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Jecker NS, Atuire CA, Bélisle-Pipon JC, Ravitsky V, Ho A. AI and the falling sky: interrogating X-Risk. J Med Ethics 2024:jme-2023-109702. [PMID: 38575195 DOI: 10.1136/jme-2023-109702] [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] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/14/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Nancy S Jecker
- Department of Bioethics & Humanities, University of Washington School of Medicine, Seattle, Washington, USA
- African Centre for Epistemology and Philosophy of Science, University of Johannesburg, Auckland Park, Gauteng, South Africa
| | - Caesar Alimsinya Atuire
- Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
- Department of Philosophy and Classics, University of Ghana, Legon, Greater Accra, Ghana
| | | | - Vardit Ravitsky
- Hastings Center, Garrison, New York, USA
- Department of Global Health and Social Medicine, Harvard University, Cambridge, Massachusetts, USA
| | - Anita Ho
- Bioethics Program, University of California San Francisco, San Francisco, California, USA
- Centre for Applied Ethics, The University of British Columbia, Vancouver, British Columbia, Canada
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Chapman CR. Primary duty is to communicate moment-in-time nature of genetic variant interpretation. J Med Ethics 2023; 49:817-818. [PMID: 37734906 DOI: 10.1136/jme-2023-109446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Carolyn Riley Chapman
- Center for Human Genetics and Genomics and Department of Population Health (Division of Medical Ethics), NYU Langone Health, New York, New York, USA
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Camanni G, Ciccone O, Lepri A, Tinarelli C, Bedetti C, Cicuttin S, Murgia N, Elisei S. 'Being disabled' as an exclusion criterion for clinical trials: a scoping review. BMJ Glob Health 2023; 8:e013473. [PMID: 37918873 PMCID: PMC10626873 DOI: 10.1136/bmjgh-2023-013473] [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: 07/19/2023] [Accepted: 10/01/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND People with disabilities (PWDs) are often excluded from biomedical research, but comprehensive data regarding their participation in clinical trials are not available. The objective of this study was to assess the rates of exclusion of PWDs from recent medical scientific research. METHODS The protocol of the study was designed according to PRISMA-ScR (PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for Scoping Reviews) guidelines. All completed interventional clinical trials registered on ClinicalTrials.gov between 2010 and 2020 regarding the 10 leading causes of global disability-adjusted life-years according to the Global Burden of Disease Study were analysed. An exclusion criterion from the study was considered explicit if it could be associated with one of the following seven categories: disability, physical impairment, cognitive impairment, behavioural or psychiatric disorders, language and communication impairment, sensory impairment. Comorbidities not more clearly defined and researcher discretion regarding exclusion of study participants were considered to be 'implicit exclusion criteria'. We assessed the appropriateness of explicit exclusion criteria in relation to the primary objectives of the trials and labelled them as 'absolute', 'relative' or 'questionable'. RESULTS The total number of trials analysed was 2710; 170 were paediatric trials (6.3%), 2374 were adult trials (87.6%) and 166 were trials including subjects of all ages (6.1%). Explicit exclusion criteria were found in 958 trials (35.3%). The disability category most frequently excluded was behavioural or psychiatric disorders, present in 588 trials (61.4%). In only 3% and 1% of the trials, the exclusion criteria were considered either 'absolute' or 'questionable', while in 96% the exclusion criteria were judged as 'relative'. Implicit exclusion criteria were present in 1205 trials (44.5%). CONCLUSIONS This study highlights the high rate of exclusion of PWDs from biomedical research and the widespread use of ill-defined exclusion criteria in clinical trials. It underscores the importance of more inclusive study designs so that PWDs can become active participants in research.
