1
|
Jecker NS, Ravitsky V, Ghaly M, Bélisle-Pipon JC, Atuire C. Proposed Principles for International Bioethics Conferencing: Anti-Discriminatory, Global, and Inclusive. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:13-28. [PMID: 37549186 DOI: 10.1080/15265161.2023.2232748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
This paper opens a critical conversation about the ethics of international bioethics conferencing and proposes principles that commit to being anti-discriminatory, global, and inclusive. We launch this conversation in the Section, Case Study, with a case example involving the International Association of Bioethics' (IAB's) selection of Qatar to host the 2024 World Congress of Bioethics. IAB's choice of Qatar sparked controversy. We believe it also may reveal deeper issues of Islamophobia in bioethics. The Section, Principles for International Bioethics Conferencing, sets forth and defends proposed principles for international bioethics conferencing. The Section, Applying Principles to Site Selection applies the proposed principles to the case example. The Section, Applying Principles Beyond Site Selection addresses other applications of the proposed principles. The Section, Objections responds to objections. We close (in the Section, Conclusion) by calling for a wider discussion of our proposed principles. One-Sentence Capsule Summary: How should bioethicists navigate the ethics of global bioethics conferencing?
Collapse
Affiliation(s)
- Nancy S Jecker
- University of Washington School of Medicine, Seattle, WA, USA
- University of Johannesburg, Auckland Park, South Africa
- Chinese University of Hong Kong, Hong Kong, China
| | - Vardit Ravitsky
- University of Montreal, Montreal, Canada
- Harvard Medical School, Boston, MA, USA
| | | | | | - Caesar Atuire
- University of Oxford, Oxford, England
- University of Ghana, Legon, Ghana
| |
Collapse
|
2
|
Rokicki S, McConnell M. Racial and Socioeconomic Disparities in Preconception Health Risk Factors and Access to Care. J Womens Health (Larchmt) 2024. [PMID: 38563909 DOI: 10.1089/jwh.2023.0560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background: Black birthing people have significantly higher risks of maternal mortality and morbidity compared with White people. Preconception chronic conditions increase the risk of adverse pregnancy outcomes, yet little is known about disparities in preconception health. This study applies an intersectional framework to examine the simultaneous contributions of racial marginalization and economic deprivation in determining disparities in preconception risk factors and access to care. Methods: Using data from the Pregnancy Risk Assessment Monitoring System, 2016-2020 (N = 123,697), we evaluated disparities by race and income in self-reported preconception hypertension, diabetes, obesity, depression, and smoking, as well as preconception insurance coverage and utilization of health care. We estimated linear regression models and calculated predicted probabilities. Results: Black respondents experienced higher probabilities of preconception obesity and high blood pressure at every income level compared with White respondents. Higher income did not attenuate the probability of obesity for Black respondents (linear trend p = 0.21), as it did for White respondents (p < 0.001). Conversely, while White respondents with low income were at higher risk of preconception depression and smoking than their Black counterparts, higher income was strongly associated with reduced risk, with significantly steeper reductions for White compared with Black respondents (difference in trends p < 0.001 for both risk factors). White respondents had higher probabilities of utilizing preconception care across all income levels, despite similar probabilities of insurance coverage. Conclusions: Higher income does not protect against the risk of preconception obesity and other preconception risk factors for Black birthing people as it does for White birthing people. Results point to the need to consider multiple forms of intersecting structural factors in policy and intervention research to improve preconception and maternal health.
Collapse
Affiliation(s)
- Slawa Rokicki
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Margaret McConnell
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Jindal M, Barnert E, Chomilo N, Gilpin Clark S, Cohen A, Crookes DM, Kershaw KN, Kozhimannil KB, Mistry KB, Shlafer RJ, Slopen N, Suglia SF, Nguemeni Tiako MJ, Heard-Garris N. Policy solutions to eliminate racial and ethnic child health disparities in the USA. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:159-174. [PMID: 38242598 DOI: 10.1016/s2352-4642(23)00262-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 01/21/2024]
Abstract
Societal systems act individually and in combination to create and perpetuate structural racism through both policies and practices at the local, state, and federal levels, which, in turn, generate racial and ethnic health disparities. Both current and historical policy approaches across multiple sectors-including housing, employment, health insurance, immigration, and criminal legal-have the potential to affect child health equity. Such policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. Policy efforts that do not directly address structural racism will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism. In Paper 2 of this Series, we build on Paper 1's summary of existing disparities in health-care delivery and highlight policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improve the health of racially and ethnically minoritised children.
