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Myers S, Kenzik K, Allee L, Dechert T, Theodore S, Jaffe A, Sanchez SE. Social Determinants of Health Associated With the Need for Urgent Versus Elective Cholecystectomy at an Urban, Safety-Net Hospital. Surg Infect (Larchmt) 2024; 25:101-108. [PMID: 38301176 DOI: 10.1089/sur.2023.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Background: Benign gallstone disease is the most frequent indication for cholecystectomy in the United States. Many patients present with complicated disease requiring urgent interventions, which increases morbidity and mortality. We investigated the association between individual and population-level social determinants of health (SDoH) with urgent versus elective cholecystectomy. Patients and Methods: All patients undergoing cholecystectomy (2014-2021) for benign gallstone disease were included. Demographic and clinical data were linked to population-level SDoH characteristics using census tracts. Data were analyzed using descriptive and inferential statistics. Results: A total of 3,197 patients met inclusion criteria; 1,913 (59.84%) underwent urgent cholecystectomy, 1,204 (37.66%) underwent emergent cholecystectomy, and 80 (2.5%) underwent interval cholecystectomy. On multinomial logistic regression, patients who were older (relative risk [RR], 1.010; p < 0.001), black (RR, 1.634; p = 0.008), and living in census tracts with a higher percent of poverty (RR, 0.017; p = 0.021) had a higher relative risk of presenting for urgent cholecystectomy. Patients who were female (RR, 0.462; p < 0.001), had a primary care provider (PCP; RR, 0.821; p = 0.018), and lived in census tracts with low supermarket access (RR, 0.764; p = 0.038) had a lower relative risk of presenting for urgent cholecystectomy. Only age (RR, 1.066; p < 0.001), female gender (RR, 0.227; p < 0.001), and having a PCP (RR, 1.984; p = 0.034) were associated with presentation for interval cholecystectomy. Conclusions: Patients who were older, black, and living in census tracts with high poverty levels had a higher relative risk of presenting for urgent cholecystectomy at our institution, whereas females and patients with PCPs were more likely to undergo elective cholecystectomy. Improved access to primary care and surgical clinics for all patients at safety-net hospitals may result in improved outcomes in the management of benign gallstone disease by increasing diagnosis and treatment in the elective setting.
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Affiliation(s)
- Sara Myers
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Kelly Kenzik
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Lisa Allee
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Tracey Dechert
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Sheina Theodore
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Abraham Jaffe
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Sabrina E Sanchez
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
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Bedi NS, Tsering D, Raubenhold R, Allee L, Mahoney EJ, Wurcel A, Byhoff E. Analysis of bias in toxicology screening of patients in serious motor vehicle collisions. Acad Emerg Med 2024; 31:185-186. [PMID: 37606997 DOI: 10.1111/acem.14793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Neil Singh Bedi
- Boston Trauma, Division of Trauma & Acute Care Surgery & Surgical Critical Care, Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Dolma Tsering
- Yale University School of Public Health, New Haven, Connecticut, USA
| | - Rachel Raubenhold
- Boston Trauma, Division of Trauma & Acute Care Surgery & Surgical Critical Care, Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Lisa Allee
- Boston Trauma, Division of Trauma & Acute Care Surgery & Surgical Critical Care, Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Eric J Mahoney
- Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Alysse Wurcel
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Elena Byhoff
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA
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Jang H, Scantling D, Allee L, Brahmbhatt TS. Secondary Traumatic Stress Disorder in the Surgical Profession. J Surg Res 2023; 292:176-181. [PMID: 37625207 DOI: 10.1016/j.jss.2023.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/05/2023] [Accepted: 06/25/2023] [Indexed: 08/27/2023]
Abstract
INTRODUCTION The psychological impact of treating individuals who have undergone severely traumatic experiences is known as secondary traumatic stress (STS). It has been well characterized by mental health therapists and social workers. Analysis of STS in surgeons and medical students is limited to merely a handful of studies, with only 1 paper describing STS in trauma surgeons and two describing STS in medical students. This review aims to provide a comprehensive account of existing work on STS, identify gaps in knowledge of STS in surgeons and medical students, and distinguish STS from other similar phenomena that have been commonly misidentified by recent works. MATERIALS AND METHODS A review of the literature in English was conducted through PubMed. MeSH terms included "STS, compassion fatigue, vicarious traumatization, and secondary trauma." All papers referenced in the identified works were screened and assessed for relevance. RESULTS Only two studies that directly assess STS in surgeons were identified. STS levels reported varied widely between the two. Similar studies were identified that focused on burnout, compassion fatigue, or post-traumatic stress disorder, which are similar but not identical. Only 1 study evaluated STS in trauma surgeons and found that 65% of those in the study had at least 1 symptom of STS. Only two studies were identified that studied STS in medical students, but with conflicting results on prevalence. It was identified that there are various measuring tools to assess for STS symptoms but no established standard of assessment that allows for cross-comparisons. CONCLUSION Knowledge of STS is extremely limited in surgeons and medical students, not only due to a general lack of awareness of STS but also due to confusion and misuse of other related terms. This review calls for more efforts to identify and address STS in surgeons and medical students while also standardizing methodologies that screen for STS symptoms.