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Affiliation(s)
- Guido Camanni
- Rehabilitation Unit, Istituto Serafico, Assisi; Perugia, Italy
| | - Ornella Ciccone
- Rehabilitation Unit, Istituto Serafico, Assisi; Perugia, Italy
| | | | | | - Chiara Bedetti
- Department of Neurology, Città di Castello Hospital, Citta di Castello, Italy
| | - Sandra Cicuttin
- Rehabilitation Unit, Istituto Serafico, Assisi; Perugia, Italy
| | - Nicola Murgia
- Department of Environmental Science and Prevention, University of Ferrara, Ferrara, Italy
| | - Sandro Elisei
- Rehabilitation Unit, Istituto Serafico, Assisi; Perugia, Italy
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Faissner M, Braun E. The ethics of coercion in mental healthcare: the role of structural racism. J Med Ethics 2023:jme-2023-108984. [PMID: 37845011 DOI: 10.1136/jme-2023-108984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
In mental health ethics, it is generally assumed that coercive measures are sometimes justified when persons with mental illness endanger themselves or others. Coercive measures are regarded as ethically justified only when certain criteria are fulfilled: for example, the intervention must be proportional in relation to the potential harm. In this paper, we demonstrate shortcomings of this established ethical framework in cases where people with mental illness experience structural racism. By drawing on a case example from mental healthcare, we first demonstrate that biases in assessing whether the coercive intervention is proportional are likely, for example, due to an overestimation of dangerousness. We then show that even if proportionality is assessed correctly, and the specific coercive intervention would thus be regarded as ethically justified according to the standard framework, coercion may still be ethically problematic. This is because the standard framework does not consider how situations in which coercive measures are applied arise. If structural racism causally contributes to such situations, the use of coercion can compound the prior injustice of racist discrimination. We conclude that the ethical analysis of coercion in mental healthcare should consider the possibility of discriminatory biases and practices and systematically take the influence of structural discrimination into account.
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Affiliation(s)
- Mirjam Faissner
- Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, Bochum, Germany
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Esther Braun
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
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Galasso I, Geiger S. Genetic research and the collective good: participants as leaders to reconcile individual and public interests. J Med Ethics 2023:jme-2022-108867. [PMID: 37673669 DOI: 10.1136/jme-2022-108867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 08/12/2023] [Indexed: 09/08/2023]
Abstract
This paper problematises the notions of public or common good as weighed against individual sovereignty in the context of medical research by focusing on genetic research. We propose the notion of collective good as the good of the particular collective in which the research was conducted. We conducted documentary and interview-based research with participant representatives and research leaders concerned with participant involvement in leading genetic research projects and around two recent genetic data controversies: the case of the UK Wellcome Sanger Institute, accused of planning unauthorised commercialisation of African DNA samples, and the case of the company Genuity Science, which planned genetic research on brain tumour samples in Ireland with no explicit patient consent. We advocate for greater specificity in circumscribing the collective to which genetic research relates and for greater efforts in including representatives of this collective as research coleaders in order to enable a more inclusive framing of the good arising from such research. Such community-based participant cogovernance and coleadership in genetic research is vital especially when minorities or vulnerable groups are involved, and it centrally requires community capacity building to help collectives articulate their own notions of the collective good.
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Affiliation(s)
- Ilaria Galasso
- School of Business, UCD, Dublin, Ireland
- Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany
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Jecker NS, Verweij M, Ravitsky V, Wangmo T, Ghaly M. Academic freedom under siege. J Med Ethics 2023:jme-2023-109498. [PMID: 37657921 DOI: 10.1136/jme-2023-109498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/20/2023] [Indexed: 09/03/2023]
Abstract
This paper describes a global pattern of declining academic freedom, often driven by powerful political interference with core functions of academic communities. It argues that countering threats to academic freedom requires doubling down on ethics, specifically standards of justice and fairness in pursuing knowledge and assigning warrant to beliefs. Using the example of the selection of a Qatari university to host the 2024 World Congress of Bioethics, the authors urge fairness towards diverse groups over time and efforts to counter injustices that conferences generate.