Collapse
Affiliation(s)
- Monique Jindal
- Department of Medicine, University of Illinois Chicago School of Medicine, Chicago, IL, USA.
| | - Elizabeth Barnert
- Department of Pediatrics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Nathan Chomilo
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Shawnese Gilpin Clark
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alyssa Cohen
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Danielle M Crookes
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA; Department of Sociology and Anthropology, College of Social Sciences and Humanities, Northeastern University, Boston, MA, USA
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katy Backes Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kamila B Mistry
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Office of Extramural Research, Education, and Priority Populations, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD, USA
| | - Rebecca J Shlafer
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, MA, USA; Center on the Developing Child, Harvard University, Boston, MA, USA
| | - Shakira F Suglia
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Nia Heard-Garris
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Institute for Policy Research, Northwestern University, Chicago, IL, USA
| |
Collapse
|
4
|
Slopen N, Chang AR, Johnson TJ, Anderson AT, Bate AM, Clark S, Cohen A, Jindal M, Karbeah J, Pachter LM, Priest N, Suglia SF, Bryce N, Fawcett A, Heard-Garris N. Racial and ethnic inequities in the quality of paediatric care in the USA: a review of quantitative evidence. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:147-158. [PMID: 38242597 DOI: 10.1016/s2352-4642(23)00251-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 08/02/2023] [Accepted: 09/08/2023] [Indexed: 01/21/2024]
Abstract
Racial and ethnic inequities in paediatric care have received increased research attention over the past two decades, particularly in the past 5 years, alongside an increased societal focus on racism. In this Series paper, the first in a two-part Series focused on racism and child health in the USA, we summarise evidence on racial and ethnic inequities in the quality of paediatric care. We review studies published between Jan 1, 2017 and July 31, 2022, that are adjusted for or stratified by insurance status to account for group differences in access, and we exclude studies in which differences in access are probably driven by patient preferences or the appropriateness of intervention. Overall, the literature reveals widespread patterns of inequitable treatment across paediatric specialties, including neonatology, primary care, emergency medicine, inpatient and critical care, surgery, developmental disabilities, mental health care, endocrinology, and palliative care. The identified studies indicate that children from minoritised racial and ethnic groups received poorer health-care services relative to non-Hispanic White children, with most studies drawing on data from multiple sites, and accounting for indicators of family socioeconomic position and clinical characteristics (eg, comorbidities or condition severity). The studies discussed a range of potential causes for the observed disparities, including implicit biases and differences in site of care or clinician characteristics. We outline priorities for future research to better understand and address paediatric treatment inequities and implications for practice and policy. Policy changes within and beyond the health-care system, discussed further in the second paper of this Series, are essential to address the root causes of treatment inequities and to promote equitable and excellent health for all children.
Collapse
Affiliation(s)
- Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Center on the Developing Child, Harvard University, Boston, MA, USA.
| | - Andrew R Chang
- Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Ashaunta T Anderson
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Aleha M Bate
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Stanely Manne Children's Research Institute, Chicago, IL, USA
| | - Shawnese Clark
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Stanely Manne Children's Research Institute, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alyssa Cohen
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Monique Jindal
- Department of Clinical Medicine, University of Illinois, Chicago, IL, USA
| | - J'Mag Karbeah
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Lee M Pachter
- Institute for Research on Equity and Community Health, ChristianaCare, Wilmington, DE, USA; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; School of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Naomi Priest
- Centre for Social Research and Methods, Australian National University, Canberra, ACT, Australia; Population Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nessa Bryce
- Department of Psychology, Harvard University, Boston, MA, USA
| | - Andrea Fawcett
- Department of Clinical and Organizational Development, Chicago, IL, USA
| | - Nia Heard-Garris
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Department of Pediatrics, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
5
|
Henrich JB, Richman I, Rabin TL, Gielissen KA, Dhond M, Canarie JX, Hirschman AF, Windham MR, Maya S, McNamara C, Pathy S, Bernstein P, Smith R, Vasquez L. It Takes a Village: An Interdisciplinary Approach to Preparing Internal Medicine Residents to Care for Patients at the Intersection of Women's Health, Gender-Affirming Care, and Health Disparities. J Womens Health (Larchmt) 2024; 33:152-162. [PMID: 38190490 DOI: 10.1089/jwh.2023.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Objective: To create an interdisciplinary curriculum to teach key topics at the intersection of women's health, gender-affirming care, and health disparities to internal medicine (IM) residents. Materials and Methods: A core team of faculty from IM, Obstetrics and Gynecology, and Surgery partnered with faculty and fellows from other disciplines and with community experts to design and deliver the curriculum. The resulting curriculum consisted of themed half-day modules, each consisting of three to four inter-related topics, updated and repeated on an ∼3-year cycle. Health equity was a focus of all topics. Module delivery used diverse interactive learning strategies. Modules have been presented to ∼175 residents annually, beginning in 2015. To assess the curriculum, we used formative evaluation methods, using primarily anonymous, electronic surveys, and collected quantitative and qualitative data. Most surveys assessed resident learning by quantifying residents' self-reported comfort with skills taught in the module pre- and postsession. Results: Of 131 residents who completed an evaluation in 2022/23, 121 (90%) "somewhat" or "strongly" agreed with their readiness to perform a range of skills taught in the module. In all previous years where pre- and postsurveys were used to evaluate modules, we observed a consistent meaningful increase in the proportion of residents reporting high levels of comfort with the material. Residents particularly valued interactive teaching methods, and direct learning from community members and peers. Conclusion: Our interdisciplinary curriculum was feasible, valued by trainees, and increased resident learning. The curriculum provides a template to address equity issues across a spectrum of women's and gender-affirming care conditions that can be used by other institutions in implementing similar curricula.