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Affiliation(s)
- Hyerim Jang
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Dane Scantling
- Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Lisa Allee
- Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Tejal S Brahmbhatt
- Division of Trauma and Acute Care Surgery & Surgical Critical Care, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
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Poulson MR, Neufeld MY, Laraja A, Allee L, Kenzik KM, Dechert T. The effect of historic redlining on firearm violence. J Natl Med Assoc 2023; 115:421-427. [PMID: 37365061 DOI: 10.1016/j.jnma.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 05/01/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Firearm homicides disproportionately affect young Black men, which in turn have lasting impact of communities of color as a whole. Previous cross-sectional studies have highlighted the role of discriminatory housing policies on the incidence of urban firearm violence. We sought to estimate the effects of racist housing policies on firearm incidence. METHODS Firearm incident data were obtained from the Boston Police Department and point locations spatially joined with vector files outlining the original 1930 Home Owner Loan Corporation (HOLC) Redlining maps. A regression discontinuity design was used to assess the increased rate of firearm violence crossing from historically "desirable" neighborhoods (Green) to historically "hazardous" neighborhoods (Red and Yellow) based on HOLC definitions. Linear regression models were fit on either side of the geographic boundaries with firearm incidents graphed at varying distances and the regression coefficient calculated at the boundary. RESULTS Crossing from desirable to Red hazardous designation there was a significant discontinuity with an increase of 4.1 firearm incidents per 1,000 people (95% CI 0.68,7.55). Similarly, when crossing from desirable areas to the Yellow hazardous designation there was a significant discontinuity and increase of 5.9 firearm incidents per 1,000 people (95% CI 1.85,9.86). There was no significant discontinuity between the two hazardous HOLC designations (coefficient -0.93, 95% CI -5.71, 3.85). CONCLUSIONS There is a significant increase in firearm incidents in historically redlined areas of Boston. This suggests that interventions should focus on downstream socioeconomic, demographic, and neighborhood detriments of historically discriminatory housing policies in order to address firearm homicides.