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Affiliation(s)
- Nancy S Jecker
- Department of Bioethics & Humanities, University of Washington School of Medicine, Seattle, Washington, USA
- African Centre for Epistomology and Philosophy of Science, University of Johannesburg, Johannesburg, Gauteng, South Africa
- Centre for Bioethics, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Marcel Verweij
- Ethics Institute, Utrecht University, Utrecht, The Netherlands
| | - Vardit Ravitsky
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Tenzin Wangmo
- Institute for Medical Ethics, University of Basel, Basel, Switzerland
| | - Mohammed Ghaly
- Research Center for Islamic Legislation and Ethics, Hamad Bin Khalifa University, Doha, Ad Dawhah, Qatar
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Blease C. Sharing online clinical notes with patients: implications for nocebo effects and health equity. J Med Ethics 2022; 49:medethics-2022-108413. [PMID: 35918134 DOI: 10.1136/jme-2022-108413] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
Patients in around 20 countries worldwide are now offered online access to at least some of their medical records. Access includes test results, medication lists, referral information, and/or the very words written by clinicians (so-called 'open notes'). In this paper, I discuss the possibility of one unintended negative consequence of patient access to their clinical notes-the potential to increase 'nocebo effects'. A growing body of research shows that nocebo effects arise by engaging perceptual and cognitive processes that influence negative expectancies, and as a consequence, adverse health effects. Studies show that increased awareness about the side effects of medications, the framing of information and the socioemotional context of care can increase the risk of nocebo effects. Connecting research into the nocebo effect with open notes provides preliminary support for the hypothesis that patient access to clinical notes might be a forum for facilitating unwanted nocebo effects. Furthermore, current findings indicate that we might expect to see systematic differences in how nocebo effects are experienced among different patient populations. The ethical implications of the tension between transparency and the potential for harm are discussed, with an emphasis on what open notes might mean for justice and equity in clinical care for a range of already marginalised patient populations. I argue that to resolve these challenges does not thereby justify 'closed notes', and conclude with suggestions for how health systems and clinicians might adapt to this innovation to reduce the risk of potential nocebo effects arising via this novel route.
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Affiliation(s)
- Charlotte Blease
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA
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Tuan WJ, Mellott M, Arndt BG, Jones J, Simpson AN. Disparities in Use of Patient Portals Among Adults in Family Medicine. J Am Board Fam Med 2022; 35:559-69. [PMID: 35641056 DOI: 10.3122/jabfm.2022.03.210486] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This study examined patient portal utilization by analyzing the pattern of time and feature use of patients, and thus to identify functionalities of portal use and patient characteristics that may inform future strategies to enhance communication and care coordination through online portals. METHODS We conducted a retrospective study of patients at 18 family medicine clinics over a 5-year period using access log records in the electronic health record database. Dimensionality reduction analysis was applied to group portal functionalities into 4 underlying feature domains: messaging, health information management, billing/insurance, and resource/education. Negative binomial regression analysis was used to evaluate how patient and practice characteristics affected the use of each feature domain. RESULTS Patients with more chronic conditions, lab tests, or prescriptions generally showed greater patient portal usage. However, patients who were male, elderly, in minority groups, or living in rural areas persistently had lower portal usage. Individuals on public insurance were also less likely than those on commercial insurance to use patient portals, although Medicare patients showed greater portal usage on health information management features, and uninsured patients had greater usage on viewing resource/education features. Having Internet access only affected the use of messaging features. CONCLUSION Efforts to enroll patients in online portals do not guarantee patients will use the portals to manage their health. When considering the use of patient portals for improving telehealth, clinicians need to be aware of technological, socioeconomic, and cultural challenges faced by their patients.
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O'Neill TR, Wang T, Newton WP. The American Board of Family Medicine's 8 Years of Experience with Differential Item Functioning. J Am Board Fam Med 2022; 35:18-25. [PMID: 35039408 DOI: 10.3122/jabfm.2022.01.210208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Differential item functioning (DIF) procedures flag examination questions in which examinees from different subpopulations who are of equal ability do not have the same probability of answering it correctly. Few medical certification boards employ DIF procedures because they do not collect the needed data on the examinee's race or ethnicity. This article summarizes the American Board of Family Medicine's (ABFM) combined use of DIF procedures and an expert panel to review certification questions for bias. METHODS ABFM certification examination data from 2013 to 2020 were analyzed using a DIF procedure to flag questions with possible ethnic or racial bias. The flagged questions were reviewed by a racially and ethnically diverse panel of content experts. If the panel judged the source of the DIF was not clinically relevant for the practice of family medicine, the question was removed from the examination. RESULTS Out of the 3487 questions analyzed, 374 unique questions (11%) were flagged by DIF procedures as potentially biased. Of the flagged questions, the review panel felt 4 should be removed for fairness. DISCUSSION Using DIF procedures and panel review can improve the quality of the board certification questions and demonstrate the organization's commitment to avoid racial or ethnic bias.