Collapse
Affiliation(s)
- Janet B Henrich
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ilana Richman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Tracy L Rabin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Katherine A Gielissen
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mukta Dhond
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, VA Connecticut Health Care System, West Haven, Connecticut, USA
| | - Joseph X Canarie
- Department of Internal Medicine, Anchor Health, Hamden, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Allister F Hirschman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Surgery, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Mary Ruth Windham
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Susan Maya
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, VA Connecticut Health Care System, West Haven, Connecticut, USA
| | - Cynthia McNamara
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, VA Connecticut Health Care System, West Haven, Connecticut, USA
| | - Shefali Pathy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Paul Bernstein
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ryan Smith
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Luz Vasquez
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, VA Connecticut Health Care System, West Haven, Connecticut, USA
| |
Collapse
|
6
|
Vo V, Chen G, Aquino YSJ, Carter SM, Do QN, Woode ME. Multi-stakeholder preferences for the use of artificial intelligence in healthcare: A systematic review and thematic analysis. Soc Sci Med 2023; 338:116357. [PMID: 37949020 DOI: 10.1016/j.socscimed.2023.116357] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/04/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Despite the proliferation of Artificial Intelligence (AI) technology over the last decade, clinician, patient, and public perceptions of its use in healthcare raise a number of ethical, legal and social questions. We systematically review the literature on attitudes towards the use of AI in healthcare from patients, the general public and health professionals' perspectives to understand these issues from multiple perspectives. METHODOLOGY A search for original research articles using qualitative, quantitative, and mixed methods published between 1 Jan 2001 to 24 Aug 2021 was conducted on six bibliographic databases. Data were extracted and classified into different themes representing views on: (i) knowledge and familiarity of AI, (ii) AI benefits, risks, and challenges, (iii) AI acceptability, (iv) AI development, (v) AI implementation, (vi) AI regulations, and (vii) Human - AI relationship. RESULTS The final search identified 7,490 different records of which 105 publications were selected based on predefined inclusion/exclusion criteria. While the majority of patients, the general public and health professionals generally had a positive attitude towards the use of AI in healthcare, all groups indicated some perceived risks and challenges. Commonly perceived risks included data privacy; reduced professional autonomy; algorithmic bias; healthcare inequities; and greater burnout to acquire AI-related skills. While patients had mixed opinions on whether healthcare workers suffer from job loss due to the use of AI, health professionals strongly indicated that AI would not be able to completely replace them in their professions. Both groups shared similar doubts about AI's ability to deliver empathic care. The need for AI validation, transparency, explainability, and patient and clinical involvement in the development of AI was emphasised. To help successfully implement AI in health care, most participants envisioned that an investment in training and education campaigns was necessary, especially for health professionals. Lack of familiarity, lack of trust, and regulatory uncertainties were identified as factors hindering AI implementation. Regarding AI regulations, key themes included data access and data privacy. While the general public and patients exhibited a willingness to share anonymised data for AI development, there remained concerns about sharing data with insurance or technology companies. One key domain under this theme was the question of who should be held accountable in the case of adverse events arising from using AI. CONCLUSIONS While overall positivity persists in attitudes and preferences toward AI use in healthcare, some prevalent problems require more attention. There is a need to go beyond addressing algorithm-related issues to look at the translation of legislation and guidelines into practice to ensure fairness, accountability, transparency, and ethics in AI.
Collapse
Affiliation(s)
- Vinh Vo
- Centre for Health Economics, Monash University, Australia.
| | - Gang Chen
- Centre for Health Economics, Monash University, Australia
| | - Yves Saint James Aquino
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Soceity, University of Wollongong, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Soceity, University of Wollongong, Australia
| | - Quynh Nga Do
- Department of Economics, Monash University, Australia
| | - Maame Esi Woode
- Centre for Health Economics, Monash University, Australia; Monash Data Futures Research Institute, Australia
| |
Collapse
|
7
|
Houtrow AJ, Jarvis JM, Fink E. Children Deserve to Be Protected from Traumatic Injuries and Receive High-quality Equitable Rehabilitative Care When Injuries Occur. J Pediatr 2023; 261:113586. [PMID: 37385336 DOI: 10.1016/j.jpeds.2023.113586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Amy J Houtrow
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Jessica M Jarvis
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ericka Fink
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
8
|
Scott JW, Neiman PU, Scott KW, Ibrahim AM, Fan Z, Fendrick AM, Dimick JB. High Deductibles are Associated With Severe Disease, Catastrophic Out-of-Pocket Payments for Emergency Surgical Conditions. Ann Surg 2023; 278:e667-e674. [PMID: 36762565 DOI: 10.1097/sla.0000000000005819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Out-of-pocket spending has risen for individuals with private health insurance, yet little is known about the unintended consequences that high levels of cost-sharing may have on delayed clinical presentation and financial outcomes for common emergency surgical conditions. METHODS In this retrospective analysis of claims data from a large commercial insurer (2016-2019), we identified adult inpatient admissions following emergency department presentation for common emergency surgical conditions (eg, appendicitis, cholecystitis, diverticulitis, and intestinal obstruction). Primary exposure of interest was enrollment in a high-deductible health insurance plan (HDHP). Our primary outcome was disease severity at presentation-determined using ICD-10-CM diagnoses codes and based on validated measures of anatomic severity (eg, perforation, abscess, diffuse peritonitis). Our secondary outcome was catastrophic out-of-pocket spending, defined by the World Health Organization as out-of-pocket spending >10% of annual income. RESULTS Among 43,516 patients [mean age 48.4 (SD: 11.9) years; 51% female], 41% were enrolled HDHPs. Despite being younger, healthier, wealthier, and more educated, HDHP enrollees were more likely to present with more severe disease (28.5% vs 21.3%, P <0.001; odds ratio (OR): 1.34, 95% CI: 1.28-1.42]); even after adjusting for relevant demographics (adjusted OR: 1.23, 95% CI: 1.18-1.31). HDHP enrollees were also more likely to incur 30-day out-of-pocket spending that exceeded 10% of annual income (20.8% vs 6.4%, adjusted OR: 3.93, 95% CI: 3.65-4.24). Lower-income patients, Black patients, and Hispanic patients were at highest risk of financial strain. CONCLUSIONS For privately insured patients presenting with common surgical emergencies, high-deductible health plans are associated with increased disease severity at admission and a greater financial burden after discharge-especially for vulnerable populations. Strategies are needed to improve financial risk protection for common surgical emergencies.
