have had their DEI title for 2 years (range 0-7 years) with an average of 7 years (range 0-30 years) of experience performing DEI work. Many (63.4%) do not receive any funded effort for their DEI roles. Most DEI leads were not tenure track (72.2%) and most commonly at the rank of assistant professor (47.2%) followed by associate professor (33.3%), full professor (16.7%), and instructor (2.8%). Conclusions This is the first known study to assess the characteristics of DEI department leaders in EM. EM DEI leadership positions are new, common, and led by diverse personal identities and are often not funded. Future directions could gain qualitative insight into this workforce to guide best practices in EM DEI leadership.
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Affiliation(s)
- Ryan E. Tsuchida
- Department of Emergency Medicine, School of Medicine and Public HealthUniversity of WisconsinMadisonWisconsinUSA
| | - Neema Mbele
- School of Medicine and Public HealthUniversity of WisconsinMadisonWisconsinUSA
| | - Zoey Chopra
- University of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Joel Moll
- Department of Emergency MedicineVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - John C. Burkhardt
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Daniel J. Hekman
- Department of Emergency Medicine, School of Medicine and Public HealthUniversity of WisconsinMadisonWisconsinUSA
| | - Marcia A. Perry
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Wenham C, Brand TL, Carlin EP, Donachie D, Fèvre S, Greve LC, Hardy E, Okello AL, Standley CJ, Stärk KDC, Lawrence Welle CC. How can gender considerations be better integrated into animal health emergency preparedness and response? J Am Vet Med Assoc 2024; 262:572-575. [PMID: 38295516 DOI: 10.2460/javma.23.10.0589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024]
Abstract
Global and national authorities have not historically approached animal health emergencies through a gendered lens. Yet these events almost certainly have gendered dimensions, such as differential engagement of women or men depending on their culturally accepted or assigned roles for animal care; risk of exposure to zoonoses; and access to emergency resources during response and recovery. Despite the role that gender seems to play with respect to animal health emergencies, little research has been conducted to better understand such dynamics, and little policy has been promulgated to address it in a way that optimizes response while ensuring equitable outcomes. This piece summarizes 3 key themes that emerged from a panel discussion on gender and animal health emergencies at the World Organisation for Animal Health Global Conference on Emergency Management in April 2023. These themes were differential gendered exposure to pathogens; a lack of equitable gender representation in animal health decision-making; and enhancement of pathways for recognizing gender in national and international actions in preparing for, detecting, and responding to animal health emergencies. Beyond increasing opportunities for women to engage in leadership, the animal health and veterinary communities will benefit from connecting practitioners with gender experts to develop more integrative approaches to emergency preparedness and management. Animal health professionals should also advocate for further research to elucidate gender-specific dynamics in human populations in the context of animal emergencies and the promulgation of evidence-based policies. Such transformative efforts will lead to better outcomes for all people who depend on and provide care for animals.
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Affiliation(s)
- Clare Wenham
- 1London School of Economics and Political Science, London, England
| | | | | | | | - Sonia Fèvre
- 2World Organisation for Animal Health, Paris, France
| | - Lydia C Greve
- 2World Organisation for Animal Health, Paris, France
| | - Emily Hardy
- 4School of Foreign Service, Georgetown University, Washington, DC
| | - Anna L Okello
- 5Australian Centre for International Agricultural Research, Canberra, ACT, Australia
| | - Claire J Standley
- 6Center for Global Health Science and Security, Georgetown University, Washington, DC
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Bouchelle Z, Yazdani M, Dalembert G, Negro D, Jenssen BP, Virudachalam S, Shea JA, Gwynn K, Morrow K, Kenyon CC. Low-Income Caregiver Perspectives on a State Education Savings Program and Receptivity to Clinic-Based Financial Counseling. Acad Pediatr 2024; 24:494-502. [PMID: 37611694 DOI: 10.1016/j.acap.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND AND OBJECTIVE In 2019, Pennsylvania launched a Children's Development Account (CDA) program that invests $100 in an education savings account for every child born in the state. However, as of 2021, only 10.6% of families claimed the investment. Low-income communities may stand to benefit most from educational investments, but few studies have assessed barriers and facilitators of uptake in these communities. We sought to examine low-income caregivers' perceptions of and barriers and facilitators to participation in a statewide CDA program and their receptivity to clinic-based financial counseling through a medical financial partnership. METHODS We surveyed 100 caregivers of Medicaid-insured children from 2 primary care practices serving a predominantly low-income community. From these 100, we purposively sampled 30 caregivers for follow-up interviews. RESULTS The 100 survey participants were predominantly female (83%), Black or African American (92%), and non-Hispanic or Latino (93%). Twenty-nine percent of survey participants were aware of the CDA program, 4% had enrolled, and 64% were interested in clinic-based financial counseling. In interviews, caregivers identified several barriers to and facilitators of engagement in the CDA program. They also identified several strategies to boost engagement, including simplifying registration, providing additional and personalized program information, expanding the investment amount, and providing clinic- and community-based outreach. CONCLUSIONS Low-income caregivers identified several barriers to enrollment in a statewide CDA program and strategies to boost enrollment, including clinic-based financial counseling. Future research should examine the effectiveness, cost-effectiveness, and long-term financial and health consequences of clinic-based financial services for low-income families.