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Sturges D, Patterson DG, Bennett IM, Cawse-Lucas J. Can Family Medicine's Counterculture History Help Shape an Anti-Racist Future? J Am Board Fam Med 2022; 35:169-72. [PMID: 35039423 DOI: 10.3122/jabfm.2022.01.210295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/08/2022] Open
Abstract
Family medicine prides itself on community engagement and has embraced its counterculture roots. After the racial and social reckoning of 2020, including the COVID-19 pandemic and the Black Lives Matters movement, family medicine, as a specialty, must embrace anti-racism as a core value to meet community needs. This article reflects on the foundational tenets of family medicine's origin. It highlights the current disparities regarding professional representation while offering equitable, intentional, and collaborative approaches to move toward and achieve anti-racism within the specialty, medical education, and the community.
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Wang T, O'Neill TR, Newton WP, Hall K, Eden AR. Racial/Ethnic Representation Among American Board of Family Medicine Certification Candidates from 1970 to 2020. J Am Board Fam Med 2022; 35:9-17. [PMID: 35039407 DOI: 10.3122/jabfm.2022.01.210322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Because improved patient outcomes and experiences have been associated with health care workforce diversity, efforts to create a diverse family physician workforce have increased. However, a metric that could properly measure family physician representation in various contexts has seldom been studied. OBJECTIVE The goal of this study is to propose a new metric logRQ and use it to examine the diversification progress of American Board of Family Medicine (ABFM) certification candidates relative to national, state, and historic populations, as well as medical school matriculants. METHODS We obtained race/ethnicity for certification candidates from the 2014 to 2020 ABFM Certification Examination Registration questionnaire and examined racial/ethnic representation relative to various populations via logRQs. RESULTS The total sample comprised 26,368 initial certification candidates and 55,347 continuing certification candidates. Asian, Hispanic, and Black's logRQ increased by 0.51, 0.42, and 0.41, respectively, in initial certification candidates compared with continuing certification candidates. In addition, logRQ standard deviation ranged from 0.19 to 0.87 across States, indicating state-level variation. Although Black and Hispanic remained underrepresented, the degree of underrepresentation had improved substantially across the past 5 decades, with logRQ increasing from -2.12 (Black) and -1.16 (Hispanic) in the 1970s to -0.46 (Black) and -0.68 (Hispanic) in the 2010s. The race/ethnicity logRQs of 2020 initial certification candidates relative to 2013 to 2014 medical school matriculants were all near 0, reflecting equitable representation. CONCLUSION We utilized the proposed metric logRQ to quantify the advancement in representation among ABFM certification candidates in different contexts. The proposed logRQ may serve as a useful tool to monitor representation progress systematically.
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Xierali IM, Nivet MA, Rayburn WF. Diversity of Department Chairs in Family Medicine at US Medical Schools. J Am Board Fam Med 2022; 35:152-7. [PMID: 35039420 DOI: 10.3122/jabfm.2022.01.210298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 11/08/2022] Open
Abstract
As designated department leader, chairs need to be sensitive to diversity and inclusiveness for recruitment and retention of faculty and visibility to medical students and resident physicians. The purpose of this analysis is to describe diversity by sex and race/ethnicity of family medicine (FM) chairs as a beginning to understand trends. METHODS: This cross-sectional, observational study involved 2018 to 2020 data from the Association of American Medical Colleges Faculty Roster. We compared this data with other department chairs, faculty, medical school matriculants, and the US general population. RESULTS: There were 407 FM chair observations. While many FM chairs were White males, this was lower than all other clinical departments combined. The proportion of chairs who were under-represented minorities was highest in FM (16.7%) compared with all other departments The distributions of FM chairs who were Black, Asian, and Native American were comparable with the US population. The proportions of Hispanic FM chairs, FM faculty, and medical school matriculants lagged behind the population. CONCLUSION: Diversity of department chairs in FM is greater than many other clinical departments and more representative of the US general population. Attention by chairs to leadership development of females and recruitment of Hispanic faculty are priorities.
