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Thomas LV, Jurkovitz CT, Zhang Z, Fawcett MR, Lenhard MJ. Neighborhood Environment and Poor Maternal Glycemic Control-Associated Complications of Gestational Diabetes Mellitus. AJPM Focus 2024; 3:100201. [PMID: 38524098 PMCID: PMC10958063 DOI: 10.1016/j.focus.2024.100201] [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: 03/26/2024]
Abstract
Introduction Risk of complications due to gestational diabetes mellitus is increasing in the U.S., particularly among individuals from racial minorities. Research has focused largely on clinical interventions to prevent complications, rarely on individuals' residential environments. This retrospective cohort study aims to examine the association between individuals' neighborhoods and complications of gestational diabetes mellitus. Methods Demographic and clinical data were extracted from electronic health records and linked to American Community Survey data from the U.S. Census Bureau for 2,047 individuals who had 2,164 deliveries in 2014-2018. Data were analyzed in 2021-2022 using Wilcoxon rank sum test and chi-square test for bivariate analyses and logistic regression for analysis of independent effects. All census tract-based variables used in the model were dichotomized at the median. Results Bivariate analysis showed that the average percentage of adults earning <$35,000 was higher in neighborhoods where individuals with complications were living than in neighborhoods where individuals without complications were living (30.40%±12.05 vs 28.94%±11.71, p=0.0145). Individuals who lived in areas with ≥8.9% of residents aged >25 years with less than high school diploma had a higher likelihood of complications than those who lived in areas with <8.9% of such residents (33.43% vs 29.02%, p=0.0272). Individuals who lived in neighborhoods that had ≥1.8% of households receiving public assistance were more likely to have complications than those who lived in areas where <1.8% of households received public assistance (33.33% vs 28.97%, p=0.0287). Logistic regression revealed that the odds of deliveries with complications were 44% higher for individuals with obesity (OR=1.44; 95% CI=1.17, 1.77), 35% greater for individuals residing in neighborhoods with higher percentages of households living below the poverty level (OR=1.35; 95% CI=1.09, 1.66), and 28% lower for individuals from neighborhoods where a higher percentage of households had no vehicles available for transportation to work (OR=0.72; 95% CI=0.59, 0.89). Conclusions Clinical interventions in concert with environmental changes could contribute to preventing maternal and neonatal complications of gestational diabetes mellitus.
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Affiliation(s)
- Leela V. Thomas
- Department of Social Work, Wesley College of Health and Behavioral Sciences, Delaware State University, Dover, Delaware
| | - Claudine T. Jurkovitz
- Institute for Research in Equity and Community Health (iREACH), ChristianaCare, Wilmington, Delaware
| | - Zugui Zhang
- Institute for Research in Equity and Community Health (iREACH), ChristianaCare, Wilmington, Delaware
| | - Mitchell R. Fawcett
- Institute for Research in Equity and Community Health (iREACH), ChristianaCare, Wilmington, Delaware
| | - M. James Lenhard
- Endocrinology and Metabolism, Metabolic Health, ChristianaCare, Wilmington, Delaware
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Sonoda K, Sales J, Bello JK, Grucza RA, Scherrer JF. Colorectal Cancer Screening Among Individuals With a Substance Use Disorder: A Retrospective Cohort Study. AJPM Focus 2024; 3:100218. [PMID: 38596162 PMCID: PMC11001631 DOI: 10.1016/j.focus.2024.100218] [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: 04/11/2024]
Abstract
Introduction There is limited evidence on colorectal cancer screening among individuals with a substance use disorder. This study aims to investigate the association between personal history of a substance use disorder and colorectal cancer colonoscopy screening completion rates. Methods This retrospective cohort study analyzed 176,300 patients, of whom 171,973 had no substance use disorder and 4,327 had a substance use disorder diagnosis from electronic health record data (January 1, 2008-December 31, 2022) in a Midwestern healthcare system. Baseline was January 1, 2013, and a 10-year follow-up period ran through December 31, 2022. The outcome was receipt of colonoscopy in the 10-year follow-up period. Patients were aged 50-65 years at baseline, meaning that they were eligible for a colonoscopy through the entirety of the 10-year follow-up period. Covariates included demographics (age, race, and neighborhood SES), health services utilization, psychiatric and physical comorbidities, and prior colonoscopy or fecal occult blood testing. Entropy balancing was used to control for confounding in weighted log-binomial models calculating RR and 95% CIs. Results Patients were on average aged 57.1 (±4.5) years, 58.2% were female, 81.0% were White, and 16.9% were of Black race. The most prevalent comorbidities were obesity (29.6%) and hypertension (29.4%), followed by smoking/nicotine dependence (21.0%). The most prevalent psychiatric comorbidity was depression (6.4%), followed by anxiety disorder (4.5%). During the 10-year follow-up period, 40.3% of eligible patients completed a colorectal cancer colonoscopy screening test, and individuals with a substance use disorder diagnosis were significantly less likely to receive a colorectal cancer colonoscopy screening test both prior to and after controlling for confounding (RR=0.73; 95% CI=0.70, 0.77 and RR=0.81; 95% CI=0.74, 0.89, respectively). Results were not modified by sex, race, psychiatric comorbidity, or neighborhood SES. Conclusions Personal history of substance use disorder was independently associated with lower screening completion rates. Healthcare professionals should recognize unique barriers among individuals with substance use disorder and then address them individually as a multidisciplinary team in the outpatient setting to reduce this health disparity.
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Affiliation(s)
- Kento Sonoda
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Joanne Sales
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Jennifer K. Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Richard A. Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, Missouri
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, Missouri
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Shara N, Mirabal-Beltran R, Talmadge B, Falah N, Ahmad M, Dempers R, Crovatt S, Eisenberg S, Anderson K. Use of Machine Learning for Early Detection of Maternal Cardiovascular Conditions: Retrospective Study Using Electronic Health Record Data. JMIR Cardio 2024; 8:e53091. [PMID: 38648629 DOI: 10.2196/53091] [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: 09/29/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Cardiovascular conditions (eg, cardiac and coronary conditions, hypertensive disorders of pregnancy, and cardiomyopathies) were the leading cause of maternal mortality between 2017 and 2019. The United States has the highest maternal mortality rate of any high-income nation, disproportionately impacting those who identify as non-Hispanic Black or Hispanic. Novel clinical approaches to the detection and diagnosis of cardiovascular conditions are therefore imperative. Emerging research is demonstrating that machine learning (ML) is a promising tool for detecting patients at increased risk for hypertensive disorders during pregnancy. However, additional studies are required to determine how integrating ML and big data, such as electronic health records (EHRs), can improve the identification of obstetric patients at higher risk of cardiovascular conditions. OBJECTIVE This study aimed to evaluate the capability and timing of a proprietary ML algorithm, Healthy Outcomes for all Pregnancy Experiences-Cardiovascular-Risk Assessment Technology (HOPE-CAT), to detect maternal-related cardiovascular conditions and outcomes. METHODS Retrospective data from the EHRs of a large health care system were investigated by HOPE-CAT in a virtual server environment. Deidentification of EHR data and standardization enabled HOPE-CAT to analyze data without pre-existing biases. The ML algorithm assessed risk factors selected by clinical experts in cardio-obstetrics, and the algorithm was iteratively trained using relevant literature and current standards of risk identification. After refinement of the algorithm's learned risk factors, risk profiles were generated for every patient including a designation of standard versus high risk. The profiles were individually paired with clinical outcomes pertaining to cardiovascular pregnancy conditions and complications, wherein a delta was calculated between the date of the risk profile and the actual diagnosis or intervention in the EHR. RESULTS In total, 604 pregnancies resulting in birth had records or diagnoses that could be compared against the risk profile; the majority of patients identified as Black (n=482, 79.8%) and aged between 21 and 34 years (n=509, 84.4%). Preeclampsia (n=547, 90.6%) was the most common condition, followed by thromboembolism (n=16, 2.7%) and acute kidney disease or failure (n=13, 2.2%). The average delta was 56.8 (SD 69.7) days between the identification of risk factors by HOPE-CAT and the first date of diagnosis or intervention of a related condition reported in the EHR. HOPE-CAT showed the strongest performance in early risk detection of myocardial infarction at a delta of 65.7 (SD 81.4) days. CONCLUSIONS This study provides additional evidence to support ML in obstetrical patients to enhance the early detection of cardiovascular conditions during pregnancy. ML can synthesize multiday patient presentations to enhance provider decision-making and potentially reduce maternal health disparities.
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Affiliation(s)
- Nawar Shara
- MedStar Health Research Institute, Hyattesville, MD, United States
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, DC, United States
| | | | | | - Noor Falah
- MedStar Health Research Institute, Hyattesville, MD, United States
| | - Maryam Ahmad
- MedStar Health Research Institute, Hyattesville, MD, United States
| | | | | | | | - Kelley Anderson
- School of Nursing, Georgetown University, Washington, DC, United States
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Wang HE, Weiner JP, Saria S, Kharrazi H. Evaluating Algorithmic Bias in 30-Day Hospital Readmission Models: Retrospective Analysis. J Med Internet Res 2024; 26:e47125. [PMID: 38422347 DOI: 10.2196/47125] [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: 03/11/2023] [Revised: 12/28/2023] [Accepted: 02/27/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The adoption of predictive algorithms in health care comes with the potential for algorithmic bias, which could exacerbate existing disparities. Fairness metrics have been proposed to measure algorithmic bias, but their application to real-world tasks is limited. OBJECTIVE This study aims to evaluate the algorithmic bias associated with the application of common 30-day hospital readmission models and assess the usefulness and interpretability of selected fairness metrics. METHODS We used 10.6 million adult inpatient discharges from Maryland and Florida from 2016 to 2019 in this retrospective study. Models predicting 30-day hospital readmissions were evaluated: LACE Index, modified HOSPITAL score, and modified Centers for Medicare & Medicaid Services (CMS) readmission measure, which were applied as-is (using existing coefficients) and retrained (recalibrated with 50% of the data). Predictive performances and bias measures were evaluated for all, between Black and White populations, and between low- and other-income groups. Bias measures included the parity of false negative rate (FNR), false positive rate (FPR), 0-1 loss, and generalized entropy index. Racial bias represented by FNR and FPR differences was stratified to explore shifts in algorithmic bias in different populations. RESULTS The retrained CMS model demonstrated the best predictive performance (area under the curve: 0.74 in Maryland and 0.68-0.70 in Florida), and the modified HOSPITAL score demonstrated the best calibration (Brier score: 0.16-0.19 in Maryland and 0.19-0.21 in Florida). Calibration was better in White (compared to Black) populations and other-income (compared to low-income) groups, and the area under the curve was higher or similar in the Black (compared to White) populations. The retrained CMS and modified HOSPITAL score had the lowest racial and income bias in Maryland. In Florida, both of these models overall had the lowest income bias and the modified HOSPITAL score showed the lowest racial bias. In both states, the White and higher-income populations showed a higher FNR, while the Black and low-income populations resulted in a higher FPR and a higher 0-1 loss. When stratified by hospital and population composition, these models demonstrated heterogeneous algorithmic bias in different contexts and populations. CONCLUSIONS Caution must be taken when interpreting fairness measures' face value. A higher FNR or FPR could potentially reflect missed opportunities or wasted resources, but these measures could also reflect health care use patterns and gaps in care. Simply relying on the statistical notions of bias could obscure or underplay the causes of health disparity. The imperfect health data, analytic frameworks, and the underlying health systems must be carefully considered. Fairness measures can serve as a useful routine assessment to detect disparate model performances but are insufficient to inform mechanisms or policy changes. However, such an assessment is an important first step toward data-driven improvement to address existing health disparities.
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Affiliation(s)
- H Echo Wang
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Jonathan P Weiner
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Johns Hopkins Center for Population Health Information Technology, Baltimore, MD, United States
| | - Suchi Saria
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Hadi Kharrazi
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Johns Hopkins Center for Population Health Information Technology, Baltimore, MD, United States
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Chehade M, Jensen ET, Wright BL. Addressing health disparities and transitions of care in eosinophilic gastrointestinal diseases. J Allergy Clin Immunol 2024:S0091-6749(24)00333-6. [PMID: 38593869 DOI: 10.1016/j.jaci.2024.04.001] [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] [Received: 01/26/2024] [Revised: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Departments of Pediatrics and Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Elizabeth T Jensen
- Departments of Epidemiology and Prevention and Internal Medicine, Gastroenterology Section, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Benjamin L Wright
- Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Ariz; Division of Allergy and Immunology, Phoenix Children's Hospital, Phoenix, Ariz
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Rai P, Sahadevan P, Mensegere AL, Issac TG, Muniz‐Terrera G, Sundarakumar JS. Rural-urban disparities in the diagnosis and treatment of hypertension and diabetes among aging Indians. Alzheimers Dement 2024; 20:2943-2951. [PMID: 38460118 PMCID: PMC11032561 DOI: 10.1002/alz.13771] [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: 12/18/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Hypertension and diabetes are modifiable risk factors for dementia. We aimed to assess rural-urban disparities in the diagnosis and treatment of these conditions among aging Indians. METHODS Participants (n = 6316) were from two parallel, prospective aging cohorts in rural and urban India. Using self-report and clinical/biochemical assessments, we subdivided participants with diabetes and hypertension into undiagnosed and untreated groups. Logistic regression and Fairlie decomposition analysis were the statistical methods utilized. RESULTS There was a significant rural-urban disparity in undiagnosed hypertension (25.14%), untreated hypertension (11.75%), undiagnosed diabetes (16.94%), and untreated diabetes (11.62%). Further, sociodemographic and lifestyle factors, such as age and tobacco use were the common contributors to the disparities in both undiagnosed hypertension and undiagnosed diabetes, whereas education and body mass index (BMI) were significant contributors to the disparity in untreated hypertension. DISCUSSION Rural Indians face significant healthcare disadvantages as compared to their urban counterparts, which prompts the urgent need for strategies for equitable healthcare.