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Affiliation(s)
- Zoe Bouchelle
- National Clinician Scholars Program (Z Bouchelle), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Pediatrics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
| | - Mishaal Yazdani
- PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa.
| | - George Dalembert
- Department of Pediatrics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Clinical Futures (G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Children's Hospital of Philadelphia, Pa.
| | - DanaRose Negro
- Perelman School of Medicine (D Negro), University of Pennsylvania, Philadelphia, Pa.
| | - Brian P Jenssen
- Department of Pediatrics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Clinical Futures (G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Children's Hospital of Philadelphia, Pa.
| | - Senbagam Virudachalam
- Department of Pediatrics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Clinical Futures (G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Children's Hospital of Philadelphia, Pa.
| | - Judy A Shea
- Department of Medicine (JA Shea), University of Pennsylvania School of Medicine, Philadelphia, Pa.
| | - Katie Gwynn
- PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa.
| | - Kate Morrow
- PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa.
| | - Chén C Kenyon
- Department of Pediatrics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Clinical Futures (G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Children's Hospital of Philadelphia, Pa.
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Acharya H, Sykes KJ, Neira TM, Scott A, Pacheco CM, Sanner M, Ablah E, Oyowe K, Ellerbeck EF, Greiner KA, Corriveau EA, Finocchario-Kessler S. A Novel Electronic Record System for Documentation and Efficient Workflow for Community Health Workers: Development and Usability Study. JMIR Form Res 2024; 8:e52920. [PMID: 38557671 PMCID: PMC11019415 DOI: 10.2196/52920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic added to the decades of evidence that public health institutions are routinely stretched beyond their capacity. Community health workers (CHWs) can be a crucial extension of public health resources to address health inequities, but systems to document CHW efforts are often fragmented and prone to unneeded redundancy, errors, and inefficiency. OBJECTIVE We sought to develop a more efficient data collection system for recording the wide range of community-based efforts performed by CHWs. METHODS The Communities Organizing to Promote Equity (COPE) project is an initiative to address health disparities across Kansas, in part, through the deployment of CHWs. Our team iteratively designed and refined the features of a novel data collection system for CHWs. Pilot tests with CHWs occurred over several months to ensure that the functionality supported their daily use. Following implementation of the database, procedures were set to sustain the collection of feedback from CHWs, community partners, and organizations with similar systems to continually modify the database to meet the needs of users. A continuous quality improvement process was conducted monthly to evaluate CHW performance; feedback was exchanged at team and individual levels regarding the continuous quality improvement results and opportunities for improvement. Further, a 15-item feedback survey was distributed to all 33 COPE CHWs and supervisors for assessing the feasibility of database features, accessibility, and overall satisfaction. RESULTS At launch, the database had 60 active users in 20 counties. Documented client interactions begin with needs assessments (modified versions of the Arizona Self-sufficiency Matrix and PRAPARE [Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences]) and continue with the longitudinal tracking of progress toward goals. A user-specific automated alerts-based dashboard displays clients needing follow-up and upcoming events. The database contains over 55,000 documented encounters across more than 5079 clients. Available resources from over 2500 community organizations have been documented. Survey data indicated that 84% (27/32) of the respondents considered the overall navigation of the database as very easy. The majority of the respondents indicated they were overall very satisfied (14/32, 44%) or satisfied (15/32, 48%) with the database. Open-ended responses indicated the database features, documentation of community organizations and visual confirmation of consent form and data storage on a Health Insurance Portability and Accountability Act-compliant record system, improved client engagement, enrollment processes, and identification of resources. CONCLUSIONS Our database extends beyond conventional electronic medical records and provides flexibility for ever-changing needs. The COPE database provides real-world data on CHW accomplishments, thereby improving the uniformity of data collection to enhance monitoring and evaluation. This database can serve as a model for community-based documentation systems and be adapted for use in other community settings.