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Nobles A, Martin BA, Casimir J, Schmitt S, Broadbent G. Stalled Progress: Medical School Dean Demographics. J Am Board Fam Med 2022; 35:163-8. [PMID: 35039422 DOI: 10.3122/jabfm.2022.01.210171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/08/2022] Open
Abstract
Medical schools have an important directive: to train the next generation of physicians. Faced with a primary care physician shortage, increasing numbers of under-represented faculty leaving academic medicine, low representation of women in leadership positions, and an ongoing pandemic, medical schools have a duty to implement solutions to alleviate these issues. Efforts have been made to create more diverse medical school classes, but those efforts are not mirrored in senior faculty demographics. In this medical students' perspective piece, the authors analyzed the demographics of medical school deans in comparison with the United States' demographics and the current composition of active physicians. The authors looked at the specialty, race/ethnicity, and gender of medical school deans in 2019. Based on the analysis, in 2019 only 11% of deans were under-represented minorities, 16% of deans were primary care physicians, and 18% of deans were women. When compared with the makeup of physicians in the United States and the population as a whole, these numbers are unrepresentative of national demographics. By hiring deans with a variety of race/ethnicities, specialties, and genders, schools set an important precedent that could lead to more pipeline programs, increased under-represented faculty retention, and more primary care physicians.
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Buikema AR, Buzinec P, Paudel ML, Andrade K, Johnson JC, Edmonds YM, Jhamb SK, Chastek B, Raja H, Cao F, Hulbert EM, Korrer S, Mazumder D, Seare J, Solow BK, Currie UM. Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database. EClinicalMedicine 2021; 39:101075. [PMID: 34493997 PMCID: PMC8413267 DOI: 10.1016/j.eclinm.2021.101075] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Racial and ethnic minority groups have been disproportionately affected by the US coronavirus disease 2019 (COVID-19) pandemic; however, nationwide data on COVID-19 outcomes stratified by race/ethnicity and adjusted for clinical characteristics are sparse. This study analyzed the impacts of race/ethnicity on outcomes among US patients with COVID-19. METHODS This was a retrospective observational study of patients with a confirmed COVID-19 diagnosis in the electronic health record from 01 February 2020 through 14 September 2020. Index encounter site, hospitalization, and mortality were assessed by race/ethnicity (Hispanic, non-Hispanic Black [Black], non-Hispanic White [White], non-Hispanic Asian [Asian], or Other/unknown). Associations between racial/ethnic categories and study outcomes adjusted for patient characteristics were evaluated using logistic regression. FINDINGS Among 202,908 patients with confirmed COVID-19, patients from racial/ethnic minority groups were more likely than White patients to be hospitalized on initial presentation (Hispanic: adjusted odds ratio 1·690, 95% CI 1·620-1·763; Black: 1·810, 1·743-1·880; Asian: 1·503, 1·381-1·636) and during follow-up (Hispanic: 1·700, 1·638-1·764; Black: 1·578, 1·526-1·633; Asian: 1·391, 1·288-1·501). Among hospitalized patients, adjusted mortality risk was lower for Black patients (0·881, 0·809-0·959) but higher for Asian patients (1·205, 1·000-1·452). INTERPRETATION Racial/ethnic minority patients with COVID-19 had more severe disease on initial presentation than White patients. Increased mortality risk was attenuated by hospitalization among Black patients but not Asian patients, indicating that outcome disparities may be mediated by distinct factors for different groups. In addition to enacting policies to facilitate equitable access to COVID-19-related care, further analyses of disaggregated population-level COVID-19 data are needed.
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Affiliation(s)
- Ami R. Buikema
- Optum, Eden Prairie, MN, USA
- Corresponding author at: 11000 Optum Circle, MN101-E300, Eden Prairie, MN 55344, USA.
