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Zvolensky MJ, Shepherd JM, Clausen BK, Robison J, Cano MÁ, de Dios M, Correa-Fernández V. Posttraumatic stress and probable post traumatic stress disorder as it relates to smoking behavior and beliefs among trauma exposed hispanic persons who smoke. J Behav Med 2024:10.1007/s10865-024-00480-8. [PMID: 38409553 DOI: 10.1007/s10865-024-00480-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
There has been little scientific effort to evaluate the associations between cigarette smoking and cessation-related constructs and exposure to traumatic events, posttraumatic stress, and Posttraumatic Stress Disorder (PTSD) symptoms among Hispanic persons who smoke in the United States (US). Such trauma-related factors may pose unique difficulties for Hispanic persons who smoke and possess a desire to quit. As such, the present investigation sought to fill this gap in the literature and examine posttraumatic stress and probable PTSD in terms of their relations with several clinically significant smoking constructs among trauma-exposed Hispanic persons who smoke from the United States. Participants included 228 Spanish-speaking Hispanic persons who endorsed prior traumatic event exposure and smoked combustible cigarettes daily (58.3% female, Mage= 32.1 years, SD = 9.65). Results indicated that posttraumatic stress symptoms were related to increased cigarette dependence, perceived barriers for smoking cessation, and more severe problems when trying to quit with effect sizes ranging from small to moderate in adjusted models. Additionally, Hispanic persons who smoke with probable PTSD compared to those without probable PTSD showcased a statistically effect for perceived barriers for cessation (p < .008) and a severity of problems when trying to quit (p < .001). No effect was evident for cigarette dependence after alpha correction. Overall, the present study offers novel empirical evidence related to the role of posttraumatic stress symptoms and PTSD among Hispanic persons who smoke in the US. Such findings highlight the need to expand this line of research to better understand the role of posttraumatic stress and PTSD among Hispanic persons who smoke which can inform smoking cessation treatments for Hispanic persons who smoke experiencing trauma-related symptomology.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA.
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Justin M Shepherd
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Bryce K Clausen
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Jillian Robison
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Miguel Ángel Cano
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, USA
| | - Marcel de Dios
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
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2
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Vest JR, Hinrichs RJ, Hosler H. How legal problems are conceptualized and measured in healthcare settings: a systematic review. HEALTH & JUSTICE 2023; 11:48. [PMID: 37979059 PMCID: PMC10656991 DOI: 10.1186/s40352-023-00246-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
Legal problems encompass issues requiring resolution through the justice system. This social risk factor creates barriers in accessing services and increases risk of poor health outcomes. A systematic review of the peer-reviewed English-language health literature following the PRISMA guidelines sought to answer the question, how has the concept of patients' "legal problems" been operationalized in healthcare settings? Eligible articles reported the measurement or screening of individuals for legal problems in a United States healthcare or clinical setting. We abstracted the prevalence of legal problems, characteristics of the sampled population, and which concepts were included. 58 studies reported a total of 82 different measurements of legal problems. 56.8% of measures reflected a single concept (e.g., incarcerated only). The rest of the measures reflected two or more concepts within a single reported measure (e.g., incarcerations and arrests). Among all measures, the concept of incarceration or being imprisoned appeared the most frequently (57%). The mean of the reported legal problems was 26%. The literature indicates that legal concepts, however operationalized, are very common among patients. The variation in measurement definitions and approaches indicates the potential difficulties for organizations seeking to address these challenges.
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Affiliation(s)
- Joshua R Vest
- Indiana University Richard M Fairbanks School of Public Health, Indianapolis, IN, USA.
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.
| | - Rachel J Hinrichs
- University Library, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Heidi Hosler
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.