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Affiliation(s)
- Harshdeep Acharya
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ, United States
| | - Kevin J Sykes
- Health and Wellness Center, Baylor Scott and White Health, Dallas, TX, United States
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Ton Mirás Neira
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Angela Scott
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Christina M Pacheco
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Matthew Sanner
- Sanner Software Solutions, Kansas City, KS, United States
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | | | - Edward F Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - K Allen Greiner
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Erin A Corriveau
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah Finocchario-Kessler
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
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Beaudoin JR, Curran J, Alexander GC. Impact of Race on Classification of Atherosclerotic Risk Using a National Cardiovascular Risk Prediction Tool. AJPM Focus 2024; 3:100200. [PMID: 38440670 PMCID: PMC10910235 DOI: 10.1016/j.focus.2024.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Introduction The use of race in clinical risk prediction tools may exacerbate racial disparities in healthcare access and outcomes. This study quantified the number of individuals reclassified for primary prevention of cardiovascular disease owing to a change in their race alone on the basis of a commonly used risk prediction tool. Methods This is a cross-sectional analysis of individuals aged 40-75 years without a history of cardiovascular events, diabetes, or other high-risk features using the 2005-2018 National Health and Nutritional Examination Survey. Authors compared atherosclerotic cardiovascular disease risk scores using the American Heart Association/American College of Cardiology equation recommended for White individuals or individuals of other races with that recommended for Black individuals. Results A total of 2,946 White individuals; 1,361 Black individuals; and 2,495 individuals of other races were included in the analysis. Using the American Heart Association/American College of Cardiology equation, the mean 10-year atherosclerotic cardiovascular disease risk was 5.80% (95% CI=5.54, 6.06) for White individuals, 7.04% (956% CI=6.69, 7.39) for Black individuals, and 4.93% (95% CI=4.61, 5.24) for individuals of other races. When using the American Heart Association/American College of Cardiology equation designated for the opposite race (White/other race versus Black), the mean atherosclerotic cardiovascular disease risk score increased by 1.02% (95% CI=0.90, 1.13) for White individuals, decreased by 1.82% (95% CI= -1.67, -1.96) for Black individuals, and increased by 0.98% (95% CI=0.85, 1.10) for individuals of other races. When using clinical atherosclerotic cardiovascular disease categories of <7.5%, 7.5%-10%, and >10%, 16.93% of all individuals were reclassified when using the American Heart Association/American College of Cardiology's equation designated for the opposite race. Conclusions Changing race within a commonly used cardiovascular risk prediction tool results in significant changes in risk classification among eligible White and Black individuals in the U.S.
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Affiliation(s)
- Jarett R. Beaudoin
- Department of Family and Community Medicine, University of California, Davis, California
| | - Jill Curran
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - G. Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland
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Trinh NHT, Talukder F, Nagendra A, Ali AM, Emmerich A, Chow L, Jenkins JH, Okereke OI. From Diversity, Equity, and Inclusion to an Antiracism Strategic Plan: An Academic Department of Psychiatry's Journey. Psychiatr Serv 2024; 75:391-394. [PMID: 38347815 DOI: 10.1176/appi.ps.20230024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The efforts of an academic psychiatry department to embark on an antiracism strategic planning process are outlined, including the establishment of an antiracism task force charged with the development of an antiracism strategic plan. The initial process of the task force is described, recommendations are summarized, and future directions are outlined.