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Long KD, Albert SM. Use of Zip Code Based Aggregate Indicators to Assess Race Disparities in COVID-19. Ethn Dis 2021; 31:399-406. [PMID: 34295126 PMCID: PMC8288471 DOI: 10.18865/ed.31.3.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective In the first six months of the pandemic, information on race and ethnicity was missing for half of the US COVID-19 cases. Combining case ascertainment with census-based zip code indicators may identify COVID-19 race-ethnicity disparities in the absence of individual-level data. Design Ecological retrospective study for the period March-July 2020. Setting Population-based investigation, Allegheny County, Pennsylvania. Participants All COVID-19 cases, adjusted for zip code area population, in the early period of the pandemic. Main Outcome Measures Monthly COVID-19 incidence and requests for human services by zip code level indicators of race-ethnicity and poverty. Results In the early period of the pandemic, COVID-19 incidence was higher in zip codes with a greater proportion of racial and ethnic minorities. Zip codes with the highest quartile of minority residents (>25.1% of population) had a COVID-19 incidence of 60.1 (95% CI: 51.7-68.5) per 10,000 in this period; zip codes with the lowest quartile of minority residents (<6.3%) had an incidence of 31.3 (95% CI: 14.4-48.2). Requests for human services during this period (volume of 211 calls and county services) confirm these disparities. Conclusion Use of census-defined race-ethnicity proportions by zip code offers a way to identify disparities when individual race-ethnicity data are unavailable.
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Affiliation(s)
- Kevin D Long
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA
| | - Steven M Albert
- University of Pittsburgh, Behavioral and Community Health Sciences, Pittsburgh, PA
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Stewart MP, Fink R, Kosirog E, Saseen JJ. Bridging health disparities: a national survey of ambulatory care pharmacists in underserved areas. Pharm Pract (Granada) 2021; 19:2359. [PMID: 34221204 PMCID: PMC8221749 DOI: 10.18549/pharmpract.2021.2.2359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/09/2021] [Indexed: 11/14/2022] Open
Abstract
Background There is a shortage of primary care medical providers, particularly in rural communities and communities of racial and ethnic minority groups. Clinical pharmacists can help fill gaps in care among these vulnerable populations. Objective To identify characteristics of ambulatory care pharmacists that pursue and maintain employment within underserved areas. Methods An original survey was distributed nationwide to ambulatory care clinical pharmacists in underserved settings. Respondent characteristics were analyzed using descriptive statistics. Results Of the 111 completed surveys, a majority of respondents were White, non-Hispanic, female, with English as their only spoken language. A majority of pharmacists completed a clinical experience or specialized training focused on underserved care prior to their position. The top three motivators for pharmacists accepting their clinical position as well as staying at their job were passion for caring for underserved populations, the presence of a faculty appointment, or the freedom and flexibility of advanced clinical roles. Conclusions With a large majority of our respondents identifying as White and unilingual, there remains a large opportunity to increase diversity in the clinical pharmacy ambulatory care workforce caring for underserved populations. There is an observed correlation between early experiential or specialized training in underserved care and pharmacists pursuing employment in these areas. Thus, one potential long-term strategy to diversify and grow the ambulatory care clinical pharmacist workforce in underserved settings is for clinical practice sites to partner with colleges of pharmacy to recruit and maintain quality individuals who can meet the needs of diverse patient populations as well as expand student and resident training opportunities in underserved settings.
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Affiliation(s)
- Morgan P Stewart
- PharmD, BCACP, BC-ADM. Clinical Assistant Professor. CommUnityCare Health Centers, Division of Pharmacy Practice, College of Pharmacy, University of Texas at Austin. Austin, TX (United States).
| | - Rhianna Fink
- PharmD, BCACP, BC-ADM. Assistant Professor, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO (United States).
| | - Emily Kosirog
- PharmD, BCACP. Director of Clinical Pharmacy Services, Salud Family Health Centers. Aurora, CO (United States).
| | - Joseph J Saseen
- PharmD, BCPS, BCACP. Professor. Departments of Clinical Pharmacy and Family Medicine, Skaggs School of Pharmacy and Pharmaceutical Sciences and School of Medicine, University of Colorado. Aurora, CO (United States).