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3
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DePolo N, Bathan K, Tran Z, Peng J, Singh P, Lum SS, Wu E. Prospective Assessment of Social Determinants of Health and Length of Stay Among Emergency General Surgery and Trauma Patients. Am Surg 2023; 89:4186-4190. [PMID: 37278008 DOI: 10.1177/00031348231180927] [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: 06/07/2023]
Abstract
BACKGROUND Social determinants of health (SDOH) including insurance and substance use affect 50-90% of health outcomes, yet there remains no standard means to quantify or predict their impact. We prospectively evaluated the effects of SDOH on length of stay (LOS) and readmissions among emergency general surgery (EGS) and trauma patients. We compared these outcomes with Medicare Diagnosis Related Group (DRG) data to better quantify the impact of SDOH. METHODS Adult (≥18 years old) EGS/trauma patients admitted July 7-28, 2020 at a Level 1 trauma center were prospectively enrolled. Primary outcomes were overall LOS, one-year readmissions, and excess LOS (eLOS), defined as days beyond DRG mean LOS. RESULTS Assessment of SDOH among the 52 patients enrolled revealed that 5.8% of patients were homeless; 26.9% experienced substance abuse; 13.5% were uninsured on admission; and 7.7% on discharge. Mean LOS was 5 ± 4 days; 1-year readmission rate 25.0%; eLOS mean 1.75 ± 2.4 days. LOS was associated with substance use (OR 70.6 95% CI 11.7-160.4). eLOS was associated with substance use (OR 6.1, 95% CI 1.5-25.1) and public or no insurance (OR 26.0, 95% CI 4.9-138.1). No correlations were found between SDOH and readmission rates. DISCUSSION EGS and trauma patients experience high rates of negative SDOH which affect clinical outcomes including LOS and readmissions. Medicare DRG determined eLOS is a fiscally relevant measure of the impact of SDOH and differs from LOS and readmissions. Further investigation is required to determine if eLOS can delineate the effects of other SDOH on admission outcomes for this patient population.
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Affiliation(s)
- Nicole DePolo
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Karen Bathan
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Zachary Tran
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Jiahao Peng
- Center for Health Research, Loma Linda University, Loma Linda, CA, USA
| | - Pramil Singh
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Sharon S Lum
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Esther Wu
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
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Johnson LW, Diaz I. Exploring the Social Determinants of Health and Health Disparities in Traumatic Brain Injury: A Scoping Review. Brain Sci 2023; 13:brainsci13050707. [PMID: 37239178 DOI: 10.3390/brainsci13050707] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/09/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Traumatic brain injury (TBI) is a global health concern, that can leave lasting physical, cognitive, and/or behavioral changes for many who sustain this type of injury. Because of the heterogeneity of this population, development of appropriate intervention tools can be difficult. Social determinants of health (SDoH) are factors that may impact TBI incidence, recovery, and outcome. The purpose of this study is to describe and analyze the existing literature regarding the prevailing SDoH and health disparities (HDs) associated with TBI in adults. A scoping review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was used to explore three electronic databases-PubMed, Medline, and CINAHL. Searches identified peer-reviewed empirical literature addressing aspects of SDoH and HDs related to TBI. A total of 123 records were identified and reduced to 27 studies based on inclusion criteria. Results revealed race/ethnicity was the most commonly reported SDoH impacting TBI, followed by an individual's insurance status. Health disparities were noted to occur across the continuum of TBI, including TBI risk, acute hospitalization, rehabilitation, and recovery. The most frequently reported HD was that Whites are more likely to be discharged to inpatient rehabilitation compared to racial/ethnic minorities. Health disparities associated with TBI are most commonly associated with the race/ethnicity SDoH, though insurance status and socioeconomic status commonly influence health inequities as well. The additional need for evidence related to the impact of other, lesser researched, SDoH is discussed, as well as clinical implications that can be used to target intervention for at-risk groups using an individual's known SDoH.
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Affiliation(s)
- Leslie W Johnson
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham, NC 27707, USA
| | - Isabella Diaz
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham, NC 27707, USA
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5
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Knight N. Advocating for Equitable Healthcare for the Undocumented Immigrant. J Christ Nurs 2022; 39:214-220. [PMID: 36048594 DOI: 10.1097/cnj.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Despite the healthcare community's increased efforts to reduce health disparities in the United States, undocumented immigrants (UIs) remain one of the highest at-risk populations. Health and public policies, societal and healthcare worker bias, and fear of deportation are among barriers to healthcare access, resulting in increasingly poor health and health outcomes. Christian nurses, guided by biblical principles and the American Nurses Association's Code of Ethics for Nurses, can advocate for UIs' healthcare needs by supporting and promoting more inclusive institutional and government policies.