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Affiliation(s)
- Michael R Poulson
- Department of Surgery, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Miriam Y Neufeld
- Department of Surgery, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | | | - Lisa Allee
- Department of Surgery, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Kelly M Kenzik
- Department of Surgery, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Tracey Dechert
- Department of Surgery, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
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Neufeld MY, Plaitano E, Janeway MG, Munzert T, Scantling D, Allee L, Sanchez SE. History repeats itself: Impact of mental illness on violent reinjury and hospital reencounters among female victims of interpersonal violence. J Trauma Acute Care Surg 2023; 95:143-150. [PMID: 37068014 PMCID: PMC10407825 DOI: 10.1097/ta.0000000000003984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Violence-related reinjury impacts both patients and health care systems. Mental illness (MI) is prevalent among violently injured individuals. The relationship between preexisting MI and violent reinjury among women has not been fully characterized. Our objective was to determine if risk of hospital reencounter-violent reinjury and all-cause-was associated with preexisting MI at time of index injury among female victims of violence. METHODS All females (15-100 + years) presenting to a level I trauma center with violent injury (2002-2019) surviving to discharge were included (N = 1,056). Exposure was presence of preexisting MI. The primary outcome was hospital reencounters for violent reinjury and all-cause within one year (through 2020). The secondary outcome was the development of a new MI within one year of index injury. Odds of reencounter and development of new MI for those with and without preexisting MI were compared with multivariable logistic regression, stratified for interaction when appropriate. RESULTS There were 404 women (38%) with preexisting MI at time of index injury. Approximately 11% of patients with preexisting MI experienced violent reinjury compared to 5% of those without within 1 year ( p < 0.001). Specifically, those with MI in the absence of concomitant substance use had more than three times the odds of violent reinjury (adjusted Odds Ratio, 3.52 (1.57, 7.93); p = 0.002). Of those with preexisting MI, 64% had at least one reencounter for any reason compared to 46% of those without ( p < 0.001 ) . Odds of all-cause reencounter for those with preexisting MI were nearly twice of those without (adjusted Odds Ratio, 1.81 [1.36, 2.42]; p < 0.0001). CONCLUSION Among female victims of violence, preexisting MI is associated with a significantly increased risk of hospital reencounter and violent reinjury within the first year after index injury. Recognition of this vulnerable population and improved efforts at addressing MI in trauma patients is critical to ongoing prevention efforts to reduce violent reinjury. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Miriam Y Neufeld
- From the Department of Surgery (M.Y.N., T.M., D.S., L.A., S.E.S.), Boston Medical Center; Department of Surgery (M.Y.N., D.S., L.A., S.E.S.), Boston University School of Medicine; Undergraduate Program in Neuroscience (E.P.), Boston University College of Arts and Sciences, Boston, Massachusetts; and Department of Surgery (M.G.J.), University of Michigan, Ann Arbor, Michigan
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Abstract
BACKGROUND Much of the recorded medical literature focuses on individual-level factors that contribute to firearm violence. Recently, studies have highlighted higher incidence of firearm violence in historically redlined and marginalized areas, but few have gone on to study the downstream associations causing these differences. This study aims to understand the effects of historic redlining and current income mobility on firearm violence. METHODS Using a retrospective cross-sectional design, shooting incidents were spatially joined with redlining vector files and linked to income mobility data (how much a child makes in adulthood). Participants included all assault and homicide incidents involving a firearm in the city of Boston, between 2016 and 2019. The exposure of interest was redlining designation as outlined by the Home Owner's Loan Corporation (HOLC) in the 1930s and income mobility, stratified by race, defined as the income of a child in their 30s compared with where they grew up (census tract level). The outcome measured was shooting rate per census block. RESULTS We find that increases in Black income mobility (BIM) and White income mobility (WIM) are associated with significant decreases in rates of firearm incidents in all HOLC designations; however, there is a larger decrease with increasing BIM (relative risk, 0.47 per unit increase in BIM [95% confidence interval, 0.35-0.64]; relative risk, 0.81 per unit increase in WIM [95% confidence interval, 0.71-0.93]). Plotting predicted rates of firearm violence in each HOLC designation at different levels of BIM, there were no significant differences in shooting rates between historically harmful and beneficial classifications above $50,000 of BIM. Despite level of WIM, there were continued disparities between harmful and beneficial HOLC classification. CONCLUSION These findings highlight the importance of structural racism in the form of redlining and discriminatory housing policies, and the preclusion from economic mobility therein, on the incidence of firearm violence today. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Michael R Poulson
- From the Department of Surgery (M.R.P., M.Y.N., A.L., L.A., K.M.K., T.D.), Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; and Institute for Cancer Outcomes and Survivorship (K.M.K.), University of Alabama-Birmingham, Birmingham, Alabama
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Allee L, Faul M, Guntipalli P, Burke PA, Rao SR, Reed DN, Gross R, Duncan TK, Palmieri TL, Cooper Z, Bulger EM, Stewart RM, Kuhls DA. The Role of the US Trauma Centers in Older Adult Fall Prevention: A National Survey. Am Surg 2021:31348211047509. [PMID: 34748452 DOI: 10.1177/00031348211047509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Approximately 27.5% of adults 65 and older fall each year, over 3 million are treated in an emergency department, and 32 000 die. The American College of Surgeons and its Committee on Trauma (ACSCOT) have urged trauma centers (TCs) to screen for fall risk, but information on the role of TC in this opportunity for prevention is largely unknown. METHODS A 29-item survey was developed by an ACSCOT Injury Prevention and Control Committee, Older Adult Falls workgroup, and emailed to 1000 trauma directors of the National Trauma Data Bank using Qualtrics. US TCs were surveyed regarding fall prevention, screening, intervention, and hospital discharge practices. Data collected and analyzed included respondent's role, location, population density, state designation or American College of Surgeons (ACS) level, if teaching facility, and patient population. RESULTS Of the 266 (27%) respondents, 71% of TCs include fall prevention as part of their mission, but only 16% of TCs use fall risk screening tools. There was no significant difference between geographic location or ACS level. The number of prevention resources (F = 31.58, P < .0001) followed by the presence of a formal screening tool (F = 21.47, P < .0001) best predicted the presence of a fall prevention program. CONCLUSION Older adult falls remain a major injury risk and injury prevention opportunity. The majority of TCs surveyed include prevention of older adult falls as part of their mission, but few incorporate the components of a fall prevention program. Development of best practices and requiring TCs to screen and offer interventions may prevent falls.