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Affiliation(s)
- Nhi-Ha T Trinh
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
| | - Farhabi Talukder
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
| | - Arun Nagendra
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
| | - Areeba M Ali
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
| | - Anne Emmerich
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
| | - Louis Chow
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
| | - Jonathan H Jenkins
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
| | - Olivia I Okereke
- Department of Psychiatry, Massachusetts General Hospital (all authors), and Harvard Medical School (Trinh, Nagendra, Emmerich, Chow, Jenkins, Okereke), Boston
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Suh M, Movva N, Jiang X, Reichert H, Pastula ST, Sacks NC, Frankenfeld C, Fryzek JP, Simões EAF. Healthcare Utilization Among Infants Covered by Medicaid and Newly Diagnosed With Respiratory Syncytial Virus. Open Forum Infect Dis 2024; 11:ofae174. [PMID: 38595954 PMCID: PMC11002947 DOI: 10.1093/ofid/ofae174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024] Open
Abstract
Background Infants covered by Medicaid have higher respiratory syncytial virus (RSV) hospitalization rates than those with commercial insurance, but findings are limited to the inpatient setting. This birth cohort study describes healthcare encounters for RSV across all settings among infants covered by Medicaid and the Children's Health Insurance Program. Methods Medicaid claims for infants born and residing in Arizona (AZ), California (CA), Florida (FL), Michigan (MI), North Carolina (NC), New York (NY), and Texas (TX) were analyzed for first diagnosis of RSV in 2016-2018 using International Classification of Diseases, Tenth Revision codes. Encounters on the day of first diagnosis were examined by setting in 7 states and by setting and race in CA, FL, and NC. Results A total of 80 945 infants were diagnosed with RSV in 7 states in 2016-2018. The highest encounter rates for first RSV diagnosis were in the emergency department (ED) in 5 states (11.0-33.4 per 1000 in AZ, CA, FL, MI, and NY) and outpatient setting in 2 states (54.8 and 68.5 per 1000 in TX and NC). Significantly higher outpatient encounter rates were found in CA and NC for White infants compared to non-White infants. In NC, ED encounter rates were significantly higher for non-White infants than White infants, whereas in CA, the rates were comparable. In these 2 states, hospitalization rates were similar across groups. In FL, compared with White infants, non-White infants had significantly higher encounter rates in each setting on the day of first RSV diagnosis. Conclusions This is the first study to describe the burden of RSV by setting and race. Medicaid infants who are newly diagnosed with RSV have the highest burden in ED and outpatient settings.
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Affiliation(s)
- Mina Suh
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Naimisha Movva
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Xiaohui Jiang
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Heidi Reichert
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Susan T Pastula
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Naomi C Sacks
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Cara Frankenfeld
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Jon P Fryzek
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Eric A F Simões
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
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Henry E, Cullinan J. Addressing the distributional consequences of spillovers in health economic evaluation: A prioritarian approach. Health Econ 2024; 33:764-778. [PMID: 38185789 DOI: 10.1002/hec.4796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024]
Abstract
Health spillovers arise when an individual's serious illness affects those close to them emotionally, psychologically, and/or physically. As a result, healthcare interventions that improve the lives of patients may also confer wider health benefits. However, contrary to widespread calls for health spillovers to be included in health economic evaluation, others have argued this could have adverse distributional consequences and equity implications. This paper presents a novel approach to spillover inclusion in health economic evaluation using a 'prioritarian transformation' of health gains that allows these equity concerns to be addressed. Affording greater weight to the incremental change in patient outcomes when incorporating carer/family health spillovers into resource allocation decisions, the method provides a feasible means of moderating the distributional impact of spillover inclusion. It also introduces a normative, theoretical perspective to a largely empirical extant literature and, as such, its axiomatic basis is examined. Finally, an illustrative example of the approach is presented to demonstrate its application.
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Affiliation(s)
- Edward Henry
- J.E. Cairnes School of Business & Economics, University of Galway, Galway, Ireland
| | - John Cullinan
- J.E. Cairnes School of Business & Economics, University of Galway, Galway, Ireland
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40
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Abdi W, Bateganya L, Blalock TW. Response to "ethically conducting hair examinations among individuals with hijabs''. J Am Acad Dermatol 2024; 90:e149-e150. [PMID: 38141928 DOI: 10.1016/j.jaad.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Affiliation(s)
- Warda Abdi
- Medical College of Georgia, Augusta, Georgia
| | | | - Travis W Blalock
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
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Ke J, Cao SZ, Darland AM, Grant-Kels JM, Mervak JE. Allocation of dermatology research opportunities to medical students: Analysis of the national academic dermatology approach. J Am Acad Dermatol 2024; 90:838-839. [PMID: 38056527 DOI: 10.1016/j.jaad.2023.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Jesper Ke
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Severine Z Cao
- Department of Dermatology, Michigan Medicine University of Michigan, Ann Arbor, Michigan
| | - Allison M Darland
- Department of Dermatology, Michigan Medicine University of Michigan, Ann Arbor, Michigan
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut, Farmington, Connecticut
| | - Julie E Mervak
- Department of Dermatology, Michigan Medicine University of Michigan, Ann Arbor, Michigan.
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Goode RW, Wilfred SA, Reyes-Rodríguez ML. From disparities to equity: striving for more in our treatments for feeding and eating disorders. Trends Mol Med 2024; 30:308-310. [PMID: 38135600 PMCID: PMC11009073 DOI: 10.1016/j.molmed.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/10/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
Adopting a framework of equity is urgently needed to reduce disparities persistent in feeding and eating disorder (FED) treatment models. This framework must emphasize the exchange of knowledge between relevant stakeholders and implementation strategies to impact practice and embrace a systemic change in the FED field.