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Affiliation(s)
- Pooja Rai
- Centre for Brain ResearchIndian Institute of ScienceBangaloreIndia
| | - Pravin Sahadevan
- Centre for Brain ResearchIndian Institute of ScienceBangaloreIndia
| | | | - Thomas G. Issac
- Centre for Brain ResearchIndian Institute of ScienceBangaloreIndia
| | - Graciela Muniz‐Terrera
- Edinburgh Dementia PreventionUniversity of EdinburghEdinburghUK
- Heritage College of Osteopathic MedicineOhio UniversityAthensOhioUSA
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Kipp R, Herzog LO, Khanna R, Zhang D. Racial and Ethnic Differences in Initiation and Discontinuation of Antiarrhythmic Medications in Management of Atrial Fibrillation. Clinicoecon Outcomes Res 2024; 16:197-208. [PMID: 38560410 PMCID: PMC10981895 DOI: 10.2147/ceor.s457992] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
Background Atrial fibrillation (AF) is associated with considerable morbidity and mortality. Timely management and treatment are critical in alleviating AF disease burden. There is significant heterogeneity in patterns of AF care. It is unclear whether there are racial and ethnic differences in treatment of AF following antiarrhythmic drug (AAD) prescription. Methods Using the Optum Clinformatics Data Mart-Socioeconomic Status database from January, 2009, through March, 2022, multivariable logistic regression techniques were used to examine the impact of race and ethnicity on rate of AAD initiation, as well as receipt of catheter ablation within two years of initiation. We compared AAD discontinuation rate by race and ethnicity groups using Cox regression models. Log-rank analyses were used to examine the rate of AF-related hospitalization. Results Among 143,281 patients identified with newly diagnosed AF, 30,019 patients (21%) were initiated on an AAD within 90 days. Patients identified as Non-Hispanic Black (NHB) were significantly less likely to receive an AAD compared to Non-Hispanic White patients (NHW) (Odds Ratio [OR] 0.90, 95% confidence interval [CI] 0.85-0.94). Compared to NHW, Hispanic (Hazard Ratio [HR] 1.08, 95% CI 1.02-1.14) and Asian patients (HR 1.17, 95% CI 1.06-1.29) have a higher rate of AAD discontinuation. Following AAD initiation, NHB patients were significantly more likely to have an AF-related hospitalization (p < 0.01). However, NHB patients were significantly less likely to receive ablation compared to NHW (HR 0.83, 95% CI 0.70-0.97), and less likely to change AAD (p < 0.01). Conclusion Patients identified as NHB are 10% less likely to receive an AAD for treatment of newly diagnosed AF. Compared to NHW, Hispanic and Asian patients were more likely to discontinue AAD treatment. Once initiated on an AAD, NHB patients were significantly more likely to have an AF -related hospitalization, but were 17% less likely to receive ablation compared to NHW patients. The etiology of, and interventions to reduce, these disparities require further investigation.
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Affiliation(s)
- Ryan Kipp
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lee-or Herzog
- Franchise Health Economics and Market Access, Johnson and Johnson, Irvine, CA, USA
| | - Rahul Khanna
- MedTech Epidemiology and Data Sciences, Johnson and Johnson, New Brunswick, NJ, USA
| | - Dongyu Zhang
- MedTech Epidemiology and Data Sciences, Johnson and Johnson, New Brunswick, NJ, USA
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8
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Mulugeta MG, Bailey G, Parsons K, Gillespie S, Johnson LM, Doh KF, Reisner A, Blackwell LS. Trends in pediatric firearm-related injuries and disparities in acute outcomes. Front Public Health 2024; 12:1339394. [PMID: 38566791 PMCID: PMC10985139 DOI: 10.3389/fpubh.2024.1339394] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Firearm-related injuries (FRI) are an increasing cause of death and injury in children. The etiology for this rise is multifactorial and includes socioeconomic factors. Despite its prevalence and documented increase over COVID-19, there is a paucity of research on disparities and the influence of social determinants of health (SDH) in pediatric FRI. This study aims to explore the epidemiology of this vulnerable population in Atlanta, trends over time and relevant dates such as COVID-19 and a state firearm law, and disparities in clinical outcomes. Methods Retrospective cohort of patients with FRI (0-20 years-old, x̄=9.8, Median = 11) presenting to our hospital EDs from January 2014 to April 2023 (N = 701) and eligible for the Trauma Registry. This period includes two major events, namely the COVID-19 pandemic (March 2020), and passage of state law Constitutional Carry Act (SB 319) (April 2022), allowing for permit-less concealed firearm carry. Single series interrupted time series (ITS) models were run and clinical outcome differences between race and insurance groups were calculated unadjusted and adjusted for confounders using inverse propensity treatment weights (IPTW). The primary outcome was mortality; secondary are admission and discharge. Results Majority of FRI involved patients who were male (76.7%), Black (74.9%), publicly insured (82.6%), ≤12 years-old (61.8%), and injured by unintentional shootings (45.6%) or assault (43.7%). During COVID-19, there was a sustained increase in FRI rate by 0.42 patients per 1,000 trauma visits per month (95% CI 0.02-0.82, p = 0.042); post-SB 319 it was 2.3 patients per 1,000 trauma visits per month (95% CI 0.23-4.31, p = 0.029). Publicly insured patients had 58% lower odds of mortality than privately insured patients (OR 0.42, 95% CI 0.18-0.99, p = 0.047). When controlled for race and mechanism of injury, among other confounding factors, this association was not significant (p = 0.652). Conclusion Pediatric FRI are increasing over time, with disproportionate burdens on Black patients, at our hospitals. Disparities in mortality based on insurance necessitate further study. As social and economic repercussions of COVID-19 are still present, and state firearm law SB 319 is still in effect, assessment of ongoing trends is warranted to inform preventative strategies.
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Affiliation(s)
| | | | - Kendall Parsons
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Scott Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Laura M. Johnson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Kiesha Fraser Doh
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Andrew Reisner
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Laura S. Blackwell
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
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Perales-Puchalt J, Peltzer J, Fracachan-Cabrera M, Perez GA, Ramírez M, Greiner KA, Burns JM. Authors' Response to Peer Reviews of "Impact of the COVID-19 Pandemic on Latino Families With Alzheimer Disease and Related Dementias: Qualitative Interviews With Family Caregivers and Primary Care Providers". JMIRx Med 2024; 5:e56439. [PMID: 38509604 PMCID: PMC11004510 DOI: 10.2196/56439] [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] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Jaime Perales-Puchalt
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
| | - Jill Peltzer
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Monica Fracachan-Cabrera
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - G Adriana Perez
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Mariana Ramírez
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jeffrey Murray Burns
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
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Perales-Puchalt J, Peltzer J, Fracachan-Cabrera M, Perez GA, Ramírez M, Greiner KA, Burns JM. Impact of the COVID-19 Pandemic on Latino Families With Alzheimer Disease and Related Dementias: Qualitative Interviews With Family Caregivers and Primary Care Providers. JMIRx Med 2024; 5:e42211. [PMID: 38488740 PMCID: PMC11004515 DOI: 10.2196/42211] [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: 08/26/2022] [Revised: 12/11/2023] [Accepted: 01/13/2024] [Indexed: 03/19/2024]
Abstract
Background Latino individuals experience disparities in the care of Alzheimer disease and related dementias (ADRD) and have disproportionately high COVID-19 infection and death outcomes. Objective We aimed to gain an in-depth understanding of the impact of the COVID-19 pandemic among Latino families with ADRD in the United States. Methods This was a qualitative study of 21 informal caregivers of Latino individuals with ADRD and 23 primary care providers who serve Latino patients. We recruited participants nationwide using convenience and snowball sampling methods and conducted remote interviews in English and Spanish. We organized the transcripts for qualitative review to identify codes and themes, using a pragmatic approach, a qualitative description methodology, and thematic analysis methods. Results Qualitative analysis of transcripts revealed eight themes, including (1) the pandemic influenced mental and emotional health; (2) the pandemic impacted physical domains of health; (3) caregivers and care recipients lost access to engaging activities during the confinement; (4) the pandemic impacted Latino caregivers' working situation; (5) the pandemic impacted health care and community care systems; (6) health care and community care systems took measures to reduce the impact of the pandemic; (7) Latino families experienced barriers to remote communication during the pandemic; and (8) caregiver social support was critical for reducing social isolation and its sequalae. Conclusions Latino families with ADRD experienced similar but also unique impacts compared to those reported in the general population. Unique impacts may result from Latino individuals' underserved status in the United States, commonly held cultural values, and their intersectionality with ADRD-related disability. Family caregiver social support was crucial during this time of adversity. These findings suggest the need for more equitable access, culturally appropriate and trustworthy content and delivery of health care and community services, as well as stronger financial and social supports for family caregivers.
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Affiliation(s)
- Jaime Perales-Puchalt
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
| | - Jill Peltzer
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Monica Fracachan-Cabrera
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - G Adriana Perez
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Mariana Ramírez
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jeffrey Murray Burns
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
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Lui PP, Kamata A. Harmonizing Assessments of Everyday Racial Discrimination Experiences: The Multigroup Everyday Racial Discrimination Scale (MERDS). Assessment 2024; 31:397-417. [PMID: 37029544 DOI: 10.1177/10731911231162357] [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: 04/09/2023]
Abstract
Reliable and valid assessment of direct racial discrimination experiences in everyday life is critical to understanding one key determinant of ethnoracial minority health and health disparities. To address psychometric limitations of existing instruments and to harmonize the assessment of everyday racial discrimination, the new Multigroup Everyday Racial Discrimination Scale (MERDS) was developed and validated. This investigation included 1,355 college and graduate students of color (Mage = 21.54, 56.0% women). Factor analyses were performed to provide evidence for structural validity of everyday racial discrimination scores. Item response theory modeling was used to investigate item difficulty relative to the level of everyday racial discrimination, and measurement error conditioned on the construct. MERDS scores were reliable, supported construct unidimensionality, and distinguished individuals who reported low to very high frequency of everyday racial discrimination. Results on the associations with racial identity and psychopathology symptoms, and utility of the scale are discussed.
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Affiliation(s)
- P Priscilla Lui
- Southern Methodist University, Dallas, TX, USA
- University of Washington, Seattle, USA
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Udoh MO, Mian Z, Anakwenze L, Okeke C, Ziegler C, Sawning S. Grow502: Centering Community in Medical Education via a Student-Created Organization Focused on Cultivating a Healthy Community. Health Promot Pract 2024; 25:173-177. [PMID: 36511091 PMCID: PMC9749053 DOI: 10.1177/15248399221136533] [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: 02/17/2024]
Abstract
The COVID-19 pandemic continues to disproportionately impact communities of color and expose health inequities. Minoritized communities experience disparities in chronic diseases, premature death, and cancer, and gaps continue to widen; systemic injustice in housing, nutrition, and environment are major contributors. At the height of the COVID-19 pandemic and racial justice movement, students at the University of Louisville School of Medicine created Grow502 to speak truth to the challenges of health disparities in Louisville, Kentucky. The goal was to pursue a healthier community by raising awareness. Community leaders and health professionals provided expert consultation. This partnership led to the co-creation of a curriculum focused on education, advocacy, community engagement, and creative media. Grow502 sought to support communities impacted by injustices due to racism, limited health literacy, redlining, and limited green space by creating programming centered on education and empowerment. Effective strategies to reduce disparities involve creating interventions with authentic engagement and context. Grow502 involves community stakeholders as active partners. We continue to intentionally seek effective collaborations and interventions that merge our mission and our diverse communities impacted by health disparities.
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Affiliation(s)
- Mike Onu Udoh
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Zoha Mian
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Lisa Anakwenze
- University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Craig Ziegler
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Susan Sawning
- University of Louisville School of Medicine, Louisville, KY, USA
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Schneider JG, Gallardo M, Fisher K, Kaffenberger BH, Korman AM. Increased mortality among African American patients with DRESS syndrome compared to White patients. Int J Dermatol 2024; 63:e80-e81. [PMID: 38102860 PMCID: PMC10922551 DOI: 10.1111/ijd.16988] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Justine G. Schneider
- College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Matthew Gallardo
- College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kristopher Fisher
- Department of Dermatology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Abraham M. Korman
- Department of Dermatology, Ohio State University Wexner Medical Center, Columbus, Ohio
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Bogner MS, Faulks D. Understanding oral health from the point of view of adults with disabilities and/or complex medical conditions: A scoping review. Spec Care Dentist 2024; 44:280-299. [PMID: 37248195 DOI: 10.1111/scd.12882] [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: 01/08/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023]
Abstract
AIM This study aimed to review the qualitative scientific literature investigating experience of the mouth and oral health amongst adults with disabilities and/or complex health conditions. METHODS A scoping review methodology was applied in accordance with the methodological framework of Arksey & O'Malley and the PRISMA-SCR checklist. Electronic searching was performed using the databases Pubmed, Embase, and PsychInfo. RESULTS Thirty articles were included in the final selection. The populations included in the selected studies were very varied in terms of health conditions and disabilities. Three major themes relating to the experience and understanding of the mouth, oral health, and function were highlighted in the review: the representation of oral health, the influence of oral health on the participant's life, and the influence of the socio-environmental context on oral health. No study explicitly described the functional, social, and psychological roles of the mouth in a comprehensive manner. CONCLUSIONS Perception of the mouth and oral health differs depending on the individual and their health condition. Oral health is described as dependent on the socio-environmental context, however, outside of the experience of dental care services, this context is not investigated in the literature. This scoping review demonstrated that exhaustive understanding of the dimensions of the mouth and oral health has not been explored in published research for this population.