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Affiliation(s)
- Lisa Allee
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Mark Faul
- Liaison to ACS COT, 1242Injury Prevention and Control Committee, USA
| | | | - Peter A Burke
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Sowmya R Rao
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Donald N Reed
- Texas Health Resources, 2910Texas Woman's University, Dallas, TX, USA
| | | | | | - Tina L Palmieri
- Shriners Hospital for Children, 8789UC Davis Health, Davis, CA, USA
| | - Zara Cooper
- 1861Brigham and Women's Hospital, Boston, MA, USA
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Poulson M, Neufeld MY, Dechert T, Allee L, Kenzik KM. Historic redlining, structural racism, and firearm violence: A structural equation modeling approach. Lancet Reg Health Am 2021; 3. [PMID: 34888540 PMCID: PMC8654098 DOI: 10.1016/j.lana.2021.100052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Firearm homicides disproportionately affect Black communities. Redlining – discriminatory lending practices of the early 20th century - are associated with current increased rates of firearm violence. Poverty and concentrated disadvantage are also associated with firearm violence. The interaction of these factors with racist redlining housing practices remains unclear. Methods: We used generalized structural equation modeling to characterize the mediators through which redlining practices of the 1930s led to present rates of firearm violence in Boston using a negative binomial model. Principle component analysis was used to create four distinct mediating variables representing census block socioeconomic and built environment information, while reducing dimensionality. We calculated the direct effect between harmful (Red and Yellow) vs beneficial (Green) designations and firearm incident rate, indirect effect between redlining designation and firearm incident rate through each mediating variable, and the total effect. The percentage mediation of each mediator was subsequently calculated. Findings: Red and Yellow areas of Boston were associated with an 11•1 (95% CI 5•5,22•4) and 11•4 (5•7,22•8) increased incident rate of shooting when compared to Green. In the pathway between Red designation and firearm incident rate, poverty and poor educational attainment mediated 20% of the interaction, share of rented housing mediated 8%, and Black share of the population 3%. In the pathway between Yellow designation and firearm incident rate, poverty and poor educational attainment mediated 16% of the association, and Black share of the population mediated 13%. Interpretation: Redlining practices of the 1930s potentially contribute to increased rates of firearm violence through changes to neighborhood environments, namely through preclusion from homeownership, poverty, poor educational attainment, and concentration (i.e. segregation) of Black communities. These downstream mediating factors serve as points for policy interventions to address urban firearm violence. Funding: Michael Poulson and Miriam Neufeld were supported by T32 Training Grants (HP10028, GM86308).