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Affiliation(s)
- Natalie Knight
- Natalie Knight, MSN, RN, CMSRN , is the nurse manager of an inpatient med-surg unit at a hospital in Illinois. She recently completed her MSN in health policy and has a growing interest in the role nurses play in advocating for healthcare legislation
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Barthélemy EJ, Affana CK, Asfaw ZK, Dams-O'Connor K, Rahman J, Jones S, Ullman J, Margetis K, Hickman ZL, Dangayach NS, Giwa AO. Racial and Socioeconomic Disparities in Neurotrauma: Research Priorities in the New York Metropolitan Area through a Global Neurosurgery Paradigm. World Neurosurg 2022; 165:51-57. [PMID: 35700861 DOI: 10.1016/j.wneu.2022.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
The New York Neurotrauma Consortium (NYNC) is a nascent multidisciplinary research and advocacy organization based in the New York Metropolitan Area (NYMA). It aims to advance health equity and optimize outcomes for traumatic brain and spine injury patients. Given the extensive racial, ethnic, and socioeconomic diversity of the NYMA, global health frameworks aimed at eliminating disparities in neurotrauma may provide a relevant and useful model for the informing research agendas of consortia like the NYNC. In this review, we present a comparative analysis of key health disparities in traumatic brain injury (TBI) that persist in the NYMA as well as in low- and middle-income countries (LMIC). Examples include: (a) inequitable access to quality care due to fragmentation of healthcare systems, (b) barriers to effective prehospital care for TBI, and (c) socioeconomic challenges faced by patients and their families during the subacute and chronic post-injury phases of TBI care. This review presents strategies to address each area of health disparity based on previous studies conducted in both LMIC and high-income country (HIC) settings. Increased awareness of healthcare disparities, education of healthcare professionals, effective policy advocacy for systemic changes, and fostering racial diversity of the trauma care workforce can guide the development of trauma care systems in the NYMA that are free of racial and related healthcare disparities.
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Affiliation(s)
- Ernest J Barthélemy
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, California, USA.
| | | | - Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Kristen Dams-O'Connor
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jueria Rahman
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Queens, New York
| | - Salazar Jones
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Queens, New York
| | - Jamie Ullman
- New York Neurotrauma Consortium, Inc., New York, New York; Institute for Neurology and Neurosurgery at North Shore University Hospital
| | - Konstantinos Margetis
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Zachary L Hickman
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Queens, New York
| | - Neha S Dangayach
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Al O Giwa
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Fu SJ, Arnow K, Trickey A, Spain DA, Morris A, Knowlton L. Financial Burden of Traumatic Injury Amongst the Privately Insured. Ann Surg 2022; 275:424-432. [PMID: 34596072 DOI: 10.1097/sla.0000000000005225] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to evaluate the overall financial burden associated with traumatic injury amongst patients with private insurance and assess the effect of high deductible plans on out-of-pocket costs (OOPCs). SUMMARY OF BACKGROUND DATA Traumatic injury can be a source of unexpected financial burden for households. However, the effect of increasing participation in higher cost-sharing private health insurance plans remains unknown. METHODS We conducted a retrospective cohort observational study, using the Clinformatics Data Mart Database, a nationwide single-payer administrative claims database to identify US adults who required emergency department services or hospital admission for single traumatic injury from 2008 to 2018. A 2-part model using a logistic regression and a generalized linear model with gamma distribution and log link was used to evaluate 12-month OOPCs after traumatic injury. Multivariable logistic regression was used to evaluate the likelihood of catastrophic health expenditure (CHE) after injury. RESULTS Of 426,945 included patients, 53% were male, 71% were white, and median age was 42 years. Patients faced monthly OOPC of $660 at the time of their injury. High deductible plan enrollment was associated with an increase of $1703 in 12-month OOPC after trauma, compared to those covered by traditional health plans. In addition to high deductible health plan enrollment, worsening injury severity and longer hospital stays were also associated with increased 12-month OOPC after trauma. Non-white minorities paid less 12-month OOPC after trauma compared to non-Hispanic white patients, but also used fewer services. Overall, the incidence of CHE was 5%; however high-deductible health plan enrollees faced a 13% chance of CHE. CONCLUSIONS Privately insured trauma patients face substantial OOPCs at the time of their injuries. High-deductible health plans are associated with increased financial vulnerability after trauma.