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Affiliation(s)
- Marie-Sophie Bogner
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Denise Faulks
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
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Grogan G, Stephens KL, Chou J, Abdalla J, Wagner R, Peek KJ, Freilich AM, DeGeorge BR. The Impact of Social Determinants of Health on the Treatment of Distal Radius Fracture. Hand (N Y) 2024:15589447241233369. [PMID: 38411105 DOI: 10.1177/15589447241233369] [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: 02/28/2024]
Abstract
BACKGROUND Disparities in social determinants of health (SDH) have been shown to play an increasingly important role in the equitable delivery of health care. Distal radius fractures (DRFs) are among the most common upper-extremity injuries encountered. This study aims to examine the influence of economic, educational, social, environmental, and healthcare disparities on management of these injuries. METHODS PearlDiver Mariner insurance claims database was analyzed for treatment patterns of DRF in patients aged 18 to 65 years based on the presence or absence of social determinants of health disparities (SDHDs). Outcome variables included the primary mode of management of DRF, including operative versus non-operative, as well as concomitant procedures. Multivariate logistic regression was used to compare fracture management modality in patients with and without SDHDs. RESULTS Of 161 704 patients identified with DRF, 38.3% had at least 1 reported SDHD. The majority of SDHDs were economic. Patients identified with 1 or more SDHDs had a higher medical comorbidity index. Patients with environmental SDHD were more likely to receive non-operative management. Within any SDHD and economic subgroups, odds of operative management were higher. No relationship was identified between SDHD and concomitant procedures. CONCLUSIONS The presence of environmental disparities in SDH may predispose patients disproportionately to non-operative management. The presence of SDHDs may influence medical decision-making in favor of open reduction and internal fixation in patients with DRF treated operatively. In treating at-risk populations, providers should be aware of the potential for implicit bias associated with SDHDs and prioritize shared decision-making between patients and physicians.
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Affiliation(s)
- Graham Grogan
- University of Mississippi Medical Center, Jackson, USA
| | - Kristen L Stephens
- Department of Plastic Surgery, University of Virginia, Charlottesville, USA
| | - Jesse Chou
- Department of Plastic Surgery, University of Virginia, Charlottesville, USA
| | - Jasmina Abdalla
- University of Virginia School of Medicine, Charlottesville, USA
| | - Ryan Wagner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - Kacy J Peek
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - Aaron M Freilich
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - Brent R DeGeorge
- Department of Plastic Surgery, University of Virginia, Charlottesville, USA
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
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Hodson A, Clancy N, Foo I. The reverse stethoscope technique: a rapid intervention for old age hearing loss. Hosp Pract (1995) 2024:1-6. [PMID: 38385177 DOI: 10.1080/21548331.2024.2320067] [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: 10/04/2023] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES Presbycusis is highly prevalent, affecting between a third and two-thirds of elderly populations. Effective communication between patient and physician has been shown to directly correlate with the quality of patient care. The Reverse Stethoscope Technique (RST) involves placing the earpieces into the patient's ears and speaking into the diaphragm. Here, we aim to show the RST is a simple and effective method to communicate with patients suffering from presbycusis in inpatient settings. METHODS Medical inpatients aged >60 years old without cognitive impairment were included in the study. A simple repetition exercise of basic English sentences was performed with and without the RST to assess hearing ability. Patients then undertook a short questionnaire. RESULTS Our study included 109 patients with varied 'self-reported' hearing. 50.5% of our cohort reported past communication difficulties with health-care professionals due to hearing difficulties. We identified that the RST increased the mean number of sentences a patient could repeat from 2.6 to 3.5 representing a statistically significant increase (p < 0.001). The technique was most beneficial for patients with 'okay' and 'poor' hearing. The majority of patients (77/109) also stated the technique reduced background noise. The RST was equally effective with facemasks. CONCLUSION Current techniques to enhance communication with patients with hearing loss are often underutilized or poorly accessible. Our study identified that the RST is a quick and effective solution that can be easily implemented for patients struggling to communicate with health-care professionals in inpatient scenarios.
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Affiliation(s)
- Alexander Hodson
- University of Edinburgh Medical School, Edinburgh UK
- Lewisham and Greenwich NHS Trust, London, UK
| | - Noah Clancy
- University of Edinburgh Medical School, Edinburgh UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Irwin Foo
- Department of Anaesthetics, Western General Hospital, Edinburgh, UK
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Hippalgaonkar N, Nguyen RHT, Cohn EB, Horowitz J, Waite AW, Mersha T, Sandoval C, Khan S, Salum K, Thomas P, Murphy AM, Brent B, Coleman L, Khosla P, Hoskins KF, Henderson V, Carnahan LR. Are We the Problem? A Call to Action for Addressing Institutional Challenges to Engaging Community Partners in Research. Int J Environ Res Public Health 2024; 21:236. [PMID: 38397725 PMCID: PMC10888328 DOI: 10.3390/ijerph21020236] [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: 12/30/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
Community-engaged research (CEnR) is a potent tool for addressing health inequities and fostering equitable relationships among communities, researchers, and institutions. CEnR involves collaboration throughout the research process, demonstrating improvements in study recruitment and retention, intervention efficacy, program sustainability, capacity building among partners, and enhanced cultural relevance. Despite the increasing demand for CEnR, institutional policies, particularly human participation protection training (HPP), lag behind, creating institutional barriers to community partnerships. Here, we highlight challenges encountered in our ongoing study, Fostering Opportunities in Research through Messaging and Education (FOR ME), focused on promoting shared decision-making around clinical trial participation among Black women diagnosed with breast cancer. Grounded in CEnR methods, FOR ME has a partnership with a community-based organization (CBO) that addresses the needs of Black women with breast cancer. Our CBO partner attempted to obtain HPP training, which was administratively burdensome and time-consuming. As CEnR becomes more prevalent, academic and research institutions, along with researchers, are faced with a call to action to become more responsive to community partner needs. Accordingly, we present a guide to HPP training for community partners, addressing institutional barriers to community partner participation in research. This guide outlines multiple HPP training pathways for community partners, aiming to minimize institutional barriers and enhance their engagement in research with academic partners.
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Affiliation(s)
- Neha Hippalgaonkar
- Division of Hematology/Oncology, University of Illinois Chicago, Chicago, IL 60612, USA; (R.H.-T.N.); (K.F.H.)
| | - Ryan Huu-Tuan Nguyen
- Division of Hematology/Oncology, University of Illinois Chicago, Chicago, IL 60612, USA; (R.H.-T.N.); (K.F.H.)
- University of Illinois Cancer Center, Chicago, IL 60612, USA; (A.W.W.); (T.M.); (L.R.C.)
| | - Eliza Brumer Cohn
- Fred Hutchinson Cancer Center, Seattle, WA 98126, USA; (E.B.C.); (K.S.); (V.H.)
| | - Joseph Horowitz
- Department of Medicine and Pediatrics, University of Illinois College of Medicine, Chicago, IL 60612, USA;
| | - Ana Williams Waite
- University of Illinois Cancer Center, Chicago, IL 60612, USA; (A.W.W.); (T.M.); (L.R.C.)
| | - Tigist Mersha
- University of Illinois Cancer Center, Chicago, IL 60612, USA; (A.W.W.); (T.M.); (L.R.C.)
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (C.S.); (A.M.M.)
| | - Christen Sandoval
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (C.S.); (A.M.M.)
| | - Sarah Khan
- Sinai Chicago, Chicago, IL 60612, USA; (S.K.); (P.K.)
| | - Kauthar Salum
- Fred Hutchinson Cancer Center, Seattle, WA 98126, USA; (E.B.C.); (K.S.); (V.H.)
| | | | - Anne Marie Murphy
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (C.S.); (A.M.M.)
| | - Beulah Brent
- Sisters Working It Out, Chicago, IL 60612, USA; (B.B.); (L.C.)
| | - Lolita Coleman
- Sisters Working It Out, Chicago, IL 60612, USA; (B.B.); (L.C.)
| | | | - Kent F. Hoskins
- Division of Hematology/Oncology, University of Illinois Chicago, Chicago, IL 60612, USA; (R.H.-T.N.); (K.F.H.)
- University of Illinois Cancer Center, Chicago, IL 60612, USA; (A.W.W.); (T.M.); (L.R.C.)
| | - Vida Henderson
- Fred Hutchinson Cancer Center, Seattle, WA 98126, USA; (E.B.C.); (K.S.); (V.H.)
| | - Leslie R. Carnahan
- University of Illinois Cancer Center, Chicago, IL 60612, USA; (A.W.W.); (T.M.); (L.R.C.)
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (C.S.); (A.M.M.)
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Kang S, Rákosy Z, Park SE, Nguyen TAP. Editorial: Women in science: public health education and promotion 2023. Front Public Health 2024; 12:1368704. [PMID: 38410672 PMCID: PMC10895030 DOI: 10.3389/fpubh.2024.1368704] [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: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Affiliation(s)
- Sunjoo Kang
- Department of Global Health and Disease Control, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Zsuzsa Rákosy
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
- Bethesda Children's Hospital, Budapest, Hungary
| | - Se Eun Park
- Department of Global Health and Disease Control, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
- International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
| | - Thi Anh Phuong Nguyen
- Faculty of International Education, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
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Hawley N, Green J, Ahlich E, Hauff C, Hermer J, Skiba MB, James DL, Nash SH. Patient perspectives of weight stigma across the cancer continuum: A scoping review. Cancer Med 2024; 13:e6882. [PMID: 38205894 PMCID: PMC10905240 DOI: 10.1002/cam4.6882] [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: 08/25/2023] [Revised: 11/22/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Weight stigma has been defined as the social devaluation and denigration of individuals because of their weight. The purpose of this scoping systematic review was to assess and understand patient experiences with weight stigma in the cancer care setting. METHODS We conducted a systematic scoping review of studies examining shame, prejudice, bias, and stigma in relation to weight and cancer-related care using five databases: PubMed, CINAHL Plus Full Text (ProQuest), Cochrane Library, PsycINFO (EBSCO), and Scopus. Articles were uploaded into Covidence for de-duplication and screening. Included studies were peer reviewed, reported adult patient experiences in cancer-related care, and were published in English between October 2012 and February 2023. Study characteristics and key findings were abstracted and qualitatively synthesized. RESULTS Publications meeting inclusion criteria yielded five studies (n = 113 participants). Most focused on the experiences of women (n = 4) and cancers which predominantly impact women (i.e., breast, cervical, endometrial; n = 4). All stages of the cancer continuum were included with studies examining screening (n = 2), treatment (n = 1), and post-treatment survivorship (n = 2). Weight discrimination was discussed in four studies and weight-biased stereotypes were discussed in three studies. Experiences of weight bias internalization were reported in four studies. One study described an instance of implicit weight bias. CONCLUSIONS Limited studies examine patient experiences of weight stigma in cancer care; however, current evidence suggests that patients do experience weight stigma in cancer-related care. This review highlights critical gaps and a need for more research on the prevalence and impact of weight stigma in cancer screening and care.
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Affiliation(s)
- Nanako Hawley
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Jennifer Green
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Erica Ahlich
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Caitlyn Hauff
- Department of Health, Kinesiology, and Sport, University of South Alabama, Mobile, Alabama, USA
| | - Janice Hermer
- Arizona State University Library, Arizona State University, Tempe, Arizona, USA
| | - Meghan B Skiba
- College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Dara L James
- College of Nursing, University of South Alabama, Mobile, Alabama, USA
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, Arizona, USA
| | - Sarah H Nash
- Department of Epidemiology, University of Iowa, Iowa, Iowa, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa, Iowa, USA
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Auyeung T, Jiang O, Taylor M, Chang V, Kwan B. A pilot study on the effectiveness of a language-specific (Chinese) pulmonary rehabilitation programme for individuals with chronic pulmonary disease: a 2-year prospective cohort study in Sydney, Australia. Intern Med J 2024; 54:274-282. [PMID: 37548152 DOI: 10.1111/imj.16167] [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: 12/14/2022] [Accepted: 06/14/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND AIMS Pulmonary rehabilitation (PR) improves dyspnoea, fatigue and healthcare-related quality of life (QoL) in patients with chronic lung disease (CLD). Non-English-speaking background (NESB) patients face language and cultural barriers that hinder their access to PR programmes, contributing to health disparities. Our trial aimed to demonstrate the effectiveness and feasibility of a Chinese language-specific PR programme on lung function, functional exercise capacity and QoL measures. METHODS A prospective cohort study was conducted over a 2-year period. Participants were enrolled in an 8-week PR programme with biweekly sessions conducted by Chinese-speaking physiotherapists. Baseline and post-rehabilitation testing included pulmonary function testing, 6-min walk test (6MWT), St. George Respiratory Questionnaire (SGQR) and Short Form Health Survey (SF-36). RESULTS We enrolled 76 patients (58% male) with a median age of 77 years (interquartile range (IQR) 68-81) and achieved a completion rate of 86.8% (n = 66). CLD included chronic obstructive pulmonary disease (42%), asthma (15%) and interstitial lung disease (3%). Baseline median forced expiratory volume in 1 s (FEV1) was 1.63 L (IQR 1.17-2.05), and the median 6MWT was 282 m (IQR 232-332). Post-intervention median 6MWT increased to 332 m (IQR 290-390), and the median FEV1 was 1.99 L (IQR 1.3-2.1). Both QoL measures (SGQR and SF-36) showed significant improvement after intervention (P < 0.05). CONCLUSION Our study demonstrates that a language-specific PR programme is feasible, improving outcomes in NESB patients with CLD. The improvement in 6MWT and QoL measures was comparable to English-based programmes. Ensuring equal access to healthcare programmes, regardless of cultural background or language barriers, is crucial in promoting health equity.