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Affiliation(s)
- Michael Poulson
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Miriam Y Neufeld
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Tracey Dechert
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Lisa Allee
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Kelly M Kenzik
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA.,Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
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Bonne S, Hink A, Violano P, Allee L, Duncan T, Burke P, Fein J, Kozyckyj T, Shapiro D, Bakes K, Kuhls D, Bulger E, Dicker R. Understanding the makeup of a growing field: A committee on trauma survey of the national network of hospital-based violence intervention programs. Am J Surg 2021; 223:137-145. [PMID: 34446215 DOI: 10.1016/j.amjsurg.2021.07.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/06/2021] [Accepted: 07/19/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Among Hospital Based Violence Intervention programs (HVIPs), little is known about variation in services provided, funding sources, or populations served. STUDY DESIGN Twenty-eight member programs of Health Alliance for Violence Intervention participated in a survey administered by the American College of Surgeons Committee on Trauma. Questions were quantitative and qualitative. For qualitative analysis, questions pertaining to the domains were assessed for common themes and assessed across all subject domains. RESULTS All programs enroll patients injured by community violence, some by intimate partner violence (IPV), trafficking, and rarely by child or elder abuse. Programs with more funding (≥$300,000 per year) were more likely federally, state, or city funded. Lower funded programs (≤$300,000 per year) were funded by foundations or philanthropy. In both qualitative and quantitative analysis, barriers to starting or sustaining HVIPs included funding, and lack of risk reduction and mental health resources. Successful programs had stable funding, adequate staffing, and buy in from hospitals and staff. CONCLUSION HVIPs serve diverse populations in variable models. There is opportunity to expand the reach of HVIPs, and the experience if existing programs is an invaluable resource.
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Affiliation(s)
- Stephanie Bonne
- Division of Trauma and Surgical Critical Care, Rutgers New Jersey Medical School, Newark, NJ 150 Bergen Street, M-228 Newark, NJ, 07103, USA.
| | - Ashley Hink
- Division of General and Acute Care Surgery, Medical University of South Carolina, 171 Ashley Ave. Charleston, SC, 29425, USA.
| | - Pina Violano
- Yale New Haven Hospital, New Haven, CT (At the Time of Publication) 20 York St New Haven, CT, 06510, USA.
| | - Lisa Allee
- Department of Surgery, Division of Trauma, Boston University Medical Center, One Boston Medical Center Plaza, Boston, MA, 02118, USA.
| | - Thomas Duncan
- Ventura County Medical Center, 300 Hillmont Ave Ventura, CA, 93003, USA.
| | - Peter Burke
- Department of Surgery, Division of Trauma, Boston University Medical Center, One Boston Medical Center Plaza, Boston, MA, 02118, USA.
| | - Joel Fein
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd Philadelphia, PA, 19104, USA.
| | - Tamara Kozyckyj
- American College of Surgeons Committee on Trauma, 633 N. Saint Clair St Chicago, IL, 60611, USA.
| | - David Shapiro
- St. Francis Hospital and Medical Center, 114 Woodland St Hartford, CT, 06105, USA.
| | - Katherine Bakes
- Department of Emergency Medicine, University of Colorado School of Medicine, 13001 E. 17th Pl, Aurora, CO, 80045, USA.
| | - Deborah Kuhls
- Division of Acute Care Surgery, University of Nevada, Las Vegas School of Medicine, 2040 W. Charleston, Blvd Las Vegas, NV, 89102, USA.
| | - Eileen Bulger
- Division of Trauma, Burn and Critical Care, University of Washington Harborview Medical Center, 325 9th Ave. Seattle, WA, 98104, USA.
| | - Rochelle Dicker
- Division of Trauma and Critical Care, University of California at Los Angeles Geffen School of Medicine, 10833 Le Conte Ave Los Angeles, CA, 90095, USA.
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Poulson M, Geary A, Annesi C, Allee L, Kenzik K, Sanchez S, Tseng J, Dechert T. National Disparities in COVID-19 Outcomes between Black and White Americans. J Natl Med Assoc 2021; 113:125-132. [PMID: 32778445 PMCID: PMC7413663 DOI: 10.1016/j.jnma.2020.07.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/11/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is very limited comprehensive information on disparate outcomes of black and white patients with COVID-19 infection. Reports from cities and states have suggested a discordant impact on black Americans, but no nationwide study has yet been performed. We sought to understand the differential outcomes for black and white Americans infected with COVID-19. METHODS We obtained case-level data from the Centers for Disease Control and Prevention on 76,442 white and 48,338 non-Hispanic Black patients diagnosed with COVID-19, ages 0 to >80+, outlining information on hospitalization, ICU admission, ventilation, and death outcomes. Multivariate Poisson regressions were used to estimate the association of race, treating white as the reference group, controlling for sex, age group, and the presence of comorbidities. RESULTS Black patients were generally younger than white, were more often female, and had larger numbers of comorbidities. Compared to white patients with COVID-19, black patients had 1.4 times the risk of hospitalization (RR 1.42, p < 0.001), and almost twice the risk of requiring ICU care (RR 1.68, p < 0.001) or ventilatory support (RR 1.81, p < 0.001) after adjusting for covariates. Black patients saw a 1.36 times increased risk of death (RR 1.36, p < 0.001) compared to white. Disparities between black and white outcomes increased with advanced age. CONCLUSION Despite the initial descriptions of COVID-19 being a disease that affects all individuals, regardless of station, our data demonstrate the differential racial effects in the United States. This current pandemic reinforces the need to assess the unequal effects of crises on disadvantaged populations to promote population health.