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Affiliation(s)
- Rachel W Goode
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Nutrition Research Institute, The University of North Carolina, Kannapolis, NC, USA
| | | | - Mae Lynn Reyes-Rodríguez
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Fins JJ. Baseball and Bioethics Revisited: The Pitch Clock and Age Discrimination in a Timeless Pastime. Camb Q Healthc Ethics 2024; 33:267-270. [PMID: 37767653 DOI: 10.1017/s096318012300049x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
In this essay, the author reflects on a decade's old essay on baseball and bioethics inspired by a conversation with the late David Thomasma. In a reprise of his earlier paper, Fins worries that modernity has come to baseball with the advent of the pitch clock and that this innovation brings age discrimination to a timeless pastime.
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Affiliation(s)
- Joseph J Fins
- Division of Medical Ethics, Weill Cornell Medical College, New York, NY, USA
- Solomon Center for Health Law & Policy, Yale Law School, New Haven, CT, USA
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Bacchi S, Kovoor JG, Goh R, Gupta AK, Tan S, Ovenden CD, To MS, Moey A, Sanders P, Chew DP, Schultz D, Kovoor P, Kleinig T, Jannes J. Pre-stroke anticoagulation for atrial fibrillation in primary English speakers and non-primary English speakers: a multicentre retrospective cohort study. Intern Med J 2024; 54:620-625. [PMID: 37860995 DOI: 10.1111/imj.16253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/16/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Anticoagulation can prevent most strokes in individuals with atrial fibrillation (AF); however, many people presenting with stroke and known AF are not anticoagulated. Language barriers and poor health literacy have previously been associated with decreased patient medication adherence. The association between language barriers and initiation of anticoagulation therapy for AF is uncertain. AIMS The aims of this study were to determine whether demographic factors, including non-English primary language, were (1) associated with not being initiated on anticoagulation for known AF prior to admission with stroke, and (2) associated with non-adherence to anticoagulation in the setting of known AF prior to admission with stroke. METHODS A multicentre retrospective cohort study was conducted for consecutive individuals admitted to the three South Australian tertiary hospitals with stroke units over a 5-year period. RESULTS There were 6829 individuals admitted with stroke. These cases included 5835 ischaemic stroke patients, 1333 of whom had pre-existing AF. Only 40.0% presenting with ischaemic stroke in the setting of known pre-existing AF were anticoagulated. When controlling for demographics, socioeconomic status and past medical history (including the components of the CHADS2VASC score and anticoagulation contraindications), having a primary language other than English was associated with a lower likelihood of having been commenced on anticoagulant for known pre-stroke AF (odds ratio: 0.52, 95% confidence interval: 0.36-0.77, P = 0.001), but was not associated with a differing likelihood of anticoagulation adherence. CONCLUSIONS A significant proportion of patients with stroke have pre-existing unanticoagulated AF; these rates are substantially higher if the primary language is other than English. Targeted research and interventions to minimise evidence-treatment gaps in this cohort may significantly reduce stroke burden.
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Affiliation(s)
- Stephen Bacchi
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rudy Goh
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Minh-Son To
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Moey
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Derek P Chew
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David Schultz
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Pramesh Kovoor
- Westmead Private Hospital, Sydney, New South Wales, Australia
| | - Timothy Kleinig
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jim Jannes
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Callender VD, Harvey VM, Hartman CL, Gohara M, Khan TT, Kwan W, Ginn LR. Do Women with Skin of Color Think They Are Well Represented in Skin Aging Prevention Information? J Clin Aesthet Dermatol 2024; 17:18-22. [PMID: 38638189 PMCID: PMC11022842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Objective There are clinical differences in healthy skin requirements and skin-aging features by race and ethnicity. However, individuals of color are underrepresented in dermatology-related medical information. We sought to gather information from women of color regarding their attitudes about the importance of the prevention of skin aging, available information, and perception of representation in skin-aging prevention information. Methods This study involved an observational, cross-sectional, online survey of women aged 18 to 70 years residing in the United States. Participants were placed into one of seven cohorts based on self-reported race/ethnicity. Relative frequencies of responses were compared across cohorts; adjusted logistic regression was used to assess perception of representation in skin-aging prevention information. Results The mean age of the 1,646 participants was 44.4 years. The mean (standard deviation) rating (from 0, "not at all important" to 10, "extremely important") of the importance of the prevention of skin aging ranged from 7.3 to 8.2 across the seven cohorts. All cohorts reported the most trusted source of information for skin-aging prevention products and treatments was a skin-care professional, but not all cohorts believed they are well represented in available sources of information. Older age, lower median household income, and a race/ethnicity of Black, Asian, "Other," and "More Than One Race" were less likely to report being well represented. Limitations People without internet access could not participate, potentially excluding some older and lower-income groups. Conclusion Women of color are less likely to feel represented in available information on the prevention of skin aging.