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Affiliation(s)
- Titus Auyeung
- Department of Respiratory Medicine, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- South Eastern Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Osborn Jiang
- Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mitchell Taylor
- Functional Lungs Physiotherapy, Sydney, New South Wales, Australia
| | - Vicky Chang
- Department of Respiratory Medicine, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Benjamin Kwan
- Department of Respiratory Medicine, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
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Pan Z, Dong W, Huang Z. Does the population size of a city matter to its older adults' self-rated health? Results of China data analysis. Front Public Health 2024; 12:1333961. [PMID: 38362206 PMCID: PMC10867327 DOI: 10.3389/fpubh.2024.1333961] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
Clarifying the association between city population size and older adults' health is vital in understanding the health disparity across different cities in China. Using a nationally representative dataset, this study employed Multilevel Mixed-effects Probit regression models and Sorting Analysis to elucidate this association, taking into account the sorting decisions made by older adults. The main results of the study include: (1) The association between city population size and the self-rated health of older adults shifts from a positive linear to an inverted U-shaped relationship once individual socioeconomic status is controlled for; the socioeconomic development of cities, intertwined with the growth of their populations, plays a pivotal role in yielding health benefits. (2) There is a sorting effect in older adults' residential decisions; compared to cities with over 5 million residents, unobserved factors result in smaller cities hosting more less-healthy older adults, which may cause overestimation of health benefits in cities with greater population size. (3) The evolving socioeconomic and human-made environment resulting from urban population growth introduces health risks for migratory older adults but yields benefits for those with local resident status who are male, aged over 70, and have lower living standards and socioeconomic status. And (4) The sorting effects are more pronounced among older adults with greater resources supporting their mobility or those without permanent local resident status. Thus, policymakers should adapt planning and development strategies to consider the intricate relationship between city population size and the health of older adults.
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Affiliation(s)
- Zehan Pan
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Weizhen Dong
- Department of Sociology and Legal Studies, University of Waterloo, Waterloo, ON, Canada
| | - Zuyu Huang
- School of Public Administration, Hunan University, Changsha, China
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Poh PF, Carey MC, Manning JC, Lee JH, Latour JM. Ethnic differences in parental experiences during the first six months after PICU discharge in Singapore: a qualitative study. Front Pediatr 2024; 11:1288507. [PMID: 38250591 PMCID: PMC10796750 DOI: 10.3389/fped.2023.1288507] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Literature on parental experiences after childhood critical illness has limited representation from diverse ethnic backgrounds. Parents from global ethnic majority groups have reported worst psychological outcomes and required more social support after childhood critical illness. Aim To explore the experiences of Chinese, Malay, and Indian parents in the first six months after Pediatric Intensive Care Unit (PICU) discharge of their child in Singapore. Methods Sequential semi-structured qualitative interviews were conducted to collect data from a convenience sample of 28 parents at one month (n = 28) and at six months (n = 22) after their child's discharge from a multidisciplinary PICU. Framework Analysis was adopted as the qualitative analysis strategy. The PICS-p framework was applied a priori in the Framework Analysis. Findings Three interdependent domains and seven themes framed the 28 accounts in which ethnically diverse parents reported psychological stressors (PICS-p: emotional health), support received (PICS-p: social health) and practical challenges (transitional health) in the first six months after childhood critical illness. In the emotional health domain, parents were affected by different stressors and had different priorities over their child's survivorship. Only Indian parents reported experiences of stress symptoms, at six months post discharge. Malay parents sought solace from their religion more than Chinese and Indian parents. In the social health domain, parents reported various sources and degree of support received. Familial supports were strong across all groups, while community support was more prominent in Malay as compared to Chinese and Indian parents. A third domain, transitional health, was introduced to capture the difficulties parents faced during the transition from PICU survival to home. Parents from non-Chinese families were more likely to report financial challenges and more involvement of spouses after discharge. Complementary medicine or commercial health products were utilized by Chinese and Malay families. Conclusion These findings reveal preferred strategies that parents from a global ethnic employ to address the emotional, social and transitional health impacts of their child's critical illness. Future care delivery may consider tailored care plans, communication strategies, and emotional support in PICUs that address the unique ethnic needs of parents during the critical six-months post their child's illness.
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Affiliation(s)
- Pei-Fen Poh
- Faculty of Health, School of Nursing and Midwifery, University of Plymouth, Plymouth, United Kingdom
- Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Matthew C. Carey
- Faculty of Health, School of Nursing and Midwifery, University of Plymouth, Plymouth, United Kingdom
| | - Joseph C. Manning
- Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Jan Hau Lee
- Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore, Singapore
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Jos M. Latour
- Faculty of Health, School of Nursing and Midwifery, University of Plymouth, Plymouth, United Kingdom
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
- School of Nursing, Fudan University, Shanghai, China
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Alter R, Cohen A, Guigue PA, Meyer R, Levin G. Ethnic disparities in the incidence of gynecologic malignancies among Israeli Women of Arab and Jewish Ethnicity: a 10-year study (2010-2019). Ther Adv Reprod Health 2024; 18:26334941231209496. [PMID: 38164343 PMCID: PMC10757790 DOI: 10.1177/26334941231209496] [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: 05/25/2023] [Accepted: 09/29/2023] [Indexed: 01/03/2024] Open
Abstract
Background Ethnic disparities in healthcare outcomes persist, even when populations share the same environmental factors and healthcare infrastructure. Gynecologic malignancies are a significant health concern, making it essential to explore how these disparities manifest in terms of their incidence among different ethnic groups. Objective To investigate ethnic disparities in the incidence of gynecologic malignancies incidence among Israeli women of Arab and Jewish ethnicity. Design Our research employs a longitudinal, population-based retrospective cohort design. Method Data on gynecologic cancer diagnoses among the Israeli population from 2010 to 2019 was obtained from a National Registry. Disease incidence rates and age standardization were calculated. A comparison between Arab and Jewish patients was performed, with Poisson regression models being used to analyze significant rate changes. Results Among Jewish women, the age-standardized ratio (ASR) for gynecologic malignancies decreased from 288 to 251 (p < 0.001) between 2014 and 2019. However, there was no significant change in the ASR among Arab women during the same period, with rates going from 192 to 186 (p = 0.802). During the study period, the incidence of ovarian cancer decreased significantly among Jewish women (p = 0.042), while the rate remained stable among Arab women (p = 0.102). A similar trend was observed for uterine cancer. The ASR of CIN III (Cervical Intraepithelial Neoplasia Grade 3) in Jewish women notably increased from 2017 to 2019, with an annual growth rate of 43.3% (p < 0.001). A similar substantial rise was observed among Arab women, with an annual growth rate of 40.5% (p < 0.001). In contrast, the incidence of invasive cervical cancer remained stable from 2010 to 2019 among women of both ethnic backgrounds. Conclusion Our findings indicate that Arab women in Israel have a lower incidence rate of gynecologic cancers, warranting further investigation into protective factors. Both ethnic groups demonstrate effective utilization of cervical screening.
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Affiliation(s)
- Roie Alter
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 9574869, Israel
| | - Adiel Cohen
- Hadassah Ein Kerem Medical Center, Department of Obstetrics and Gynecology, Jerusalem, Israel
| | | | - Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Gabriel Levin
- Hadassah-Hebrew University Medical Center, Gynecologic Oncology, Jerusalem, Israel
- Lady Davis Institute/Jewish General Hospital, McGill University, Montreal, Canada
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Alsakarneh S, Jaber F, Beran A, Aldiabat M, Abboud Y, Hassan N, Abdallah M, Abdelfattah T, Numan L, Clarkston W, Bilal M, Shaukat A. The National Burden of Colorectal Cancer in the United States from 1990 to 2019. Cancers (Basel) 2024; 16:205. [PMID: 38201632 PMCID: PMC10778178 DOI: 10.3390/cancers16010205] [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: 12/07/2023] [Revised: 12/23/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
CRC accounts for approximately a tenth of all cancer cases and deaths in the US. Due to large differences in demographics among the different states, we aim to determine trends in the CRC epidemiology and across different states, age groups, and genders. CRC rates, age-adjusted to the standard US population, were obtained from the GBD 2019 database. Time trends were estimated as annual percentage change (APC). A pairwise comparison was conducted between age- and gender-specific trends using the tests of parallelism and coincidence. Age-specific trends were also assessed in two age subgroups: younger adults aged 15-49 years and older adults aged 50-74 years. We also analyzed the prevalence, incidence, mortality, and DALYs in the US between 1990 and 2019. A total of 5.53 million patients were diagnosed with CRC in the US between 1990 and 2019. Overall, CRC incidence rates have significantly increased in younger adults (11.1 per 100,000 persons) and decreased in older adults (136.8 per 100,000 persons) (AAPC = 1.2 vs. -0.6; AAPC difference = 1.8, p < 0.001). Age-specific trends were neither identical (p < 0.001) nor parallel (p < 0.001), suggesting that CRC incidence rates are different and increasing at a greater rate in younger adults compared to older adults. However, for both men and women (49.4 and 35.2 per 100,000 persons), incidence rates have decreased over the past three decades at the same rate (AAPC = -0.5 vs. -0.5; AAPC difference = 0, p = 0.1). Geographically, the southern states had the highest mortality rates with Mississippi having the highest rate of 20.1 cases per 100,000 population in 2019. Massachusetts, New York, and the District of Colombia had the greatest decreases in mortality over the study period (-42.1%, -41.4%, and -40.9%). Decreased mortality was found in all states except Mississippi, where the mortality of CRC increased over the study period (+1.5%). This research provides crucial insights for policymakers to tailor resource allocation, emphasizing the dynamic nature of CRC burden across states and age groups, ultimately informing targeted strategies for prevention and intervention.
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Affiliation(s)
- Saqr Alsakarneh
- Department of Internal Medicine, University of Missouri, Kansas City, MO 64110, USA; (F.J.); (N.H.)
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri, Kansas City, MO 64110, USA; (F.J.); (N.H.)
| | - Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Mohammad Aldiabat
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA;
| | - Yazan Abboud
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07013, USA;
| | - Noor Hassan
- Department of Internal Medicine, University of Missouri, Kansas City, MO 64110, USA; (F.J.); (N.H.)
| | - Mohamed Abdallah
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Thaer Abdelfattah
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, PA 15212, USA;
| | - Laith Numan
- Division of Gastroenterology and Hepatology, Saint Louis University, St. Louis, MO 63103, USA;
| | - Wendell Clarkston
- Division of Gastroenterology and Hepatology, University of Missouri, Kansas City, MO 64110, USA;
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA;
| | - Aasma Shaukat
- Division of Gastroenterology, Department of Medicine and Population Health, Grossman School of Medicine, New York University, New York, NY 10003, USA;
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25
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Deboever N, Correa AM, Feldman H, Mathur U, Hofstetter WL, Mehran RJ, Rice DC, Roth JA, Sepesi B, Swisher SG, Walsh GL, Vaporciyan AA, Antonoff MB, Rajaram R. Disparities in early-stage lung cancer outcomes at minority-serving hospitals compared with nonminority serving hospitals. J Thorac Cardiovasc Surg 2024; 167:329-337.e4. [PMID: 37116780 DOI: 10.1016/j.jtcvs.2023.04.025] [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] [Received: 01/04/2023] [Revised: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVES Disparities in cancer care are omnipresent and originate from a multilevel set of barriers. Our objectives were to describe the likelihood of undergoing surgery for early-stage non-small cell lung cancer at minority-serving hospitals (MSHs), and evaluate the association of race/ethnicity with resection based on MSH status. METHODS A retrospective study using the National Cancer Database (2008-2016) was conducted including patients with clinical stage I non-small cell lung cancer. MSHs were defined as hospitals in the top decile of providing care to Hispanic or African American patients. The primary outcome evaluated was receipt of definitive surgery at MSHs vs non-MSHs. Outcomes related to race/ethnicity stratified by hospital type were also investigated. RESULTS A total of 142,580 patients were identified from 1192 hospitals (120 MSHs and 1072 non-MSHs). Most patients (85% [n = 121,240]) were non-Hispanic White, followed by African American (9% [n = 12,772]), and Hispanic (3%, [n= 3749]). MSHs cared for 7.4% (n = 10,491) of the patients included. In adjusted analyses, patients treated at MSHs were resected less often than those at non-MSHs (odds ratio, 0.87; 95% CI, 0.76-1.00; P = .0495). African American patients were less likely to receive surgery in the overall analysis (P < .01), and at MSHs specifically (P < .01), compared with non-Hispanic White patients. Hispanic patients had similar rates of resection in the overall analysis (P = .11); however, at MSHs, they underwent surgery more often compared with non-Hispanic White patients (P = .02). Resected patients at MSHs had similar overall survival (median, 91.7 months; 95% CI, 86.6-96.8 months) compared with those resected at non-MSHs (median, 85.7 months; 95% CI, 84.5-86.8 months). CONCLUSIONS Patients with early-stage non-small cell lung cancer underwent resection less often at MSHs compared with non-MSHs. Disparities related to underutilization of surgery for African American patients continue to persist, regardless of hospital type.
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Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Arlene M Correa
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Hope Feldman
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Urvashi Mathur
- University of Texas Rio Grande Valley Medical School, Edinburg, Tex
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ravi Rajaram
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
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Sadeghi B, Tran J, Tsai IS, Sadigh G. Role of Online Patient Portal Self-Scheduling and Self-Referral Pathways to Decrease Health Disparity for Screening Mammography. J Am Coll Radiol 2024; 21:147-153. [PMID: 37516158 DOI: 10.1016/j.jacr.2023.06.027] [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: 04/06/2023] [Revised: 05/20/2023] [Accepted: 06/05/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE The aim of this study was to assess the rate of self-scheduling and self-referral for screening mammography and to assess sociodemographic factors associated with their use in an academic health care system in southern California. METHODS Patients scheduled for screening mammography between February 1, 2021, and September 20, 2022, were included in this retrospective study. Multivariable logistic regression models were used to assess associations among sociodemographic factors, self-referral, and online self-scheduling pathways. RESULTS In total, 22,306 patients were scheduled for screening mammography (mean age, 59 years; 66.8% White, 20.4% Asian, and 20.6% Hispanic). Overall, 3,566 (16.0%) used online self-scheduling, and 1,232 (5.5%) self-referred for screening mammography. Patients 70 years or older (versus 50 years or younger) (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.34-0.51), Spanish (versus English) speakers (OR, 0.22; 95% CI, 0.16-0.31), and those on Medicaid (versus commercially insured) (OR, 0.71; 95% CI, 0.50-0.99) were less likely to self-schedule. Hispanic patients (versus non-Hispanic) (OR, 1.39; 95% CI, 1.20-1.61), Asian patients (versus White) (OR, 1.64; 95% CI, 1.46-1.85), and patients residing in the most (versus least) disadvantaged neighborhoods (OR, 1.16; 95% CI, 1.02-1.33) were more likely to self-schedule. Furthermore, patients 70 years or older (versus 50 or younger) (OR, 0.70; 95% CI, 0.52-0.93) and Spanish speakers (OR, 0.05; 95% CI, 0.03-0.09) were less likely to self-refer, whereas Black patients (versus White) (OR, 1.89; 95% CI, 1.30-2.75), patients on Medicaid (versus commercially insured) (OR, 3.70; 95% CI, 2.65-5.13), and patients living in the most (versus least) disadvantaged neighborhoods (OR, 1.52; 95% CI, 1.27-1.82) were more likely to self-refer. CONCLUSIONS Sociodemographic differences in online patient portal use and self-referral for screening mammography suggest that the two pathways have been successful in addressing some of the existing scheduling barriers and are a step toward closing the disparity gap.