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Affiliation(s)
- Sue J Fu
- S-SPIRE, Department of Surgery, Division of General Surgery, Stanford University
- Health Research and Development, Veteran Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Katherine Arnow
- S-SPIRE, Department of Surgery, Division of General Surgery, Stanford University
| | - Amber Trickey
- S-SPIRE, Department of Surgery, Division of General Surgery, Stanford University
| | - David A Spain
- S-SPIRE, Department of Surgery, Division of General Surgery, Stanford University
| | - Arden Morris
- S-SPIRE, Department of Surgery, Division of General Surgery, Stanford University
| | - Lisa Knowlton
- S-SPIRE, Department of Surgery, Division of General Surgery, Stanford University
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Hand and Upper Extremity Trauma in the Undocumented Immigrant Population in the United States. PLASTIC AND RECONSTRUCTIVE SURGERY - GLOBAL OPEN 2022; 10:e4117. [PMID: 35198348 PMCID: PMC8856121 DOI: 10.1097/gox.0000000000004117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
Undocumented immigrants in the United States are at risk for upper extremity trauma due to occupational exposure, and decreased access to healthcare can worsen outcomes. The purpose of this study was to compare documented versus undocumented patients in a large cohort of patients in New York City's most diverse neighborhood in order to characterize upper extremity trauma in this population.
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9
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Olafson SN, Cohen RB, Parsikia A, Moran B, Kaplan MJ, Leung P. Insurance Status Impacts Hospital Discharge for Penetrating Trauma Survivors. Am Surg 2021; 88:1996-2002. [PMID: 34053228 DOI: 10.1177/00031348211023396] [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: 11/16/2022]
Abstract
BACKGROUND Despite equalized acute care in trauma, disparities exist in the long-term outcomes of trauma survivors. Prior studies have revealed insurance status plays a role in the discharge destination of blunt trauma survivors. This is yet to be described in patients with penetrating traumatic injury. METHODS A retrospective chart review from 2009 to 2019 from an urban Level 1 trauma center identified adult patients who survived penetrating trauma to discharge. Patients were categorized by insurance status. Patient demographics, discharge destination, and hospital length of stay (LOS) were analyzed using the t-test and ANOVA. RESULTS 1806 patients were identified with 1410 survivors to hospital discharge. Among the survivors, 26.8% were uninsured, 13.1% were privately insured, and 60.0% had Medicare/Medicaid. The uninsured patients were significantly less likely to be discharged to a rehabilitation facility or skilled nursing facility (OR = .49, 95% CI .35-.71) compared to the insured patients. Uninsured survivors had shorter LOS compared to the other groups (5.8 vs. 7.3, P < .01.) Severity of injury did not significantly influence the discharge destination or LOS between the groups. CONCLUSION Despite recent health care reform, many trauma patients remain uninsured. Our study shows that uninsured penetrating trauma survivors are less likely to be discharged to rehabilitation and skilled nursing facilities. This may contribute to uninsured trauma survivors not receiving appropriate post-traumatic care and could lead to the accrual of undue disability, long-term complications, and increased societal burdens.
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Affiliation(s)
- Samantha N Olafson
- Department of Surgery, 6566Einstein Medical Center, Philadelphia, PA, USA
| | - Ryan B Cohen
- Department of Surgery, 6566Einstein Medical Center, Philadelphia, PA, USA
| | - Afshin Parsikia
- Department of Surgery, 6566Einstein Medical Center, Philadelphia, PA, USA
| | - Benjamin Moran
- Department of Surgery, 6566Einstein Medical Center, Philadelphia, PA, USA
| | - Mark J Kaplan
- Department of Surgery, 6566Einstein Medical Center, Philadelphia, PA, USA
| | - Pak Leung
- Department of Surgery, 6566Einstein Medical Center, Philadelphia, PA, USA
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10
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Pappadis MR, Sander AM, Struchen MA, Kurtz DM. Soy diferente: a qualitative study on the perceptions of recovery following traumatic brain injury among Spanish-speaking U.S. immigrants. Disabil Rehabil 2020; 44:2400-2409. [PMID: 33108224 DOI: 10.1080/09638288.2020.1836045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To explore the impact of traumatic brain injury (TBI) on the quality of life (QoL) and self-concept of Spanish-speaking U.S. Hispanic immigrants with TBI. MATERIALS AND METHODS A prospective, qualitative study conducted in a county level I trauma center and community. Semi-structured interviews on QoL and self-concept following TBI were conducted with 24 Spanish-speaking U.S. Hispanic immigrants with TBI living in the community at least 6 months following injury. RESULTS Perceived facilitators of QoL included faith, hopefulness in