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Affiliation(s)
- Valerie D. Callender
- Dr. Callender is with Callender Dermatology and Cosmetic Center in Glenn Dale, Maryland
| | - Valerie M. Harvey
- Dr. Harvey is with Tidewater Physicians Multispecialty Group in Newport News, Virginia
| | - Corey L. Hartman
- Dr. Hartman is with Skin Wellness Dermatology in Birmingham, Alabama
| | - Mona Gohara
- Dr. Gohara is with Dermatology Physicians of Connecticut in Branford, Connecticut
| | - Tanya T. Khan
- Dr. Khan is with Khan Eyelid and Facial Aesthetics in Dallas, Texas
| | - William Kwan
- Dr. Kwan is with Lasky Skin Center in Beverly Hills, California
| | - Lisa R. Ginn
- Dr. Ginn is with Skin@LRG in Chevy Chase, Maryland
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Hallman TG, Qureshi U, Gutowski KS, Arcelona C, Donaldson R, Gosain AK. The Price of Productivity: Evaluating the Cost of a Research Year. J Surg Educ 2024; 81:495-502. [PMID: 38418357 DOI: 10.1016/j.jsurg.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/06/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Research years during medical school are becoming increasingly common amongst applicants to competitive residency programs. As many of these positions are unpaid, it is important to consider the financial implications of these experiences and the feasibility of participation from students of all backgrounds. This study aims to quantify the cost of a research year during medical school. DESIGN/SETTING We identified the top 50 NIH-funded medical schools of 2022 and obtained cost-of-living information for each of their respective counties. Estimated loan interest accrual resulting from a research year was calculated using information on the cost of attendance to medical school and annual interest rates for federal education loans. Cost-of-living calculations were stratified by geographic region, and interest accrual calculations by timing of research year and attendance at public versus private medical schools. RESULTS Top 50 NIH-funded medical schools in the West are located in counties with the highest mean and median costs of living, each approaching nearly $45,000 per year. Medical schools in the Midwest are located in counties with the lowest mean and median cost of living, at less than $36,000 annually. Estimated loan interest accrual resulting from a research year ranges from $3177 to $17,789, depending on timing of the research year and type of medical school attended. CONCLUSIONS This study exemplifies the significant financial burden that a research year can impose on medical students. As more residency applicants pursuing competitive specialties opt for research years during medical school, it is important to consider the associated financial implications. Many research year opportunities are unpaid or underpaid, which may prevent interested individuals from participating; this is especially the case for those who are from lower socioeconomic backgrounds. Moving forward, it is imperative that we ensure the availability of equitable and funded research year opportunities for students of all backgrounds.
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Affiliation(s)
- Taylor G Hallman
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Umer Qureshi
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Kristof S Gutowski
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Christian Arcelona
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Rachel Donaldson
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Arun K Gosain
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.
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Vajravelu ME, Chu PY, Frank DA, Ragavan MI, Vajravelu RK. Projected impact of anti-obesity pharmacotherapy use on racial and ethnic disparities in adolescent obesity. Pediatr Obes 2024; 19:e13103. [PMID: 38318987 DOI: 10.1111/ijpo.13103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/22/2023] [Accepted: 12/18/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Paediatric obesity disproportionately impacts individuals from minoritized racial and ethnic backgrounds. Recent guidelines support use of anti-obesity pharmacotherapy for adolescents with obesity, but the potential impact on disparities in obesity prevalence has not been evaluated. OBJECTIVES To model changes in obesity prevalence with increasing utilization of anti-obesity pharmacotherapy among adolescents. METHODS Data representative of American adolescents ages 12-17 years were obtained from the National Health and Nutrition Examination Survey, cycles 2011 through pre-pandemic 2020. A body mass index (BMI) reduction of 16.7% was applied to each participant based on clinical trial results of weekly subcutaneous semaglutide 2.4 mg among adolescents. Utilization disparities were based on utilization of the same medication class among adults. Obesity prevalence was calculated assuming utilization of 10%-100%, stratified by race and ethnicity. RESULTS Among 4442 adolescents representing 26 247 384 American adolescents, projected overall obesity prevalence decreased from 22.2% to 8.4% with 100% utilization. However, disparities increased relative to Non-Hispanic White youth, with prevalence among Non-Hispanic Black and Mexican American youth ranging from 40%-60% higher to 90%-120% higher, respectively. CONCLUSIONS Increasing utilization of anti-obesity pharmacotherapy may widen relative disparities in obesity, particularly if utilization is unequal. Advocacy for equitable access is needed to minimize worsening of obesity-related disparities.