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Affiliation(s)
- Ben Sadeghi
- Department of Radiological Sciences, University of California, Irvine, Orange, California
| | - Julia Tran
- Department of Radiological Sciences, University of California, Irvine, Orange, California
| | - Irene S Tsai
- Department of Radiological Sciences, University of California, Irvine, Orange, California; Director of Breast Imaging, University of California, Irvine
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California, Irvine, Orange, California; Associate Editor, JACR; Director of Health Services and Comparative Outcome Research, University of California, Irvine.
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Falk GE, Okut H, Lightner JS, Farrokhian N, LaCrete F, Chiu A, Shnayder Y, Bond J, Sykes KJ. Forecasting Rural and Urban Otolaryngologists, Radiation Oncologists, and Oropharyngeal Carcinoma. Laryngoscope 2024; 134:136-142. [PMID: 37395265 DOI: 10.1002/lary.30809] [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: 11/23/2022] [Revised: 03/04/2023] [Accepted: 05/24/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To forecast oropharyngeal carcinoma (OPC) incidence with otolaryngologist and radiation oncologist numbers per population by rural and urban counties through 2030. METHODS Incident OPC cases were abstracted from the Surveillance, Epidemiology, and End Results 19 database, and otolaryngologists and radiation oncologists from the Area Health Resources File by county from 2000 to 2018. Variables were analyzed by metropolitan counties with over 1,000,000 people (large metros), rural counties adjacent to a metro (rural adjacent), and rural counties not adjacent to a metro (rural not adjacent). Data were forecasted via an unobserved components model with regression slope comparisons. RESULTS Per 100,000 population, forecasted OPC incidence increased from 2000 to 2030 (large metro: 3.6 to 10.6 cases; rural adjacent: 4.2 to 11.9; rural not adjacent: 4.3 to 10.1). Otolaryngologists remained stable for large metros (2.9 to 2.9) but declined in rural adjacent (0.7 to 0.2) and rural not adjacent (0.8 to 0.7). Radiation oncologists increased from 1.0 to 1.3 in large metros, while rural adjacent remained similar (0.2 to 0.2) and rural not adjacent increased (0.2 to 0.6). Compared to large metros, regression slope comparisons indicated similar forecasted OPC incidence for rural not adjacent (p = 0.58), but greater for rural adjacent (p < 0.001, r = 0.96). Otolaryngologists declined for rural regions (p < 0.001 and p < 0.001, r = -0.56, and r = -0.58 for rural adjacent and not adjacent, respectively). Radiation oncologists declined in rural adjacent (p < 0.001, r = -0.61), while increasing at a lesser rate for rural not adjacent (p = 0.002, r = 0.96). CONCLUSIONS Rural OPC incidence disparities will grow while the relevant, rural health care workforce declines. LEVEL OF EVIDENCE NA Laryngoscope, 134:136-142, 2024.
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Affiliation(s)
- Grace E Falk
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Hayrettin Okut
- Office of Research and Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas, U.S.A
| | - Joseph S Lightner
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, U.S.A
| | - Nathan Farrokhian
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Frantzlee LaCrete
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Alexander Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Justin Bond
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
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Abstract
There is clear need for more effective public health policies. Coupled with calls for more effective policies, increasing demand to address public health disparities experienced by systemically marginalized and historically oppressed groups emphasizes the long-standing need for policies that improve public health equity. Such need is highlighted when examining public health issues such as alcohol- and substance-exposed pregnancy (ASEP): Current policies are ineffective at reducing ASEP, and marginalized groups experience disproportionately lower benefits and higher negative consequences as a result of such policies. Powerful strategies to develop more effective policies that can account for the complexity of such issues, such as systems science methods (SSMs), are becoming popular. However, current best practices for such methods often do not emphasize the additional efforts that will be required to develop equitable, not just effective policies. Using ASEP as an example of a crucial complex issue requiring new policy, we suggest additional steps to include in SSM projects for developing more effective policies that will also help stakeholders determine high-equity policies to reduce health disparities. These steps include modeling structural differences experienced by marginalized groups via systemic racism and oppression, incorporating existing cultural and community sources of strength and resilience as key areas for policy development, and evaluating the sustainability of policies as a dimension of efficacy. We also discuss using community-based participatory approaches as a framework for all SSM processes to ensure that policy development itself is grounded in equitable shared decision-making for marginalized individuals.
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Affiliation(s)
- Arielle R Deutsch
- Avera Health, Sioux Falls, SD, USA
- University of South Dakota, Vermillion, SD, USA
| | - Mohammad S Jalali
- Harvard Medical School, Boston, MA, USA
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Leah Frerichs
- The University of North Carolina at Chapel Hill, NC, USA
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29
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Diallo AF, Mackiewicz M, Sargent L, Roman YM, Slattum PW, Waters L, Bennett J, Battle K, Zanjani F, Gendron T, Winship J, Ford G, Falls K, Price ET, Parsons P, Chung J. Cultivating Relationships as a Community-Based Recruitment Strategy in Transdisciplinary Aging Research: Lessons From an Academic-Community Partnership. Fam Community Health 2024; 47:32-40. [PMID: 37831622 PMCID: PMC10841158 DOI: 10.1097/fch.0000000000000383] [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] [Indexed: 10/15/2023]
Abstract
Participation of Black American older adults in community-engaged research remains challenging in health sciences. The objectives of this study were to describe the specific efforts, successes, and challenges in recruiting Black American older adults in research led by the Health and Wellness in Aging Across the Lifespan core, part of the Virginia Commonwealth University Institute for Inclusion, Inquiry, and Innovation (iCubed). We conducted a cross-case analysis of 6 community-engaged research projects using the community-engaged research continuum model. Successful recruitment strategies comprised a multifaceted approach to community-based collaboration, including a wellness program with a long standing relationship with the community, engaging key stakeholders and a community advisory board, and building a community-based coalition of stakeholders. Posting flyers and modest monetary compensation remain standard recruitment strategies. The cross-case analysis offered critical lessons on the community's nature and level of engagement in research. Relationship building based on trust and respect is essential to solving complex aging issues in the community.
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Affiliation(s)
- Ana F. Diallo
- School of Nursing, Virginia Commonwealth University, Richmond, USA
| | - Marissa Mackiewicz
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, USA
| | - Lana Sargent
- School of Nursing, Virginia Commonwealth University, Richmond, USA
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, USA
| | - Youssef M. Roman
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, USA
| | - Patricia W. Slattum
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, USA
- Virginia Geriatric Education Center, Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, USA
| | - Leland Waters
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, USA
- Virginia Geriatric Education Center, Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, USA
| | | | - Kimberly Battle
- School of Nursing, Virginia Commonwealth University, Richmond, USA
| | - Faika Zanjani
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, USA
| | - Tracey Gendron
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, USA
| | - Jodi Winship
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, USA
| | - Gregory Ford
- Community member
- Beacon Communities, LLC, Richmond, Virginia, USA
| | - Katherine Falls
- School of Nursing, Virginia Commonwealth University, Richmond, USA
| | - Elvin T. Price
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, USA
| | - Pamela Parsons
- School of Nursing, Virginia Commonwealth University, Richmond, USA
| | - Jane Chung
- School of Nursing, Virginia Commonwealth University, Richmond, USA
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Wang H, El-Abbadi N. Food Insecurity, Race and Ethnicity, and Cognitive Function Among United States Older Adults. J Nutr 2024; 154:233-242. [PMID: 37984739 PMCID: PMC10925888 DOI: 10.1016/j.tjnut.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: 05/16/2023] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Cognitive impairment and dementia are severe public health issues in aging populations, which can be exacerbated by insufficient or unhealthy dietary intake. Food (in)security status is linked to cognitive function among older adults, but the relationship is complex and can vary by sociodemographic characteristics. OBJECTIVE This article aimed to investigate the association between food insecurity and cognitive function among United States older adults and explore potential variations by race and ethnicity groups. METHODS We prospectively examined changes in cognitive function and incidence of cognitive impairment alongside the presence of self-reported food insecurity among older adults of different racial and ethnic groups. Data were from the 2012-2018 Health and Retirement Study (HRS) and the 2013 Health Care and Nutrition Study (HCNS), including N = 6,638 United States adults aged 50 years and older. Food insecurity was measured by a self-reported United States Household Food Security Survey Module, and cognitive function was assessed by the modified version of the Telephone Interview for Cognitive Status. RESULTS Results showed that 17% of United States older adults reported food insecurity in the 2013 HCNS. Compared with food secure older adults, those reporting food insecurity experienced worsened cognitive functioning over time (B = -0.63, p < .001), and they were more likely to have onset of cognitive impairment (OR= 1.46, p < .001) in the 6-y observation. Compared with non-Hispanic White older adults, being non-Hispanic Black, non-Hispanic Other, or Hispanic was associated with 2.96, 2.09, or 1.26 odds (p < .001) of cognitive impairment (2012-2018), respectively. Older adults of racial and ethnic minority groups also had higher risks of experiencing the double burden of cognitive impairment alongside food insecurity compared with non-Hispanic White older adults. CONCLUSION Findings underscore racial and ethnic structural disparities in food security and cognitive health in the United States aging population.
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Affiliation(s)
- Haowei Wang
- Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, NY, United States.
| | - Naglaa El-Abbadi
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States
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Nakajima M, Mohamud S, Haji A, Pratt R, al'Absi M. Barriers and facilitators of colorectal cancer screening among East African men in Minnesota: a qualitative investigation. Ethn Health 2024; 29:112-125. [PMID: 37968812 DOI: 10.1080/13557858.2023.2271189] [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: 03/06/2022] [Accepted: 08/14/2023] [Indexed: 11/17/2023]
Abstract
Objective: This study aimed to explore barriers and facilitators to colorectal cancer (CRC) screening among East African men in Minnesota.Design: Six focus groups were conducted in Minneapolis and St. Paul, MN, USA. Participants were asked to describe individual and structural barriers to CRC screening, and discuss strategies that would address individual and structural barriers to screening. Audio-recorded conversations were transcribed verbatim and translated to English. The transcriptions were analyzed using a thematic analysis. Major themes that emerged on individual barriers were lack of knowledge, fear, and privacy.Results: Themes that emerged on structural barriers were distrust in the medical system, lack of health care coverage, and access to the health care system. Education, client reminders, mass media, increased clarity in communication with the provider and translator, and increased access to health care were frequently mentioned strategies to increase CRC screening in the East African community. Participants expressed favorable views toward the concept of patient navigation.Conclusion: Our findings indicate the need to develop culturally appropriate, multi-faced, intervention programs that are aimed at eliminating personal, cultural, and structural barriers.
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Affiliation(s)
- Motohiro Nakajima
- Department of Social System Design, Eikei University of Hiroshima, Japan
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Sakhaudiin Mohamud
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Abdifatah Haji
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Mustafa al'Absi
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
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Dutta R, Tuli S, Shukla M, Patil P, van Duinen AJ, Thivalapill N, Ghoshal R, Jayaram A, Roy N, Gadgil A. Geographic and socioeconomic inequities in cesarean delivery rates at the district level in Madhya Pradesh, India: A secondary analysis of the national family health survey-5. Glob Health Action 2023; 16:2203544. [PMID: 37139686 PMCID: PMC10161939 DOI: 10.1080/16549716.2023.2203544] [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: 05/05/2023] Open
Abstract
BACKGROUND In India, caesarean delivery (CD) accounts for 17% of the births, of which 41% occur in private facilities. However, areas to CD in rural areas are limited, particularly for the poor populations. Little information is available on state-wise district-level CD rates by geography and the population wealth quintiles, especially in Madhya Pradesh (MP), the fifth most populous and third poorest state. OBJECTIVE Investigate geographic and socioeconomic inequities of CD across the 51 districts in MP and compare the contribution of public and private healthcare facilities to the overall state CD rate. METHODS This cross-sectional study utilised the summary fact sheets of the National Family Health Survey (NFHS)-5 performed from January 2019 to April 2021. Women aged 15 to 49 years, with live births two years preceding the survey were included. District-level CD rates in MP were used to determine the inequalities in accessing CD in the poorer and poorest wealth quintiles. CD rates were stratified as <10%, 10-20% and >20% to measure equity of access. A linear regression model was used to examine the correlation between the fractions of the population in the two bottom wealth quintiles and CD rates. RESULTS Eighteen districts had a CD rate below 10%, 32 districts were within the 10%-20% threshold and four had a rate of 20% or higher. Districts with a higher proportion of poorer population and were at a distance from the capital city Bhopal were associated with lower CD rates. However, this decline was steeper for private healthcare facilities (R2 = 0.382) revealing a possible dependency of the poor populations on public healthcare facilities (R2 = 0.009) for accessing CD. CONCLUSION Although CD rates have increased across MP, inequities within districts and wealth quintiles exist, warranting closer attention to the outreach of government policies and the need to incentivise CDs where underuse is significant.