Collapse
Affiliation(s)
- John W Scott
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan Medical School, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Pooja U Neiman
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Kirstin W Scott
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
| | - Andrew M Ibrahim
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan Medical School, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Zhaohui Fan
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan Medical School, Ann Arbor, MI
| | - A Mark Fendrick
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Justin B Dimick
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan Medical School, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| |
Collapse
|
9
|
Perrin‐Stowe TIN, Horner M, Coon JJ, Lynch LR, de Flamingh A, Alexander NB, Golebie E, Swartz TM, Bader AC, Halsey SJ. "Where do I even start?" Recommendations for faculty diversifying syllabi in ecology, evolution, and the life sciences. Ecol Evol 2023; 13:e9719. [PMID: 36620406 PMCID: PMC9810791 DOI: 10.1002/ece3.9719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/31/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023] Open
Abstract
Diversifying curricula is of increasing interest in higher education, including in ecology and evolution and allied fields. Yet, many educators may not know where to start. Here we provide a framework for meeting standard curriculum goals while enacting anti-racist and anti-colonial syllabi that is grounded in the development of a sustainable network of educators. In addition to highlighting this professional learning process and sharing the list of resources our group has developed, we provide suggestions to help educators highlight contributions of minoritized groups, explore multiple ways of knowing, and perform critical assessments of foundational views of life and environmental science fields. We further discuss the key classroom dynamics that affect the success of such anti-racist and anti-colonial initiatives. The retention and success of minoritized students in ecology and evolution depends on whether we address injustices in our fields. Our hope is that our fellow educators will use this paper to catalyze their own efforts to diversify their courses.
Collapse
Affiliation(s)
| | - Melissa Horner
- Department of SociologyUniversity of MissouriColumbiaMissouriUSA
| | - Jaime J. Coon
- Department of BiologyEarlham CollegeRichmondIndianaUSA,Department of Environmental SustainabilityEarlham CollegeRichmondIndianaUSA
| | - Lauren R. Lynch
- Department of Natural Resources and Environmental SciencesUniversity of Illinois at Urbana‐ChampaignChampaignIllinoisUSA
| | - Alida de Flamingh
- Carl R. Woese Institute for Genomic BiologyUniversity of Illinois at Urbana‐ChampaignChampaignIllinoisUSA
| | - Nathan B. Alexander
- Department of Natural Resources and Environmental SciencesUniversity of Illinois at Urbana‐ChampaignChampaignIllinoisUSA
| | - Elizabeth Golebie
- Department of Natural Resources and Environmental SciencesUniversity of Illinois at Urbana‐ChampaignChampaignIllinoisUSA
| | - Timothy M. Swartz
- Department of Biology, Center for BiodiversityTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Alyssa C. Bader
- Department of AnthropologyUniversity of Colorado BoulderBoulderColoradoUSA
| | - Samniqueka J. Halsey
- Applied Computational Ecology LabSchool of Natural ResourcesUniversity of MissouriColumbiaMissouriUSA
| |
Collapse
|
10
|
Li Q, Douglas JA, Subica AM. Examining neighbourhood-level disparities in Black, Latina/o, Asian, and White physical health, mental health, chronic conditions, and social disadvantage in California. Glob Public Health 2023; 18:2273425. [PMID: 37902041 DOI: 10.1080/17441692.2023.2273425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023]
Abstract
Racial/ethnic minority individuals in the U.S. experience numerous health disparities versus Whites, often due to differences in social determinants. Yet, limited large-scale research has examined these differences at the neighbourhood level. We merged 2021 PLACES Project and 2020 American Community Survey data across 3,211 census tracts (neighbourhoods) defined as majority (>50%) Black, Latina/o, Asian or White. T-tests and hierarchical linear regressions were used to examine differences and associations between neighbourhoods on key health (general health, mental health, obesity, diabetes, cancer, coronary heart disease, chronic obstructive pulmonary disease, stroke), and social outcomes (income, unemployment, age, population density). Results indicated that minority neighbourhoods in California exhibited stark health and social disparities versus White neighbourhoods, displaying worse outcomes on nearly every social and health variable/condition examined; particularly for Black and Latina/o neighbourhoods. Moreover, regression findings revealed that, after considering income, unemployment, and population density, (1) fair/poor mental health and higher percentages of Black, Latina/o and Asian residents in neighbourhoods independently associated with greater neighbourhood fair/poor physical health, and (2) fair/poor mental health significantly associated with greater prevalence of obesity and COPD. This study thus underscores the need to address the profound health and social disparities experienced by minority neighbourhoods for more equitable neighbourhoods.