recovery, empathy for others, and support from others. Perceived barriers to QoL mentioned were symptoms/consequences of injury, employment/financial changes, loss of independence, fear/uncertainty, stigma/shame, lack of medical care, and decreased social integration. Participants described their self-concept after TBI as either a maintained self or loss of self. Those who viewed themselves differently reported physical and emotional changes, gender role conflict, loss of self-worth, and total loss due to the TBI. CONCLUSIONS Spanish-speaking U.S. Hispanic immigrants held a strong faith and positive outlook after TBI in spite of the significant barriers to recovery. A need exists for programs to support creatively the recovery of Spanish-speaking U.S. Hispanic immigrants with limited access to care and resources.IMPLICATIONS FOR REHABILITATIONSpanish-speaking U.S. Hispanic immigrants may experience significant barriers to care following traumatic brain injury (TBI), such as access to rehabilitation services and follow-up care.Rehabilitation professionals should consider the importance of faith and encourage positive thinking and social support when working with Spanish-speaking U.S. Hispanic immigrants on how to cope with TBI-related challenges.Access to Spanish-speaking rehabilitation professionals, translators and Spanish language educational materials could help reduce language-related barriers to recovery among Spanish-speaking U.S. immigrants with TBI.Rehabilitation facilities should develop partnerships with community-based organizations serving the uninsured or underinsured to address the access to rehabilitation and medical needs of Spanish-speaking U.S. immigrants with TBI.
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Affiliation(s)
- Monique R Pappadis
- Division of Rehabilitation Sciences and Sealy Center on Aging, University of Texas Medical Branch at Galveston, Galveston, TX, USA.,TIRR Memorial Hermann Brain Injury Research Center, Houston, TX, USA
| | - Angelle M Sander
- TIRR Memorial Hermann Brain Injury Research Center, Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, TX, USA
| | - Margaret A Struchen
- TIRR Memorial Hermann Brain Injury Research Center, Houston, TX, USA.,Center for Rehabilitation Psychology and Neuropsychology, PC, Walnut Creek, CA, USA
| | - Diana M Kurtz
- TIRR Memorial Hermann Brain Injury Research Center, Houston, TX, USA.,Spring Branch Counseling Center, Houston, TX, USA
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11
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Outcomes in Critically Ill Patients With Traumatic Brain Injury: Ethnicity, Documentation, and Insurance Status. Crit Care Med 2020; 48:31-40. [PMID: 31567403 DOI: 10.1097/ccm.0000000000004043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Disparities in traumatic brain injury outcomes for ethnic minorities and the uninsured have previously been demonstrated; however, outcomes in undocumented immigrants have not been examined. We wanted to determine whether ethnicity, insurance, and documentation status served as risk factors for disparities in traumatic brain injury outcomes between undocumented immigrants and documented residents. DESIGN Retrospective study. SETTING Patients diagnosed with traumatic brain injury admitted to the surgical/trauma ICU at a level 1 trauma center serving a large immigrant population in New York City from 2009 to 2016. PATIENTS Four-hundred seventy-one traumatic brain injury patients requiring surgical/trauma ICU admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Undocumented immigrants constituted 29% of the population, were younger (39 vs 57 yr old, respectively; p < 0.0001), Hispanic (83%; p < 0.0001), and uninsured (87%; p < 0.0001). Falls resulted in the majority of traumatic brain injuries in the total population, however, undocumented immigrants were almost twice as likely to be assaulted (p = 0.0032). There was no difference in presence of midline shifts, Injury Severity Score, Glasgow Coma Score, hypotension, hypoxia, and pupillary reactions between undocumented immigrants and documented residents. Undocumented immigrants presented with significantly more effaced basilar cisterns (p = 0.0008). There was no difference in hospital care between undocumented immigrants and documented residents as determined by emergency department to surgical/trauma ICU transfer times (p = 0.967). Undocumented immigrants were more likely to be discharged home (53% vs 33%, respectively; p = 0.0009) and less likely to be sent to rehabilitation (25% vs 32%, respectively; p = 0.0009). After adjusting length of stay and mortality for covariates, undocumented immigrants had shorter length of stay (p < 0.05) and there was no difference in hospital mortality between undocumented immigrants and documented residents. CONCLUSIONS Undocumented immigrants with traumatic brain injuries were more likely to be younger, have shorter length of stay, and experience similar mortality rates to documented residents. Social economic status may play a role in events prior to hospitalization and likely does in disposition outcomes.