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Affiliation(s)
- Mary Ellen Vajravelu
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Patricia Y Chu
- Division of Endocrinology and Diabetes, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David A Frank
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Maya I Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ravy K Vajravelu
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Phoenix M, Moll S, Vrzovski A, Bhaskar L, Micsinszki S, Bruce E, Mulalu L, Hossain P, Freeman B, Mulvale G, Consortium C. Advancing a collective vision for equity-based cocreation through prototyping at an international forum. Health Expect 2024; 27:e14041. [PMID: 38567877 PMCID: PMC10989061 DOI: 10.1111/hex.14041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/26/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Cocreation has the potential to engage people with lived and living experiences in the design and evaluation of health and social services. However, guidance is needed to better include people from equity-deserving groups (EDGs), who are more likely to face barriers to participation, experience ongoing or historical harm, and benefit from accessible methods of engagement. OBJECTIVE The aim of this international forum (CoPro2022) was to advance a collective vision for equity-based cocreation. DESIGN A participatory process of engagement in experiential colearning and arts-based creative and reflective dialogue. Visual prototypes were created and synthesised to generate a collective vision for inclusive equity-based cocreation. SETTING AND PARTICIPANTS The Forum was held at the Gathering Place by the Grand River in Ohsweken, Ontario, Canada. A total of 48 participants attended the forum. They were purposely invited and have intersecting positionalities (21 academic experts, six experience experts, 10 trainees, and 11 members of EDGs) from nine countries (Bangladesh, Botswana, Canada, England, Italy, Norway, Scotland, Singapore, Sweden). COPRO2022 ACTIVITIES: CoPro2022 was an immersive experience hosted on Indigenous land that encouraged continuous participant reflection on their own worldviews and those of others as participants openly discussed the challenges and opportunities with engaging EDGs in cocreation activities. Visual prototypes and descriptions created in small groups were informed by participants' reflections on the panel presentations at the Forum and their own experiences with equity-based cocreation. Following the event, the authorship team inductively coded themes from the prototype descriptions and met to discuss the cross-cutting themes. These informed the design of an illustrated collective vision for Equity Based Co-Creation (EqCC). RESULTS Six prototypes were cocreated by each small group to illustrate their vision for EqCC. Within these, four cross-cutting themes were identified: (i) go to where people are, (ii) nurture relationships and creativity, (iii) reflect, replenish and grow, (iv) and promote thriving and transformation. These four themes are captured in the Collective EqCC Vision to guide a new era of inclusive excellence in cocreation activities. PATIENT OR PUBLIC CONTRIBUTION Service users, caregivers, and people with lived experience were involved in leading the design of the CoPro2022 and co-led the event. This included activities at the event such as presenting, facilitating small and large group discussion, leading art-based activities, and reflecting with the team on the lessons learned. People with lived experience were involved in the analysis and knowledge sharing from this event. Several members of the research team (students and researchers) also identified as members of EDGs and were invited to draw from their personal and academic knowledge.