Collapse
Affiliation(s)
- Qiuxi Li
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, CA, USA
| | - Jason A Douglas
- Department of Health, Society, and Behavior, Program in Public Health, Center for Environmental Health Disparities Research, University of California, Irvine, CA, USA
| | - Andrew M Subica
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, CA, USA
| |
Collapse
|
11
|
Richardson S, Verma A, Sanaiha Y, Chervu NL, Pan C, Williamson CG, Benharash P. Racial disparities in outcomes for extracorporeal membrane oxygenation in the United States. Am J Surg 2023; 225:113-117. [PMID: 36180299 DOI: 10.1016/j.amjsurg.2022.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/09/2022] [Accepted: 09/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Racial disparities in extracorporeal membrane oxygenation (ECMO) outcomes in patients with a broad set of indications are not well documented. METHODS Adults requiring ECMO were identified in the 2016-2019 National Inpatient Sample. Patient and hospital characteristics, including mortality, clinical outcomes, and resource utilization were analyzed using multivariable regressions. RESULTS Of 43,190 adult ECMO patients, 67.8% were classified as White, 18.1% Black, and 10.4% Hispanic. Although mortality for Whites declined from 47.5 to 41.0% (P = 0.002), it remained steady for others. Compared to White, Asian/Pacific Islander (PI) race was linked to increased odds of mortalty (AOR = 1.4, 95% CI = 1.1-2.0). Black race was associated with increased odds of acute kidney injury (AOR = 1.4, 95%-CI: 1.2-1.7), while Hispanic race was linked to neurologic complications (AOR 21.6; 95% CI 1.2-2.3). Black and Hispanic race were also associated with increased incremental costs. CONCLUSIONS Race-based disparities in ECMO outcomes persist in the United States. Further work should aim to understand and mitigate the underlying reasons for such findings.
Collapse
Affiliation(s)
- Shannon Richardson
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nikhil L Chervu
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Chelsea Pan
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Catherine G Williamson
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| |
Collapse
|
12
|
Abu-Saad K, Daoud N, Kaplan G, Ziv A, Cohen AD, Olmer L, Pollack D, Kalter-Leibovici O. Comparing Patient Perspectives on Diabetes Management to the Deficit-Based Literature in an Ethnic Minority Population: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14769. [PMID: 36429486 PMCID: PMC9691122 DOI: 10.3390/ijerph192214769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Marginalized racial/ethnic minorities have disproportionately high rates of type 2 diabetes prevalence, complications and mortality. Researchers and policymakers have typically addressed these disparities using a deficit-based discourse focused on individual/cultural deficiencies or failure. A mixed-methods study was used to compare the deficit discourse to the perspectives of adults with diabetes in the Arab minority in Israel, using data from 10 focus groups (5 men's, 5 women's) and 296 quantitative in-person surveys. Both qualitative and quantitative data were triangulated. In addition, multivariable regression models tested associations between diabetes management perspectives and participant characteristics. Contrary to the deficit-based characterizations of patients as fatalistic and unknowledgeable, participants viewed diabetes as a chronic disease with serious complications. They expressed more support for patient responsibility in diabetes management than for passive fatalism, and were less fatalistic as educational level and adequacy of diabetes self-care training increased. The impact of social/environmental barriers and changing cultural norms on lifestyle behaviors was highlighted. Over 95% used prescription medications for diabetes management, although 35% reported economic barriers. The deficit discourse is not well-aligned with Arab patients' evolving perceptions and needs, and has deflected attention from the socioeconomic/structural determinants of health, and the healthcare system's responsibility to provide effective, culturally-relevant diabetes services.
Collapse
Affiliation(s)
- Kathleen Abu-Saad
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Nihaya Daoud
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84015, Israel
| | - Giora Kaplan
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Arnona Ziv
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Arnon D. Cohen
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84015, Israel
| | - Liraz Olmer
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Daphna Pollack
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Ofra Kalter-Leibovici
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52621, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| |
Collapse
|
13
|
Dismantling Structural Barriers: Resident Clinics Refocused on Equity. Obstet Gynecol 2022; 140:739-742. [PMID: 36201760 DOI: 10.1097/aog.0000000000004920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/09/2022] [Indexed: 11/07/2022]
Abstract
Disparities in health by race, ethnicity, and socioeconomic status within obstetrics and gynecology are well described and prompt evaluation for structural barriers. Academic medicine has a historical role in caring for marginalized populations, with medical trainees often serving as first-line clinicians for outpatient care. The ubiquitous approach of concentrating care of marginalized patients within resident and trainee clinics raises ethical questions regarding equity and sends a clear message of value that is internalized by learners and patients. A path forward is elimination of the structural inequities caused by maintenance of clinics stratified by training level, thereby creating an integrated patient pool for trainees and attending physicians alike. In this model, demographic and insurance information is blinded and patient triage is guided by clinical acuity and patient preference alone. To address structural inequities in our health care delivery system, we implemented changes in our department. Our goals were to improve access and patient experience and to send a unified message to our patients, learners, and faculty-our clinical staff, across all training levels, are committed to giving the highest standard of care to all people, regardless of insurance status or ability to pay. Academic medical centers must look internally for structural barriers that contribute to health care disparities within obstetrics and gynecology as we aim to make progress toward equity.