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Affiliation(s)
- Rohini Dutta
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Mary Horigan Connors Centre for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - Shagun Tuli
- Department of General Practice, School of Medicine, University of Limerick, Limerick, Ireland
| | - Minal Shukla
- Department of Obstetrics and Gynecology, Public Health Consultant, India
| | - Priti Patil
- Department of Statistics, Bhabha Atomic Research Centre Hospital, Mumbai, India
| | - Alex J van Duinen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, St. Olavs Hospital Universitetssykehuset Trondheim, Trondheim, Norway
| | - Neil Thivalapill
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rakhi Ghoshal
- Gender Equality Centre, CARE India, New Delhi, India
| | - Anusha Jayaram
- Department of Surgery, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- The George Institute for Global Health, New Delhi, India
| | - Anita Gadgil
- The George Institute for Global Health, New Delhi, India
- Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, India
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Pichardo CM, Ezeani A, Pichardo MS, Agurs‐Collins T, Powell‐Wiley TM, Ryan B, Minas TZ, Bailey‐Whyte M, Tang W, Dorsey TH, Wooten W, Loffredo CA, Ambs S. Association of neighborhood gentrification with prostate cancer and immune markers in African American and European American men. Cancer Med 2023; 13:e6828. [PMID: 38151903 PMCID: PMC10807554 DOI: 10.1002/cam4.6828] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/11/2023] [Accepted: 10/24/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Prior studies showed that neighborhood deprivation increases the risk of lethal prostate cancer. However, the role of neighborhood gentrification in prostate cancer development and outcome remains poorly understood. We examined the relationships of gentrification with prostate cancer and serum proteome-defined inflammation and immune function in a diverse cohort. METHODS The case-control study included 769 cases [405 African American (AA), 364 European American (EA) men] and 1023 controls (479 AA and 544 EA), with 219 all-cause and 59 prostate cancer-specific deaths among cases. Geocodes were linked to a neighborhood gentrification index (NGI) derived from US Census data. Cox and logistic regression, and MANOVA, were used to determine associations between NGI, as continuous or quintiles (Q), and outcomes. RESULTS Adjusting for individual socioeconomic status (SES), continuous NGI was positively associated with prostate cancer among all men (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.01-1.14). AA and low-income men experienced the highest odds of prostate cancer when residing in tracts with moderate gentrification, whereas EA men experienced reduced odds of regional/metastatic cancer with increased gentrification in SES-adjusted analyses. Continuous NGI also associated with mortality among men presenting with localized disease and low-income men in SES-adjusted Cox regression analyses. NGI was not associated with serum proteome-defined chemotaxis, inflammation, and tumor immunity suppression. CONCLUSIONS Findings show that neighborhood gentrification associates with prostate cancer and mortality in this diverse population albeit associations were heterogenous within subgroups. The observations suggest that changing neighborhood socioeconomic environments may affect prostate cancer risk and outcome, likely through multifactorial mechanisms.
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Affiliation(s)
| | - Adaora Ezeani
- Division of Cancer Control and Population Sciences, NCINIHRockvilleMarylandUSA
| | - Margaret S. Pichardo
- Department of Surgery, Hospital of the University of PennsylvaniaPenn MedicinePhiladelphiaPennsylvaniaUSA
| | - Tanya Agurs‐Collins
- Division of Cancer Control and Population Sciences, NCINIHRockvilleMarylandUSA
| | - Tiffany M. Powell‐Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute (NHLBI)National Institutes of HealthBethesdaMarylandUSA
- Intramural Research Program, National Institute on Minority Health and Health Disparities (NIMHD)National Institutes of HealthBethesdaMarylandUSA
| | - Brid Ryan
- Laboratory of Human Carcinogenesis, National Cancer Institute (NCI)National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Tsion Zewdu Minas
- Laboratory of Human Carcinogenesis, National Cancer Institute (NCI)National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Maeve Bailey‐Whyte
- Laboratory of Human Carcinogenesis, National Cancer Institute (NCI)National Institutes of Health (NIH)BethesdaMarylandUSA
- School of MedicineUniversity of LimerickLimerickIreland
| | - Wei Tang
- Laboratory of Human Carcinogenesis, National Cancer Institute (NCI)National Institutes of Health (NIH)BethesdaMarylandUSA
- Data Science & Artificial Intelligence, R&DAstraZenecaGaithersburgMarylandUSA
| | - Tiffany H. Dorsey
- Laboratory of Human Carcinogenesis, National Cancer Institute (NCI)National Institutes of Health (NIH)BethesdaMarylandUSA
| | - William Wooten
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center Biostatistics Shared ServiceBaltimoreMarylandUSA
| | - Christopher A. Loffredo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer CenterGeorgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, National Cancer Institute (NCI)National Institutes of Health (NIH)BethesdaMarylandUSA
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Santiago LH, Vargas RB, Pipolo DO, Pan D, Tiwari S, Dehghan K, Bazargan-Hejazi S. Predictors of hospital readmissions in adult patients with sickle cell disease. Am J Blood Res 2023; 13:189-197. [PMID: 38223313 PMCID: PMC10784118] [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] [Received: 05/09/2023] [Accepted: 10/03/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Sickle cell disease (SCD) is the most common inherited blood disorder, affecting primarily Black and Hispanic individuals. In 2016, 30-day readmissions incurred 95,445 extra days of hospitalization, $152 million in total hospitalization costs, and $609 million in total hospitalization charges. OBJECTIVES 1) To estimate hospital readmissions within 30 days among patients with SCD in the State of California. 2) Identify the factors associated with readmission within 30 days for SCD patients in California. METHODS We conducted a retrospective observational study of adult SCD patients hospitalized in California between 2005 and 2014. Descriptive statistics and logistic regression models were used to examine significant differences in patient characteristics and their association with hospital readmissions. RESULTS From 2,728 individual index admissions, 70% presented with single admission, 10% experienced one readmission, and 20% experienced ≥ two readmissions within 30 days. Significant predictors associated with zero vs. one readmission were male gender (OR=1.37, CI: 1.06-1.77), Black ethnicity (OR=3.27, CI: 1.71-6.27) and having Medicare coverage (OR=1.89, CI: 1.30-2.75). Lower likelihood of readmission was found in those with a Charlson Comorbidity index of three or more (OR=0.53, CI: 0.29-0.97). For zero vs. ≥ two readmissions, significant predictors were male gender (OR=1.43, CI: 1.17-1.74), Black ethnicity (OR=6.90, CI: 3.41-13.97), Hispanic ethnicity (OR=2.33, CI: 1.05-5.17), Medicare coverage (OR=3.58, CI: 2.68-4.81) and Medi-Cal coverage (OR=1.70, CI: 1.31-2.20). Lower likelihood for having two or more readmissions were associated with individuals aged 65+ (OR=0.97, CI: 0.96-0.98) and those with self-payment status (OR=0.32, CI: 0.12-0.54). CONCLUSIONS In California, male, Black, and Hispanic patients, as well as those covered by Medicare or Medi-Cal, were found to have an increased risk of hospital readmissions. Redirecting outpatient goals to address these patient populations and risk factors is crucial for reducing readmission rates.
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Affiliation(s)
- Laura H Santiago
- College of Medicine, Charles R. Drew University of Medicine and ScienceLos Angeles, CA, USA
- David Geffen School of Medicine, UCLALos Angeles, CA, USA
| | - Roberto B Vargas
- College of Medicine, Charles R. Drew University of Medicine and ScienceLos Angeles, CA, USA
- David Geffen School of Medicine, UCLALos Angeles, CA, USA
| | - Derek O Pipolo
- College of Medicine, Charles R. Drew University of Medicine and ScienceLos Angeles, CA, USA
| | - Deyu Pan
- College of Medicine, Charles R. Drew University of Medicine and ScienceLos Angeles, CA, USA
| | - Sweta Tiwari
- College of Medicine, Charles R. Drew University of Medicine and ScienceLos Angeles, CA, USA
| | - Kaveh Dehghan
- College of Medicine, Charles R. Drew University of Medicine and ScienceLos Angeles, CA, USA
| | - Shahrzad Bazargan-Hejazi
- College of Medicine, Charles R. Drew University of Medicine and ScienceLos Angeles, CA, USA
- David Geffen School of Medicine, UCLALos Angeles, CA, USA
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Gee GC, Chien J, Sharif MZ, Penaia C, Tran E. East is east … or is it? Racialization of Asian, Middle Eastern, and Pacific Islander persons. Epidemiol Rev 2023; 45:93-104. [PMID: 37312559 DOI: 10.1093/epirev/mxad007] [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: 09/30/2022] [Revised: 04/28/2023] [Accepted: 06/05/2023] [Indexed: 06/15/2023] Open
Abstract
The conventional use of racial categories in health research naturalizes "race" in problematic ways that ignore how racial categories function in service of a White-dominated racial hierarchy. In many respects, racial labels are based on geographic designations. For instance, "Asians" are from Asia. Yet, this is not always a tenable proposition. For example, Afghanistan resides in South Asia, and shares a border with China and Pakistan. Yet, people from Afghanistan are not considered Asian, but Middle Eastern, by the US Census. Furthermore, people on the west side of the Island of New Guinea are considered Asian, whereas those on the eastern side are considered Pacific Islander. In this article, we discuss the complexity of the racial labels related to people originating from Oceania and Asia, and, more specifically, those groups commonly referred to as Pacific Islander, Middle Eastern, and Asian. We begin with considerations of the aggregation fallacy. Just as the ecological fallacy refers to erroneous inferences about individuals from group data, the aggregation fallacy refers to erroneous inferences about subgroups (eg, Hmong) from group data (ie, all Asian Americans), and how these inferences can contribute to stereotypes such as the "model minority." We also examine how group averages can be influenced merely by the composition of the subgroups, and how these, in turn, can be influenced by social policies. We provide a historical overview of some of the issues facing Pacific Islander, Middle Eastern, and Asian communities, and conclude with directions for future research.
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Affiliation(s)
- Gilbert C Gee
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA 90025, United States
| | - Jessie Chien
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA 90025, United States
| | - Mienah Z Sharif
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA 98195, United States
- Center for the Study of Racism, Social Justice and Health, University of California at Los Angeles, Los Angeles, CA 90025, United States
| | - Corina Penaia
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90025, United States
| | - Emma Tran
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA 90025, United States
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Ashenafi SG, Martinez GM, Jatlaoui TC, Koppaka R, Byrne-Zaaloff M, Falcón AP, Frank A, Keitt SH, Matus K, Moss S, Ruddock C, Sun T, Waterman MB, Wu TY. Design and Implementation of a Federal Program to Engage Community Partners to Reduce Disparities in Adult COVID-19 Immunization Uptake, United States, 2021-2022. Public Health Rep 2023:333549231208642. [PMID: 38111108 DOI: 10.1177/00333549231208642] [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: 12/20/2023] Open
Abstract
Vaccination disparities are part of a larger system of health inequities among racial and ethnic groups in the United States. To increase vaccine equity of racial and ethnic populations, the Centers for Disease Control and Prevention (CDC) designed the Partnering for Vaccine Equity program in January 2021, which funded and supported national, state, local, and community organizations in 50 states-which include Indian Health Service Tribal Areas; Washington, DC; and Puerto Rico-to implement culturally tailored activities to improve access to, availability of, and confidence in COVID-19 and influenza vaccines. To increase vaccine uptake at the local level, CDC partnered with national organizations such as the National Urban League and Asian & Pacific Islander American Health Forum to engage community-based organizations to take action. Lessons learned from the program include the importance of directly supporting and engaging with the community, providing tailored messages and access to vaccines to reach communities where they are, training messengers who are trusted by those in the community, and providing support to funded partners through trainings on program design and implementation that can be institutionalized and sustained beyond the COVID-19 pandemic. Building on these lessons will ensure CDC and other public health partners can continue to advance vaccine equity, increase vaccine uptake, improve health outcomes, and build trust with communities as part of a comprehensive adult immunization infrastructure.
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Affiliation(s)
- Samrawit G Ashenafi
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gisela Medina Martinez
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tara C Jatlaoui
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ram Koppaka
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | | | - Synovia Moss
- National Council of Negro Women, Washington, DC, USA
| | | | - Tracy Sun
- Asian & Pacific Islander American Health Forum, Washington, DC, USA
| | | | - Tsu-Yin Wu
- Center for Health Disparities Innovations and Studies, Eastern Michigan University, Ypsilanti, MI, USA
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John A, M J, Rubeshkumar P, Ganeshkumar P, Masanam Sriramulu H, Narnaware M, Singh Bedi G, Kaur P. Implementation of a Triage Protocol Outside the Hospital Setting for Timely Referral During the COVID-19 Second Wave in Chennai, India. JMIR Form Res 2023; 7:e42798. [PMID: 37235721 PMCID: PMC10758940 DOI: 10.2196/42798] [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: 09/19/2022] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 05/28/2023] Open
Abstract
India experienced a surge in COVID-19 cases during the second wave in the period of April-June 2021. A rapid rise in cases posed challenges to triaging patients in hospital settings. Chennai, the fourth largest metropolitan city in India with an 8 million population, reported 7564 COVID-19 cases on May 12, 2021, nearly 3 times higher than the number of cases in the peak of COVID-19 in 2020. A sudden surge of cases overwhelmed the health system. We had established standalone triage centers outside the hospitals in the first wave, which catered to up to 2500 patients per day. In addition, we implemented a home-based triage protocol from May 26, 2021, to evaluate patients with COVID-19 who were aged ≤45 years without comorbidities. Among the 27,816 reported cases between May 26 and June 24, 2021, a total of 16,022 (57.6%) were aged ≤45 years without comorbidities. The field teams triaged 15,334 (55.1%), and 10,917 (39.2%) patients were evaluated at triage centers. Among 27,816 cases, 19,219 (69.1%) were advised to self-isolate at home, 3290 (11.8%) were admitted to COVID-19 care centers, and 1714 (6.2%) were admitted to hospitals. Only 3513 (12.7%) patients opted for the facility of their choice. We implemented a scalable triage strategy covering nearly 90% of the patients in a large metropolitan city during the COVID-19 surge. The process enabled early referral of high-risk patients and ensured evidence-informed treatment. We believe that the out-of-hospital triage strategy can be rapidly implemented in low-resource settings.