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Affiliation(s)
- Michael Poulson
- Department of Surgery, Boston University/Boston Medical Center; Boston University School of Medicine
| | - Alaina Geary
- Department of Surgery, Boston University/Boston Medical Center; Boston University School of Medicine
| | | | - Lisa Allee
- Department of Surgery, Boston University/Boston Medical Center
| | - Kelly Kenzik
- Department of Surgery, Boston University/Boston Medical Center; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sabrina Sanchez
- Department of Surgery, Boston University/Boston Medical Center; Boston University School of Medicine
| | - Jennifer Tseng
- Department of Surgery, Boston University/Boston Medical Center; Boston University School of Medicine
| | - Tracey Dechert
- Department of Surgery, Boston University/Boston Medical Center; Boston University School of Medicine.
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11
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Janeway MG, Zhao X, Rosenthaler M, Zuo Y, Balasubramaniyan K, Poulson M, Neufeld M, Siracuse JJ, Takahashi CE, Allee L, Dechert T, Burke PA, Li F, Kalesan B. Clinical diagnostic phenotypes in hospitalizations due to self-inflicted firearm injury. J Affect Disord 2021; 278:172-180. [PMID: 32961413 DOI: 10.1016/j.jad.2020.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 07/07/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND . Hospitalized self-inflicted firearm injuries have not been extensively studied, particularly regarding clinical diagnoses at the index admission. The objective of this study was to discover the diagnostic phenotypes (DPs) or clusters of hospitalized self-inflicted firearm injuries. METHODS . Using Nationwide Inpatient Sample data in the US from 1993 to 2014, we used International Classification of Diseases, Ninth Revision codes to identify self-inflicted firearm injuries among those ≥18 years of age. The 25 most frequent diagnostic codes were used to compute a dissimilarity matrix and the optimal number of clusters. We used hierarchical clustering to identify the main DPs. RESULTS . The overall cohort included 14072 hospitalizations, with self-inflicted firearm injuries occurring mainly in those between 16 to 45 years of age, black, with co-occurring tobacco and alcohol use, and mental illness. Out of the three identified DPs, DP1 was the largest (n=10,110), and included most common diagnoses similar to overall cohort, including major depressive disorders (27.7%), hypertension (16.8%), acute post hemorrhagic anemia (16.7%), tobacco (15.7%) and alcohol use (12.6%). DP2 (n=3,725) was not characterized by any of the top 25 ICD-9 diagnoses codes, and included children and peripartum women. DP3, the smallest phenotype (n=237), had high prevalence of depression similar to DP1, and defined by fewer fatal injuries of chest and abdomen. LIMITATIONS . Claims data. CONCLUSIONS . There were three distinct diagnostic phenotypes in hospitalizations due to self-inflicted firearm injuries. Further research is needed to determine how DPs can be used to tailor clinical care and prevention efforts.
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Affiliation(s)
- Megan G Janeway
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | - Xiang Zhao
- Department of Medicine and Mathematics and Statistics, Boston University School of Medicine and Graduate School of Arts and Sciences, Boston, MA, USA
| | - Max Rosenthaler
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Yi Zuo
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Michael Poulson
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | - Miriam Neufeld
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | - Jeffrey J Siracuse
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | | | - Lisa Allee
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | - Tracey Dechert
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | - Peter A Burke
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | - Feng Li
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China
| | - Bindu Kalesan
- Department of Medicine and Community Health Sciences, Boston University, 72 E Concord St L-516, Boston, MA 02118, USA.