Collapse
|
14
|
Bell JAH, Salis M, Tong E, Nekolaichuk E, Barned C, Bianchi A, Buchman DZ, Rodrigues K, Shanker RR, Heesters AM. Clinical ethics consultations: a scoping review of reported outcomes. BMC Med Ethics 2022; 23:99. [PMID: 36167536 PMCID: PMC9513991 DOI: 10.1186/s12910-022-00832-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical ethics consultations (CEC) can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council (MRC) proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. OBJECTIVE The primary objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization. METHODS We searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. RESULTS Forty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality (n = 31), process factors (n = 23), and clinical factors (n = 19). The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes. CONCLUSIONS This scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC.
Collapse
Affiliation(s)
- Jennifer A H Bell
- Department of Clinical and Organizational Ethics, University Health Network, Toronto, ON, Canada. .,Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada. .,The Institute for Education Research, University Health Network, Toronto, ON, Canada. .,Dalla Lana School of Public Health and Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Marina Salis
- Dalla Lana School of Public Health and Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada.,Department of Philosophy, University of Toronto, Toronto, ON, Canada.,William Osler Health System, Brampton, ON, Canada
| | - Eryn Tong
- Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Erica Nekolaichuk
- Gerstein Science Information Centre, University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Claudia Barned
- Department of Clinical and Organizational Ethics, University Health Network, Toronto, ON, Canada.,The Institute for Education Research, University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health and Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada.,Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montreal, Montreal, QC, Canada
| | - Andria Bianchi
- Department of Clinical and Organizational Ethics, University Health Network, Toronto, ON, Canada.,The Institute for Education Research, University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health and Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada.,KITE Research Institute, Toronto Rehabilitation, Toronto, ON, Canada
| | - Daniel Z Buchman
- Dalla Lana School of Public Health and Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kevin Rodrigues
- Department of Clinical and Organizational Ethics, University Health Network, Toronto, ON, Canada.,The Institute for Education Research, University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health and Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Ruby R Shanker
- Department of Clinical and Organizational Ethics, University Health Network, Toronto, ON, Canada.,The Institute for Education Research, University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health and Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Ann M Heesters
- Department of Clinical and Organizational Ethics, University Health Network, Toronto, ON, Canada.,The Institute for Education Research, University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health and Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
15
|
Ebel NH, Lai JC, Bucuvalas JC, Wadhwani SI. A review of racial, socioeconomic, and geographic disparities in pediatric liver transplantation. Liver Transpl 2022; 28:1520-1528. [PMID: 35188708 PMCID: PMC9949889 DOI: 10.1002/lt.26437] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/21/2022] [Accepted: 02/15/2022] [Indexed: 02/07/2023]
Abstract
Equity is a core principle in both pediatrics and solid organ transplantation. Health inequities, specifically across race, socioeconomic position, or geography, reflect a moral failure. Ethical principles of prudential life span, maximin principle, and fair innings argue for allocation priority to children related to the number of life years gained, equal access to transplant, and equal opportunity for ideal posttransplant outcomes. Iterative policy changes have aimed to narrow these disparities to achieve pediatric transplant equity. These policy changes have focused on modifying pediatric priority for organ allocation to eliminate mortality on the pediatric transplant waiting list. Yet disparities remain in pediatric liver transplantation at all time points: from access to referral for transplantation, likelihood of living donor transplantation, use of exception narratives, waitlist mortality, and inequitable posttransplant outcomes. Black children are less likely to be petitioned for exception scores, have higher waitlist mortality, are less likely to be the recipient of a living donor transplant, and have worse posttransplant outcomes compared with White children. Children living in the most socioeconomically deprived neighborhoods have worse posttransplant outcomes. Children living farther from a transplant center have higher waitlist mortality. Herein we review the current knowledge of these racial and ethnic, socioeconomic, and geographic disparities for these children. To achieve equity, stakeholder engagement is required at all levels from providers and health delivery systems, learning networks, institutions, and society. Future initiatives must be swift, bold, and effective with the tripartite mission to inform policy changes, improve health care delivery, and optimize resource allocation to provide equitable transplant access, waitlist survival, and posttransplant outcomes for all children.