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Affiliation(s)
- Alby John
- Greater Chennai Corporation, Government of Tamil Nadu, Chennai, India
| | - Jagadeesan M
- Greater Chennai Corporation, Government of Tamil Nadu, Chennai, India
| | - Polani Rubeshkumar
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
| | | | | | - Manish Narnaware
- Greater Chennai Corporation, Government of Tamil Nadu, Chennai, India
| | | | - Prabhdeep Kaur
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
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Herington J, McCradden MD, Creel K, Boellaard R, Jones EC, Jha AK, Rahmim A, Scott PJH, Sunderland JJ, Wahl RL, Zuehlsdorff S, Saboury B. Ethical Considerations for Artificial Intelligence in Medical Imaging: Data Collection, Development, and Evaluation. J Nucl Med 2023; 64:1848-1854. [PMID: 37827839 PMCID: PMC10690124 DOI: 10.2967/jnumed.123.266080] [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: 11/28/2022] [Revised: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
The development of artificial intelligence (AI) within nuclear imaging involves several ethically fraught components at different stages of the machine learning pipeline, including during data collection, model training and validation, and clinical use. Drawing on the traditional principles of medical and research ethics, and highlighting the need to ensure health justice, the AI task force of the Society of Nuclear Medicine and Molecular Imaging has identified 4 major ethical risks: privacy of data subjects, data quality and model efficacy, fairness toward marginalized populations, and transparency of clinical performance. We provide preliminary recommendations to developers of AI-driven medical devices for mitigating the impact of these risks on patients and populations.
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Affiliation(s)
- Jonathan Herington
- Department of Health Humanities and Bioethics and Department of Philosophy, University of Rochester, Rochester, New York
| | - Melissa D McCradden
- Department of Bioethics, Hospital for Sick Children, Toronto and Dana Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Creel
- Department of Philosophy and Religion and Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Elizabeth C Jones
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Abhinav K Jha
- Department of Biomedical Engineering and Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Arman Rahmim
- Departments of Radiology and Physics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter J H Scott
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - John J Sunderland
- Departments of Radiology and Physics, University of Iowa, Iowa City, Iowa
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri; and
| | | | - Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland;
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Salt E, Wiggins A, Pick A, Bada H, Howard C, Currie M, Rayens MK. A case-control study comparing rates and diagnoses of hospital readmission in infants affected by neonatal abstinence syndrome. J Matern Fetal Neonatal Med 2023; 36:2162820. [PMID: 36597833 DOI: 10.1080/14767058.2022.2162820] [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: 01/05/2023]
Abstract
OBJECTIVE Rates of neonatal abstinence syndrome/neonatal opioid withdrawal syndrome (NAS/NOWS), a withdrawal syndrome from opioids and other substances resulting from intrauterine exposure, have been increasing exponentially in the U.S. To improve health outcomes, it is important to understand population health risks, including rehospitalization and related diagnoses, using current data. This study will compare and describe the rates of rehospitalization, the demographic characteristics and the rehospitalization diagnoses and age at diagnosis between the infants affected by NAS/NOWS to those sampled who were unaffected. This study will also describe the frequency of NAS/NOWS births per year along with a yearly comparison of readmissions in those affected by NAS/NOWS to those who were not (2016-2020). METHODS Health claims data were used to conduct a case/control study. Diagnosis codes for neonatal withdrawal syndrome/NAS/NOWS (P04.49 or P96.1 and P96.1 alone) from 1 October 2015 to 1 June 2021 were extracted, and controls were case-matched based on month/year of birth. Rehospitalizations following birth and the related diagnoses were described and grouped using the Agency of Healthcare Research Quality Clinical Classifications Software Refined Frequency distribution. The chi-square test of association and generalized estimating equation modeling were used for data analysis. RESULTS Infants affected by NAS/NOWS are 2.7 times more likely to have a rehospitalization. White, non-Hispanic neonates (OR = 1.5; p = .007) and those infants residing in rural areas (OR = 1.9; p < .001) were disproportionately affected. We identified a host of admission diagnoses with increased prevalence in infants affected by NAS/NOWS when compared to those who were not affected (e.g. infectious diseases, feeding disorders). CONCLUSIONS Infants with NAS/NOWS are at increased risk of rehospitalization with a host of diagnoses, and specific demographic groups (White, rural) are more highly affected.
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Affiliation(s)
- Elizabeth Salt
- University of Kentucky, College of Nursing, Lexington, KY, USA
| | - Amanda Wiggins
- University of Kentucky, College of Nursing, Lexington, KY, USA
| | - Abigail Pick
- University of Kentucky, College of Nursing, Lexington, KY, USA
| | - Henrietta Bada
- Division of Maternal and Child Health, Kentucky Department of Public Health, Frankfort, KY, USA
| | - Christina Howard
- Department of Pediatrics, Pediatric Forensic Medicine, University of Kentucky, Lexington, KY, USA
| | - Melissa Currie
- Pediatric Forensic Medicine, University of Louisville School of Medicine, Norton Children's Pediatric Protection Specialists, Louisville, KY, USA
| | - Mary Kay Rayens
- University of Kentucky, College of Nursing, Lexington, KY, USA
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Nguyen HM, Mahabaleshwarkar R, Nandkeolyar S, Pokharel Y, McWilliams A, Taylor Y. Blood Pressure Control in a Diverse Population of Hypertensive Patients With Heart Failure. Am J Cardiol 2023; 208:25-30. [PMID: 37806186 DOI: 10.1016/j.amjcard.2023.09.038] [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: 08/08/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 10/10/2023]
Abstract
Hypertensive patients with heart failure (HF), with reduced or preserved ejection fraction, belong to a vulnerable subset with high mortality risks. In HF patients, the current clinical guideline recommends attaining a systolic blood pressure (BP) <130 mm Hg. However, levels of BP control and their correlates in this subgroup are not well understood. Our study aimed at establishing levels of BP control and its associated factors in a geographically, racially diverse population of hypertensive patients with HF. Our study involved 10,802 patients within a large health system in the Charlotte metropolitan area in 2019. We documented a high prevalence of systolic BP ≥130 mm Hg, 48.1% (95% confidence interval 47.4% to 48.8%), and of BP ≥130/80 mm Hg, 57.6% (57.0% to 58.3%). From a multivariate logistic regression model, systolic BP ≥130 mm Hg was associated with race-ethnicity (p <0.0001), gender (p = 0.0001), insurance (p <0.0001), attribution with a primary care physician (p = 0.0001). Non-Hispanic Blacks (vs non-Hispanic Whites odds ratio [OR] 1.38, 1.28 to 1.48), women (OR 1.12, 1.06 to 1.19), and uninsured patients (vs privately insured OR 1.43, 1.20 to 1.72) had a higher risk of systolic BP ≥130 mm Hg; patients with primary care physician attribution had a lower risk of systolic BP ≥130 mm Hg (OR 0.87, 0.81 to 0.94). Similar results were found with the outcome BP ≥130/80 mm Hg. Overall, further efforts are needed to optimize treatment in hypertensive patients with HF and improve health equity across patient communities.
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Affiliation(s)
- Hieu Minh Nguyen
- Center for Health System Sciences (CHASSIS), Atrium Health, Charlotte, North Carolina.
| | | | | | - Yashashwi Pokharel
- Section of Cardiology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Andrew McWilliams
- Information Technology, Atrium Health, Charlotte, North Carolina; Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Yhenneko Taylor
- Center for Health System Sciences (CHASSIS), Atrium Health, Charlotte, North Carolina; Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina
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White RS, Tangel VE, Lui B, Jiang SY, Pryor KO, Abramovitz SE. Racial and Ethnic Disparities in Delivery In-Hospital Mortality or Maternal End-Organ Injury: A Multistate Analysis, 2007-2020. J Womens Health (Larchmt) 2023; 32:1292-1307. [PMID: 37819719 DOI: 10.1089/jwh.2023.0245] [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: 10/13/2023] Open
Abstract
Background: In the United States, Black maternal mortality is 2-4 × higher than that of White maternal mortality, with differences also present in severe maternal morbidity and other measures. However, limited research has comprehensively studied multilevel social determinants of health, and their confounding and effect modification on obstetrical outcomes. Materials and Methods: We performed a retrospective multistate analysis of adult inpatient delivery hospitalizations (Florida, Kentucky, Maryland, New Jersey, New York, North Carolina, and Washington) between 2007 and 2020. Multilevel multivariable models were used to test the confounder-adjusted association for race/ethnicity and the binary outcomes (1) in-hospital mortality or maternal end-organ injury and (2) in-hospital mortality only. Stratified analyses were performed to test effect modification. Results: The confounder-adjusted odds ratio showed that Black (1.33, 95% confidence interval [CI]: 1.30-1.36) and Hispanic (1.14, 95% CI: 1.11-1.18) as compared with White patients were more likely to die in-hospital or experience maternal end-organ injury. For Black and Hispanic patients, stratified analysis showed that findings remained significant in almost all homogeneous strata. After statistical adjustment, Black as compared with White patients were more likely to die in-hospital (1.49, 95% CI: 1.21-1.82). Conclusions: Black and Hispanic patients had higher adjusted odds of in-patient mortality and end-organ damage after birth than White patients. Race and ethnicity serve as strong predictors of health care inequality, and differences in outcomes may reflect broader structural racism and individual implicit bias. Proposed solutions require immense and multifaceted active efforts to restructure how obstetrical care is provided on the societal, hospital, and patient level.
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Affiliation(s)
- Robert S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Virginia E Tangel
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Briana Lui
- Weill Cornell Medical College, Weill Cornell Medicine, New York, New York, USA
| | - Silis Y Jiang
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Kane O Pryor
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Sharon E Abramovitz
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
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Dumedah G, Iddrisu S, Asare C, Adu-Prah S, English S. Inequities in spatial access to health services in Ghanaian cities. Health Policy Plan 2023; 38:1166-1180. [PMID: 37728231 DOI: 10.1093/heapol/czad084] [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: 04/01/2023] [Revised: 08/12/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023] Open
Abstract
Consideration of health equity is fundamental to enhancing the health of those who are economically/socially disadvantaged. A vital characteristic of health equity and therefore health disparity is the level of spatial access to health services and its distribution among populations. Adequate knowledge of health disparity is critical to enhancing the optimal allocation of resources, identification of underserved populations and improving the efficiency and performance of the health system. The provision of such insight for sub-Saharan African (SSA) cities is a challenge and is severely limited in the literature. Accordingly, this study examined the disparities in potential spatial access to health services for four selected urban areas in Ghana based on: (1) the number of physicians per population; (2) access score based on a weighted sum of access components; (3) travel time to health services and (4) the combined evaluation of linkages between travel distance, settlement area, population and economic status. The overall spatial access to health services is low across all selected cities varying between 3.02 and 1.78 physicians per 10 000 persons, whereas the access score is between 1.70 and 2.54. The current number of physicians needs to be increased by about five times to satisfy the World Health Organization's standard. The low spatial access is not equitable across and within the selected cities, where the economically disadvantaged populations were found to endure longer travel distances to access health services. Inequities were found to be embedded within the selected cities where economically poor populations are also disadvantaged in their physical access to healthcare. The health facilities in all cities have reasonable travel distances separating them but are inadequately resourced with physicians. Thus, increasing the physician numbers and related resources at spatially targeted existing facilities would considerably enhance spatial access to health services.
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Affiliation(s)
- Gift Dumedah
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ashanti Region 0000, Ghana
| | - Seidu Iddrisu
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ashanti Region 0000, Ghana
| | - Christabel Asare
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ashanti Region 0000, Ghana
| | - Samuel Adu-Prah
- Department of Environmental and Geosciences, Sam Houston State University, Huntsville, TX 77341, USA
| | - Sinead English
- School of Biological Sciences, University of Bristol, Bristol BS8 1QU, UK
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Kim S, Yoon H, Jang Y. Access to Primary Healthcare and Discussion of Memory Loss with a Healthcare Provider in Adults with Subjective Cognitive Decline: Does Race/Ethnicity Matter? Behav Sci (Basel) 2023; 13:955. [PMID: 37998701 PMCID: PMC10669110 DOI: 10.3390/bs13110955] [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: 10/16/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
Because subjective cognitive decline (SCD) manifests before the clinical and irreversible onset of dementia, efforts to address SCD are imperative for the early identification and prevention of dementia. For people who actually experience SCD, having a usual source of care may be an important catalyst for addressing memory issues. This study investigates the relationship between having a usual source of care and the discussion of SCD with healthcare providers, while taking into account racial and ethnic differences. The pooled 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) from 47 states in the U.S. was used. The sample included 7900 individuals aged 50 and older who reported significant cognitive decline. Using logistic regression with state-level clustering, we found that those with a usual source of healthcare were almost twice as more likely to discuss memory loss with a healthcare provider. In order to test for the multiplicative effects, we included an interaction term between each race category and having a primary care provider (PCP). There was a significant interaction effect between Hispanic ethnicity and having a PCP (OR = 0.25, p < 0.05). While non-Hispanic respondents who had a PCP had a higher probability of discussing memory issues with a healthcare provider (42% vs. 25%), Hispanic respondents with a PCP were less likely to discuss their memory loss with a healthcare provider (36% vs. 49%). The study adds to the growing literature on the vital role of the primary care service in provision of service to those with cognitive decline, while revealing ethnic disparity in memory-loss-related communication with healthcare providers in a primary care setting.