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Neufeld MY, Janeway MG, Lee SY, Miller MI, Smith EA, Kalesan B, Allee L, Dechert T, Sanchez SE. Utilization of mental health services in pediatric patients surviving penetrating trauma resulting from interpersonal violence. Am J Surg 2021; 221:233-239. [PMID: 32690211 PMCID: PMC7736092 DOI: 10.1016/j.amjsurg.2020.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Violent trauma has lasting psychological impacts. Our institution's Community Violence Response Team (CVRT) offers mental health services to trauma victims. We characterized implementation and determined factors associated with utilization by pediatric survivors of interpersonal violence-related penetrating trauma. METHODS Analysis included survivors (0-21 years) of violent penetrating injury at our institution (2011-2017). Injury and demographic data were collected. Nonparametric regression models determined factors associated with utilization. RESULTS There was initial rapid uptake of CVRT (2011-2013) after which it plateaued, serving >80% of eligible patients (2017). White race and higher injury severity were associated with receipt and duration of services. In post-hoc analysis, race was found to be associated with continued treatment but not with initial consultation. CONCLUSION Successful implementation required three years, aiding >80% of patients. CVRT is a blueprint to strengthen existing violence intervention programs. Efforts should be made to ensure that barriers to providing care, including those related to race, are overcome.
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Affiliation(s)
- Miriam Y Neufeld
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
| | - Megan G Janeway
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
| | - Su Yeon Lee
- Montefiore Medical Center, 111 E 210th St, Bronx, NY, 10467, USA.
| | - Matthew I Miller
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
| | - Erin A Smith
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
| | - Bindu Kalesan
- Boston University School of Medicine and Public Health, 715 Albany St, Boston, MA, 02118, USA.
| | - Lisa Allee
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
| | - Tracey Dechert
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
| | - Sabrina E Sanchez
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
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Janeway MG, Talutis S, Cornell E, Jreige N, Liang V, Sanchez S, Allee L, Munzert T, Dechert T. Disparities in Rehab Placement for Victims of Violence. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ogburn JA(T, Espey E, Pierce-Bulger M, Waxman A, Allee L, Haffner WH, Howe J. Midwives and Obstetrician-Gynecologists Collaborating for Native American Women’s Health. Obstet Gynecol Clin North Am 2012; 39:359-66. [DOI: 10.1016/j.ogc.2012.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Saxe GN, Miller A, Bartholomew D, Hall E, Lopez C, Kaplow J, Koenen KC, Bosquet M, Allee L, Erikson I, Moulton S. Incidence of and Risk Factors for Acute Stress Disorder in Children with Injuries. ACTA ACUST UNITED AC 2005; 59:946-53. [PMID: 16374286 DOI: 10.1097/01.ta.0000187659.37385.16] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To assess the incidence of and risk factors for Acute Stress Disorder (ASD) in children with injuries. Numerous studies have documented the increased incidence of PTSD in those initially diagnosed with ASD. PTSD symptoms cause tremendous morbidity and may persist for many years in some children. METHODS Children hospitalized with one or more injuries were interviewed and assessed with the following: Child Stress Disorders Checklist (CSDC), Family Strains Scale, Brief Symptom Inventory (BSI) and Facial Pain Scale. RESULTS Participants included sixty-five children (ages 7-18 years). The mechanisms of injury varied (e.g. MVC, penetrating). The mean injury severity score was 8.9 +/- 7. The mean length of hospital stay was 4.6 +/- 4.6 days. Altogether, 18 (27.7%) of participants met DSM IV criteria for ASD during their acute hospital stay. Risk factors such as level of family stress, caregiver stress, child's experience of pain, and child's age were predictive of acute stress symptoms. CONCLUSION We have identified four risk factors of ASD that have implications for the treatment, and possibly, preventative intervention for PTSD. Further investigation and greater understanding of risk factors for ASD in children with injuries may facilitate the design of acute interventions to prevent the long-term negative outcomes of traumatic events.
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Affiliation(s)
- Glenn N Saxe
- Department of Child and Adolescent Psychiatry, Boston Medical Center, MA 02118, USA.
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