Collapse
Affiliation(s)
- Noelle H Ebel
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics Stanford University Stanford California USA Division of Gastroenterology, Hepatology & NutritionDepartment of Medicine University of California San Francisco California USA Division of Pediatric HepatologyDepartment of Pediatrics Icahn School of Medicine at Mount Sinai New York New York USA Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of PediatricsUniversity of CaliforniaSan Francisco California USA
| | | | | | | |
Collapse
|
16
|
COVID-19 Vaccine Coverage and Sociodemographic, Behavioural and Housing Factors Associated with Vaccination among People Experiencing Homelessness in Toronto, Canada: A Cross-Sectional Study. Vaccines (Basel) 2022; 10:vaccines10081245. [PMID: 36016133 PMCID: PMC9412474 DOI: 10.3390/vaccines10081245] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
People experiencing homelessness were prioritized for COVID-19 vaccination in Toronto, Canada, due to the high risk of infection and associated complications relative to the general population. We aimed to ascertain COVID-19 vaccine coverage in this population and explore factors associated with the receipt of at least one dose. We collected survey and blood sample data from individuals ages 16+ recruited by random selection at 62 shelters, hotels and encampment sites between 16 June 2021 and 9 September 2021. We report vaccine coverage by dose number and explored sociodemographic, behavioral, health and housing factors associated with vaccination using multivariable modified Poisson regression. In total, 80.4% (95% CI 77.3–83.1%) received at least one vaccine dose, and 63.6% (CI 60.0–67.0%) received two or more doses. Vaccination was positively associated with age (every 10 years adjusted rate ratio (aRR) 1.05 [95% CI 1.03–1.08]), and receipt of influenza vaccination (aRR 1.19 [95% CI 1.11–1.27]). Factors negatively associated with vaccination included female gender (aRR 0.92 [95% CI 0.85–1.0]), Black racial self-identification (aRR 0.89 [95% CI 0.80–0.99]) and low frequencies of masking in public places (aRR 0.83 [95% CI 0.72–0.95]). COVID-19 vaccine coverage is very high among people experiencing homelessness in Toronto, suggesting advocacy and outreach efforts may have been effective.
Collapse
|
17
|
Burnett-Bowie SAM, Zeidman JA, Soltoff AE, Carden KT, James AK, Armstrong KA. Attitudes and Actions Related to Racism: the Anti-RaCism (ARC) Survey Study. J Gen Intern Med 2022; 37:2337-2344. [PMID: 35157198 PMCID: PMC9360374 DOI: 10.1007/s11606-021-07385-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/22/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Racism negatively impacts health and well-being. Members of the medical community must intervene to address racism. OBJECTIVE To assess whether attitudes about the impact of racism on health or society are associated with intervening around racism. DESIGN Cross-sectional survey of a large department of medicine in an urban academic setting. PARTICIPANTS Interns, residents, fellows, and faculty. MAIN MEASURES The primary outcome was the likelihood of intervening around an observed racist encounter or a racist policy. Predictor variables included age, gender identity, race/ethnicity, and attitudes about racism. KEY RESULTS Although the majority of the 948 respondents endorsed the impact of racism on health and other societal effects, levels of endorsement were lower among older individuals, or those reporting male gender identity or selecting other race. Higher endorsement of the impact of racism on health was associated with increased odds of speaking up about a racist encounter or racist policy, with odds ratios from 1.18 to 1.30 across scenarios. Likelihood of speaking up about racism did not differ by racial or ethnic group, but older individuals were generally more likely to speak up and individuals between 20 and 29 years of age were more likely to speak with someone other than leadership or the source of a racist encounter. CONCLUSIONS Awareness of the effects of racism on health is associated with increased likelihood of intervening when a racist encounter is observed or a racist policy is noted. Including information on the impact of racism on health and creating safe spaces to discuss racism may increase the likelihood of bystander intervention in anti-racism strategies.
Collapse
Affiliation(s)
- Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA, 02114-2696, USA.
| | - Jessica A Zeidman
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexander E Soltoff
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kylee T Carden
- Department of Physics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Aisha K James
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Katrina A Armstrong
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
18
|
Abstract
This study uses data from the state-level Youth Risk Behavioral Survey to evaluate mental health and substance use outcomes among homeless and nonhomeless adolescents in 2019.
Collapse
Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, Massachusetts
| | - Katherine A. Koh
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Rishi K. Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
19
|
Charleston L, Savage-Edwards B, Bragg SM, Baygani SK, Dennehy EB. Migraine history and response to lasmiditan across racial and ethnic groups. Curr Med Res Opin 2022; 38:721-730. [PMID: 35350937 DOI: 10.1080/03007995.2022.2057152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The robust enrollment in SPARTAN and SAMURAI provided the opportunity to present post-hoc descriptive details on migraine disease characteristics and treatment outcomes after treatment with lasmiditan, a selective serotonin (5-HT1F) receptor agonist, in racial and ethnic subgroups. METHODS Descriptive data from racial (White [W](n = 3471) and Black or African American [AA](n = 792)) and ethnic (Hispanic or Latinx [HL](n = 775) and Non-Hispanic or Latinx [Non-HL](n = 3637)) populations are presented on pooled data from two double-blind, placebo-controlled, randomized Phase 3 studies (SAMURAI [NCT02439320] and SPARTAN [NCT2605174]). Patients were treated with lasmiditan (50 (SPARTAN only), 100, or 200 mg) or placebo for a single migraine attack of moderate-to-severe intensity. Efficacy data were recorded in an electronic diary at baseline, 30, 60, 90, and 120 min. Safety was evaluated and reported by occurrences of adverse events. RESULTS Clinical characteristics were generally similar across populations. W participants had longer migraine history than AA participants, and Non-HL participants had more migraine disability than HL participants. In the lasmiditan single-attack studies, AA participants waited longer than W participants to take study drug. A higher proportion of HL participants rated baseline migraine severity as severe compared to Non-HL participants. Response to lasmiditan was similar across racial and ethnic groups, including pain response, freedom from most bothersome symptom and migraine-related disability, and safety and tolerability. Across multiple outcomes, AA and HL participants tended to report more positive outcomes. CONCLUSIONS There were few differences in demographic and clinical characteristics across racial and ethnic groups. Similar lasmiditan efficacy and safety outcomes were observed in AA versus W participants, and in HL versus Non-HL participants. Small observed differences may be driven by a tendency toward a more positive response observed across all treatment groups by AA and HL participants.