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Affiliation(s)
- Michelle Phoenix
- School of Rehabilitation Sciences, CanChildMcMaster UniversityHamiltonOntarioCanada
| | - Sandra Moll
- School of Rehabilitation SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Alexa Vrzovski
- Ahousaht First NationAhousatBritish ColombiaCanada
- Indigenous Project Coordinator, School of MedicineToronto Metropolitan UniversityTorontoOntarioCanada
| | - Le‐Tien Bhaskar
- Health Research Methods, Evidence, and Impact (Health Policy)McMaster UniversityHamiltonOntarioCanada
| | - Samantha Micsinszki
- School of Rehabilitation Sciences, CanChildMcMaster UniversityHamiltonOntarioCanada
| | - Emma Bruce
- School of Rehabilitation SciencesMcMaster UniversityHamiltonOntarioCanada
| | | | - Puspita Hossain
- Health Research Methods, Evidence, and Impact (Health Policy)McMaster UniversityHamiltonOntarioCanada
| | - Bonnie Freeman
- School of Social Work and Indigenous Studies DepartmentMcMaster University; Algonquin/Mohawk, Member of the Six Nations of the Grand RiverCanada
| | - Gillian Mulvale
- Health Policy and Management, DeGroote School of BusinessMcMaster UniversityHamiltonOntarioCanada
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Arsenault-Lapierre G, Bui T, Godard-Sebillotte C, Kang N, Sourial N, Rochette L, Massamba V, Quesnel-Vallée A, Vedel I. Sex Differences in Healthcare Utilization in Persons Living with Dementia Between 2000 and 2017: A Population-Based Study in Quebec, Canada. J Aging Health 2024:8982643241242512. [PMID: 38554023 DOI: 10.1177/08982643241242512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2024]
Abstract
Objectives: Describe sex differences in healthcare utilization and mortality in persons with new dementia in Quebec, Canada. Methods: We conducted a repeated cohort study from 2000 to 2017 using health administrative databases. Community-dwelling persons aged 65+ with a new diagnosis of dementia were included. We measured 23 indicators of healthcare use across five care settings: ambulatory care, pharmacological care, acute hospital care, long-term care, and mortality. Clinically meaningful sex differences in age-standardized rates were determined graphically through expert consultations. Results: Women with dementia had higher rates of ambulatory care and pharmacological care, while men with dementia had higher acute hospital care, admission to long-term care, and mortality. There was no meaningful difference in visits to cognition specialists, antipsychotic prescriptions, and hospital death. Discussion: Men and women with dementia demonstrate differences in healthcare utilization and mortality. Addressing these differences will inform decision-makers, care providers and researchers and guide more equitable policy and interventions in dementia care.
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Affiliation(s)
- Genevieve Arsenault-Lapierre
- Center for Research and Expertise in Social Gerontology, Centre Intégré Universitaire de Santé et Services Sociaux Du Centre-Ouest de l'Ile de Montréal, Montreal, QC, Canada
| | - Tammy Bui
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Claire Godard-Sebillotte
- McGill University Health Centre Research Institute, Montreal, QC, Canada
- Department of Medicine Division of Geriatrics, McGill University, Montreal, QC, Canada
| | - Nia Kang
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Nadia Sourial
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montreal, Montreal, QC, Canada
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Louis Rochette
- Institut National de Santé Publique Du Québec, Montreal, QC, Canada
| | | | - Amélie Quesnel-Vallée
- Department of Equity, Ethics, and Policy, School of Population and Global Health, McGill University, Montreal, QC, Canada
- Department of Sociology, McGill University, Montreal, QC, Canada
| | - Isabelle Vedel
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
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50
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Mattoon ER, Miles M, Broderick NA, Casadevall A. Analysis of justification for author order and gender bias in author order among those contributing equally. mBio 2024:e0064624. [PMID: 38551345 DOI: 10.1128/mbio.00646-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024] Open
Abstract
The practice of designating two or more authors as equal contributors (ECs) on a scientific publication is increasingly common as a form of sharing credit. However, EC authors are often unclearly attributed on curriculum vitae (CVs) or citation engines, and it is unclear how research teams determine author order within an EC listing. In response to studies showing that male authors were more likely to be placed first in an EC listing, the American Society for Microbiology (ASM) required that authors explain the reasons for author order beginning in 2020. In this study, we analyze data from over 2,500 ASM publications to see how this policy affected gender bias and how research teams are making decisions on author order. Data on publications from 2018 to 2021 show that gender bias was largely nonsignificant both before and after authors were asked by ASM to provide an EC statement. The most likely reasons for EC order included alphabetical order, seniority, and chance, although there were differences for publications from different geographic regions. However, many research teams used unique methods in order selection, highlighting the importance of EC statements to provide clarity for readers, funding agencies, and tenure committees. IMPORTANCE First-author publications are important for early career scientists to secure funding and educational opportunities. However, an analysis published in eLife in 2019 noted that female authors are more likely to be placed second even when both authors report they have contributed equally. American Society for Microbiology announced in response that they would require submissions to include a written justification of author order. In this paper, we analyze the resultant data and show that laboratories are most likely to use some combination of alphabetical order, seniority, and chance to determine author order. However, the prevalence of these methods varies based on the research team's geographic location. These findings highlight the importance of equal contributor statements to provide clarity for readers, funding agencies, and tenure committees. Furthermore, this work is critically important for understanding how these decisions are made and provides a glimpse of the sociology of science.
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Affiliation(s)
- Ellie Rose Mattoon
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maisha Miles
- American Society for Microbiology, Washington, DC, USA
| | | | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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