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Affiliation(s)
- Seoyoun Kim
- Department of Sociology, Texas State University, San Marcos, TX 78666, USA;
| | - Hyunwoo Yoon
- Department of Social Welfare, Institute of Social Welfare, Kongju National University, Gongju-si 32588, Republic of Korea
| | - Yuri Jang
- Edward R. Roybal Institute on Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90007, USA;
- Department of Social Welfare, Ewha Womans University, Seoul 07985, Republic of Korea
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Abboud Y, Pendyala N, Le A, Mittal A, Alsakarneh S, Jaber F, Hajifathalian K. The Incidence of Rectal Neuroendocrine Tumors Is Increasing in Younger Adults in the US, 2001-2020. Cancers (Basel) 2023; 15:5286. [PMID: 37958459 PMCID: PMC10650543 DOI: 10.3390/cancers15215286] [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: 09/12/2023] [Revised: 10/29/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
Prior non-comparative data showed increasing incidence of rectal neuroendocrine tumors (RNET) in the US. We aimed to evaluate age-specific RNET incidence rates and time-trends in demographic- and tumor-specific populations. The RNET age-adjusted incidence rates were calculated from the United States Cancer Statistics (USCS) database between 2001 and 2020. The population was stratified by age into older (≥55 years) and younger adults (<55 years), as well as by sex and race. The tumors were categorized by their stage at diagnosis into early and late. The annual percentage change (APC) and average APC (AAPC) were estimated using joinpoint regression and Monte Carlo permutation analysis. Pairwise comparison assessed for parallelism and coincidence. There were 59,846 patients diagnosed with RNET between 2001 and 2020 (50.3% women). Overall, the RNET incidence rates during this period were increasing in younger but not older adults (AAPC = 3.12 vs. -1.10; AAPC difference = 4.22, p < 0.001), with non-identical non-parallel data (p-values < 0.001). While similar results were seen in men, a greater age-specific difference was noted in women (AAPC = 3.31 vs. -1.10; AAPC difference = 4.41, p = 0.003). The difference between younger and older adults was seen in non-Hispanic White (AAPC-difference = 4.89; p < 0.001) and non-Hispanic Black (AAPC-difference = 3.33; p = 0.03) patients, and, in most years, among Hispanic and Non-Hispanic Asian/Pacific Islander patients, and it was mostly driven by early-stage tumors (AAPC-difference = 3.93; p < 0.001). The nationwide data show a significantly increasing RNET incidence in younger adults, most notably in younger women and in early-stage tumors, seen in various races. Future studies should evaluate RNET risk factors and outcomes in demographic-specific populations.
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Affiliation(s)
- Yazan Abboud
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA; (N.P.); (A.L.); (A.M.)
| | - Navya Pendyala
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA; (N.P.); (A.L.); (A.M.)
| | - Alexander Le
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA; (N.P.); (A.L.); (A.M.)
| | - Anmol Mittal
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA; (N.P.); (A.L.); (A.M.)
| | - Saqr Alsakarneh
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.A.); (F.J.)
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.A.); (F.J.)
| | - Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA;
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McCloskey K, Henao D, Gregory C, Corsig L, Plummer D. Breastfeeding Disparities During the COVID-19 Pandemic: Race/Ethnicity, Age, Education, and Insurance Payor. J Hum Lact 2023; 39:615-624. [PMID: 37515445 DOI: 10.1177/08903344231187907] [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: 07/30/2023]
Abstract
BACKGROUND There are well-documented disparities in rates of continued breastfeeding. Existing research regarding breastfeeding during COVID-19 has raised concerns that the pandemic may have exacerbated these disparities. RESEARCH AIMS The aim of this research was first to quantify disparities in any breastfeeding associated with the maternal factors of race/ethnicity, age, insurance payor, and zip code rates of education in North Carolina. Second, we aimed to investigate any changes in these disparities before and during the COVID-19 pandemic. METHOD This was an observational study, with a retrospective, longitudinal design. Participants included infants who were born in one of eight medical centers across North Carolina from either September 1, 2019 to October 31, 2019 (pre-COVID: n = 1,104) or from April 1, 2020 to May 31, 2020, (during COVID: n = 1,157), and whose caregivers reported whether they were breastfeeding at either a 3-month or 6-month postnatal follow-up (N = 2,261). Mixed effects logistic models, including random effects of zip code, assessed predictors associated with probability of breastfeeding cessation at 3- and 6-month child well-check. RESULTS Overall, younger maternal age, being non-Hispanic Black, not having commercial insurance, and residing in a zip code with lower rates of higher education, were all independently associated with earlier breastfeeding cessation across both cohorts. Disparities did not significantly change during the COVID-19 pandemic. CONCLUSION We did not find support for the hypothesis that the COVID-19 pandemic might have exacerbated breastfeeding disparities. Nevertheless, there is a continued need to eliminate existing disparities.
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Affiliation(s)
- Kiran McCloskey
- Office of Health Equity, Novant Health, Winston-Salem, NC, USA
| | - David Henao
- Office of Health Equity, Novant Health, Winston-Salem, NC, USA
| | - Chere Gregory
- Office of Health Equity, Novant Health, Winston-Salem, NC, USA
| | - Laura Corsig
- Department for Lactation Services, Novant Health, Charlotte, NC, USA
| | - Dianne Plummer
- Women and Children's Institute, Novant Health, Winston-Salem, NC, USA
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Wasser LM, Cassidy J, Cecconi K, McGinnis-Thomas D, Ayalon A, Zaheer HA, Waxman EL, Sahel JA, Williams AM. Predictors of Clinic Attendance After Community-Based Vision Screening. Transl Vis Sci Technol 2023; 12:2. [PMID: 37910081 PMCID: PMC10627300 DOI: 10.1167/tvst.12.11.2] [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: 06/29/2023] [Accepted: 09/21/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose The purpose of this study was to analyze appointment attendance rates and patient characteristics associated with follow-up adherence after referral from a community vision screening event. Methods A retrospective chart review of patients who attended a 2021 or 2022 community vision screening event and were referred to the university clinic for further care. Appointments were offered without charge and scheduled at the event. Associations between patients' clinical and demographic characteristics and appointment attendance were assessed by binary logistical regression. Results A total of 935 patients attended the annual community vision screening events held in 2021 and 2022. Of these patients, 117 (13%) were referred to the clinic for follow-up, of whom 56 (48%) attended their scheduled follow-up appointment. The most common reasons for clinic referral included cataract (12, 10%), diabetic retinopathy (11, 9%), glaucoma (9, 8%), and challenging refractive error (9, 8%). Health insurance and male gender were predictors of follow-up (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 1.19-7.99, P = 0.021 and OR = 2.72, 95% CI = 1.10-6.61, P = 0.035, respectively). Conclusions Half of the referred patients followed up after vision screening. Providing appointment scheduling at the point of care and offering follow-up care at no cost may help to promote clinic follow-up, but further assessment of barriers to regular eye care is warranted. Health insurance most strongly predicted successful clinic attendance. Translational Relevance This study emphasizes the enduring impact of health insurance status as a barrier to accessing comprehensive vision care.
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Affiliation(s)
- Lauren M. Wasser
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel
| | - Julie Cassidy
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Katherine Cecconi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dana McGinnis-Thomas
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anfisa Ayalon
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Haniah A. Zaheer
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evan L. Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew M. Williams
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Khan S, Gutierrez JA, Chapurin N, Nguyen SA, Soler ZM, Schlosser RJ. The impact of race on olfaction: A systematic review and meta-analysis. Int Forum Allergy Rhinol 2023; 13:2063-2072. [PMID: 37183309 DOI: 10.1002/alr.23184] [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: 02/28/2023] [Revised: 04/24/2023] [Accepted: 05/11/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Many studies have identified a higher degree of Olfactory Dysfunction (OD) in Black patients compared to White patients. This study aims to analyze olfactory outcomes in different races. METHODS The PubMed, Scopus, and CINAHL databases were searched from inception to September 5, 2022, for English-language articles documenting self-reported and psychophysical OD stratified by race. A meta-analysis of proportions, comparison of weighted proportions, and comparison of means were performed in MedCalc 20.218. In the quantitative analysis, 79,297 patients were included, comprising 79.3% Whites, 16.1% Blacks, and 4.6% Hispanics. RESULTS A total of 14 studies were meta-analyzed. The prevalence of self-reported OD in Hispanic, White, and Black patients was 19.5% (95% CI, 16.6% to 22.6%), 17.2% (95% CI, 10.5% to 25.0%), and 13.9% (95% CI, 9.3% to 19.2%), respectively (p < 0.0007). The prevalence of psychophysical OD in Black, White, and Hispanic patients was 30.3% (95% CI, 24.2% to 36.9%), 24.2% (95% CI, 20.1% to 28.5%), and 18.4% (95% CI, 16.3% to 20.7%), respectively (p < 0.0001). Blacks reported a greater extent of unrecognized OD compared to Whites, with a difference of 16.5% (95% CI, 15.0% to 17.9%) versus 5.8% (95% CI, 3.4% to 8.0%), respectively (p < 0.0001). Hispanic rates of self-reported OD and psychophysical OD were not statistically different. CONCLUSIONS Our findings suggest that Blacks have the highest rate of psychophysical OD and are more likely to underreport their awareness compared to Whites.
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Affiliation(s)
- Sofia Khan
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Endoscopic Skull Base Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jorge A Gutierrez
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Endoscopic Skull Base Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nikita Chapurin
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Endoscopic Skull Base Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Endoscopic Skull Base Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Endoscopic Skull Base Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Endoscopic Skull Base Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Vicerra PMM. Variations in cognition by human capital characteristics: a cross-sectional analysis of Brazilian older adults. Front Public Health 2023; 11:1257961. [PMID: 37942239 PMCID: PMC10628778 DOI: 10.3389/fpubh.2023.1257961] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction The productivity of individuals is assumed to decline upon reaching old age when cognitive ability is considered. This assumption is false, especially if the human development characteristics of people are analyzed, which highlights the need to recognize the heterogeneity among subpopulations. Methods Using Wave two of the Brazilian Longitudinal Study on Aging, conducted from 2019 to 2021, this study explored the onset and speed of cognitive aging among older individuals aged at least 60 in Brazil, with reference to their education and income levels. Results It was observed that although higher human capital characteristics yielded results toward later cognitive decline, women benefited more from having higher educational attainment levels. Such a pattern was similar among men and increased income levels. Disparities in cognitive performance, whether from education or income, were greatest at age 60, and this advantage diminished as age progressed. Conclusion Viewing the older population as homogeneous in terms of health function is restrictive. It should be recognized that variations in social status affect individuals' health status into old age and therefore their respective potential for productivity should be maximized.
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Cho J. Interpreters as Translation Machines: Telephone Interpreting Challenges as Awareness Problems. Qual Health Res 2023; 33:1037-1048. [PMID: 37635440 PMCID: PMC10552352 DOI: 10.1177/10497323231191712] [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] [Indexed: 08/29/2023]
Abstract
Telehealth has been widely adopted during the COVID-19 pandemic, and this article examines challenges faced by telephone interpreters in working with healthcare providers in the context of the Australian healthcare system. Based on one-on-one interviews with 67 healthcare interpreters in Australia, it explores various elements which affect communication processes in telephone interpreting and interpreters' views on healthcare providers' abilities to collaborate with interpreters. Data analysis indicates that telephone interpreting is often affected by a lack of briefing, poor acoustics and the absence of visual cues. While these factors pose significant challenges to telephone interpreters, a provider's tendency to see interpreters as 'translation machines' was perceived as a deeper underlying problem by the interpreters. The mechanistic approaches to interpreting among healthcare providers pose barriers to interpreter-provider collaboration and exacerbate communication problems caused by the external elements in telephone-interpreted encounters. The article calls for urgent need to raise awareness of interpreting among healthcare providers as a key to ensuring desirable health outcomes for patients from minority backgrounds.
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Affiliation(s)
- Jinhyun Cho
- Department of Linguistics, Macquarie University, Sydney, NSW, Australia
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50
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Heintz HL, Paik JM, Baird L, Driver JA, Moye J. What matters most to older adults: Racial and ethnic considerations in values for current healthcare planning. J Am Geriatr Soc 2023; 71:3254-3266. [PMID: 37528798 DOI: 10.1111/jgs.18525] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/14/2023] [Accepted: 07/04/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Clarifying what matters most informs current care planning for adults with multiple comorbidities. We describe how adults aged 55+ rate what matters most and differences in Black and White participants. METHODS Participants (N = 247, Age M = 63.61 ± 5.26) who self-identified as Black (n = 89), White (n = 96), or other racial and ethnic groups (n = 62) completed an online survey. Healthcare values in four domains, (1) important factors for managing health, (2) functioning, (3) enjoying life, and (4) connecting, were assessed with the What Matters Most-Structured Tool. Frailty was assessed with the FRAIL scale. RESULTS Concerns about pain and finances were rated as the most influential when making healthcare decisions across groups. Black participants rated religious and racial, ethnic, and cultural considerations as more important in healthcare decision-making than did White participants (Black participant M = 1.93 ± 0.85 vs. White participant M = 1.26 ± 0.52), citing concerns about health equity, disparity, and representation. Across the sample, specific aspects of functioning (e.g., ability to think clearly, walk, and see) and connecting (e.g., with family and friends and with God) were highly valued. Black participants rated the ability to dress or bathe, exercise, and connect with God as more important than did White participants, and they were also more likely to rate length of life as more important relative to quality of life. Value ratings were not associated with other demographic or health factors. CONCLUSIONS Adults aged 55+ from diverse groups highly value functioning and connections when making health decisions, with important contextual distinctions between Black participants and White participants. This study population was relatively young; future studies in older populations are needed.
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Affiliation(s)
- Hannah L Heintz
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Julie M Paik
- New England Geriatric Research Education and Clinical Center (GRECC), Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Lola Baird
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jane A Driver
- New England Geriatric Research Education and Clinical Center (GRECC), Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Moye
- New England Geriatric Research Education and Clinical Center (GRECC), Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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