Collapse
Affiliation(s)
- Larry Charleston
- Department of Neurology and Ophthalmology, Michigan State University College of Human Medicine, East Lansing, MI, USA
| | | | | | | | - Ellen B Dennehy
- Eli Lilly and Company, Indianapolis, IN, USA
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| |
Collapse
|
20
|
Case SM, Kerr GS, Chandler M, Stone VE, Blanco I, Feldman CH. Recognizing Racial Bias and Promoting Diversity in the Rheumatology Workforce. Arthritis Rheumatol 2022; 74:1459-1463. [PMID: 35467800 DOI: 10.1002/art.42151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/21/2022] [Accepted: 04/19/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Siobhan M Case
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Division of Immunology, Boston Children's Hospital, Boston, MA
| | - Gail S Kerr
- Department of Rheumatology, DC Veterans Affairs Medical Center, Georgetown and Howard University Hospitals, Washington, DC
| | - Mia Chandler
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Division of Immunology, Boston Children's Hospital, Boston, MA
| | - Valerie E Stone
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Irene Blanco
- Department of Medicine - Rheumatology, Albert Einstein College of Medicine, Bronx, NY
| | - Candace H Feldman
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
21
|
Fleming E, Raskin SE, Brody E. From describing disparities to understanding why disparities exist: Anti-racist methods to support dental public health research. J Public Health Dent 2022; 82 Suppl 1:73-78. [PMID: 35726470 PMCID: PMC9541958 DOI: 10.1111/jphd.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
Racism is understudied in the oral health literature at the same time that race is overutilized as an explanatory factor in study design. Social and behavioral methodologies offer conceptual models that can be used to include racism in dental public health questions. In addition, interdisciplinary and mixed methods approaches allow for understanding racism as an underlying cause of social and health disparities and exploring solutions that address historical, institutional, social, political, and economic drivers of oral health inequity, while recognizing the limits of measuring racism quantitatively. In a collective acknowledgement of the limitations of conventional methods, there are new opportunities to explore how qualitative and mixed methods research can serve as drivers for both social justice and health equity, while building and sustaining a diverse research workforce that can better close these disparities and offer antiracist solutions to oral health inequities.
Collapse
Affiliation(s)
- Eleanor Fleming
- Department of Dental Public health, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Sarah E Raskin
- iCubed Oral Health Core, L. Douglas Wilder School of Government and Public Affairs and Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Erica Brody
- Health Sciences Library, Virginia Commonwealth University, Richmond, Virginia, USA
| |
Collapse
|
22
|
Hollmann P. #AGS22: Offering the Latest to Learn in Medication Use, COVID-19 Research, Dementia Treatments, Health Equity & More. J Gerontol Nurs 2022; 48:51-52. [PMID: 35201927 DOI: 10.3928/00989134-20220209-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
23
|
Patterns of Allergic Contact Dermatitis in African Americans in a Major Metropolitan Area Over a 10-Year Period. Dermatitis 2021; 33:70-79. [PMID: 34967773 DOI: 10.1097/der.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Differences in patterns of allergic contact dermatitis (ACD) among underrepresented minority populations are not well studied. OBJECTIVE The aim of the study was to investigate patterns of ACD in African American and White patch-tested patients in a distinct metropolitan area over a 10-year period. METHODS We conducted a retrospective review of 297 ACD patients patch tested from 2009 to 2019. Differences in allergen frequency, relevance, and sources of exposure were evaluated. Fisher exact test analyses were performed to examine these differences. RESULTS Among 297 patients, 215 were White and 47 were African American. The most common sensitizers differed between the 2 groups. African American patients also reacted with statistically significant greater frequency to disperse dye blue (P = 0.019) and textile dye mix (P = 0.001). The most common source of positive patch tests for all patients was personal care products (72%). Occupational allergy was greater in African American male patients, and personal care product exposure was greater in White male patients (P = 0.009). CONCLUSIONS Our study highlights the differing patterns of sensitization seen in African American and White patients. This is likely due to differences in personal care product use or occupational allergy. Additional studies with larger sample sizes are needed to expand upon these differences.
Collapse
|