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12
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Rizzolo K, Novick TK, Cervantes L. Dialysis Care for Undocumented Immigrants With Kidney Failure in the COVID-19 Era: Public Health Implications and Policy Recommendations. Am J Kidney Dis 2020; 76:255-257. [PMID: 32413372 PMCID: PMC7217077 DOI: 10.1053/j.ajkd.2020.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/04/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Katherine Rizzolo
- Department of Internal Medicine, Maine Medical Center, Portland, ME.
| | - Tessa K Novick
- Division of Nephrology, Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin, TX
| | - Lilia Cervantes
- Division of Hospital Medicine and Office of Research, Denver Health, Denver, CO; Division of General Internal Medicine and Hospital Medicine, University of Colorado, Denver, CO
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13
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de Jager E, Levine AA, Udyavar NR, Burstin HR, Bhulani N, Hoyt DB, Ko CY, Weissman JS, Britt LD, Haider AH, Maggard-Gibbons MA. Disparities in Surgical Access: A Systematic Literature Review, Conceptual Model, and Evidence Map. J Am Coll Surg 2020; 228:276-298. [PMID: 30803548 DOI: 10.1016/j.jamcollsurg.2018.12.028] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Elzerie de Jager
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA; College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Adele A Levine
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | - N Rhea Udyavar
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | | | - Nizar Bhulani
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | | | - Clifford Y Ko
- American College of Surgeons, Chicago, IL; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Joel S Weissman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | - L D Britt
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA
| | - Adil H Haider
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | - Melinda A Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA.
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Haines KL, Agarwal S, Jung HS. Socioeconomics affecting quality outcomes in Asian trauma patients within the United States. J Surg Res 2018; 228:63-67. [PMID: 29907231 DOI: 10.1016/j.jss.2018.02.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 02/17/2018] [Accepted: 02/27/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Asian-Americans and Pacific Islanders are often considered as a uniform group when examining race in health outcomes. However, the generally favorable economic outcomes in this group belie significant socioeconomic variance between its heterogeneous subgroups. This study evaluates the impact of socioeconomic status on the health outcomes of Asian trauma patients. METHODS From 2012 to 2015, 52,704 Asians who presented to trauma centers were registered with the National Trauma Data Bank with known disposition. Chi2 and multivariate logistic regression analysis for mortality were performed controlling for age, gender, comorbidities, injury severity, insurance, race, and ethnicity. Negative binomial regression analysis with margins for length of stay (LOS) was performed. Subgroup analysis was done for polytrauma (Injury Severity Score >15, n = 14,787). RESULTS Asians represent 1.8% of the trauma population. Uninsured Asians were 1.9 times more likely to die than privately insured Asians (P < 0.001). Medicare patients were 1.8 times more likely to die (P < 0.001). Eighty-one Asians identified themselves as Hispanic, and there was no significant difference in their mortality or LOS for this group (P = 0.06, P = 0.18). Bleeding disorders, diabetes, cirrhosis, hypertension, respiratory disease, cancer, esophageal varices, angina, cerebrovascular accident, and dependent health care before trauma all individually affected mortality and were controlled for in this model (P < 0.05). LOS was 1.7 d longer in Medicaid patients (2.2 d with polytrauma) and 1.1 d longer in workman's compensation patients (2.1 d with polytrauma). Uninsured had a shorter LOS (P < 0.005). Asian males with polytrauma stayed 1.6 d longer than females (P < 0.001), and age did not affect LOS for this group. CONCLUSIONS Noteworthy socioeconomic disparities influence Asian trauma patients independent of their race. Mortality is affected by insurance status, despite controlling for injury severity and comorbidities.
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Affiliation(s)
- Krista L Haines
- Division of Trauma and Critical Care, Department of Surgery, Duke School of Medicine and Public Health, Duke University, Durham, North Carolina.
| | - Suresh Agarwal
- Division of Trauma and Critical Care, Department of Surgery, Duke School of Medicine and Public Health, Duke University, Durham, North Carolina
| | - Hee Soo Jung
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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