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Mbous YPV, Mohamed R, Kelley GA, Kelly KM. Interventions to improve physical activity in colorectal cancer survivors: protocol for a systematic review and meta-analysis of randomized controlled trials. J Adv Nurs 2021; 77:3921-3932. [PMID: 33969910 DOI: 10.1111/jan.14879] [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: 03/08/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022]
Abstract
AIM To examine the effectiveness of physical activity (PA) interventions on changes in PA among colorectal cancer survivors, including an examination of theoretical versus atheoretical-driven approaches, with a special focus on their effectiveness across ethnic and racial minorities. DESIGN Systematic review with aggregated data meta-analyses. DATA SOURCES Using six databases (Cochrane Central Register of Controlled Trials, PubMed, PsycINFO, CINAHL with full text, Scopus and Web of Science), we will screen for randomized controlled trials written in English from May 1, 1993 up to December 31, 2020. REVIEW METHODS Dual study-selection and data abstraction will be performed. The Behavior Change Technique Taxonomy (v1) will be used to examine behavior change techniques among selected studies, while the Theory Coding Scheme will be used to assess the extent of theory use. Risk of bias will be assessed using the revised Cochrane risk-of-bias tool for randomized trials, while the strength of the evidence will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation instrument. In addition, intervention delivery will be appraised using the Template for Intervention Description and Replication. Changes in PA from each study will be calculated using the standardized mean difference effect size (Hedge's g). Results will be pooled using the inverse-variance heterogeneity model. Heterogeneity (Cochran's Q) and inconsistency (I2 ) will be examined, while small-study effects (publication bias) will be evaluated using the Doi plot and LFK Index. Meta-regression will also be conducted to examine for potential associations between changes in physical activity and selected covariates (theoretical versus atheoretical-driven approaches, race/ethnicity). DISCUSSION This systematic review will identify specific racial/ethnic minorities for whom interventions are most effective and summarize the evidence of the effectiveness of theoretical vs. theoretical based intervention. IMPACT This systematic review can direct policymakers and practitioners towards actions that are likely to bring about positive physical activity behaviour change.
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Affiliation(s)
- Yves Paul Vincent Mbous
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Robert C. Byrd Health Sciences Center [North], Morgantown, WV, USA
| | - Rowida Mohamed
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Robert C. Byrd Health Sciences Center [North], Morgantown, WV, USA
| | - George A Kelley
- School of Public Health, Department of Biostatistics, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV, USA
| | - Kimberly Michelle Kelly
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Robert C. Byrd Health Sciences Center [North], Morgantown, WV, USA
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Rohatgi KW, Humble S, McQueen A, Hunleth JM, Chang SH, Herrick CJ, James AS. Medication Adherence and Characteristics of Patients Who Spend Less on Basic Needs to Afford Medications. J Am Board Fam Med 2021; 34:561-70. [PMID: 34088816 DOI: 10.3122/jabfm.2021.03.200361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/19/2020] [Accepted: 11/22/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Among individuals with low income, cost is a well-established barrier to medication adherence. Spending less on basic needs to pay for medication is a particularly concerning cost-coping strategy and may be associated with worse health outcomes. The aims of this study were (1) to describe the demographic and health status characteristics of those who report spending less on basic needs to pay for medication, and (2) to understand the associated psychosocial and financial challenges of these individuals. METHODS We administered a survey to primarily low-income adults (n = 270) in St. Louis, MO, as part of a larger study from 2016 to 2018. Logistic regression was used to model odds of reporting spending less on basic needs to pay for medication. RESULTS Spending less on basic needs to pay for medication was significantly more likely in individuals with fair or poor health status, greater number of chronic conditions, greater medication expenditure, and difficulty paying bills. Individuals who spent less on basic needs were less likely to be fully adherent to their medication regimen. CONCLUSIONS Screening for unmet basic needs and offering referrals to social safety net programs in the primary care setting may help patients achieve sustainable medication adherence.
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Khanna N, Klyushnenkova EN, Kaysin A. Association of COVID-19 With Race and Socioeconomic Factors in Family Medicine. J Am Board Fam Med 2021; 34:S40-7. [PMID: 33622817 DOI: 10.3122/jabfm.2021.S1.200338] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Recent data demonstrated that socioeconomic, environmental, demographic, and health factors can contribute to vulnerability for coronavirus 2019 (COVID-19). The goal of this study was to assess association between severe acute respiratory syndrome coronavirus (SARS CoV-2) infection and demographic and socioeconomic factors in patients from a large academic family medicine practice to support practice operations. METHODS Patients referred for SARS CoV-2 testing by practice providers were identified using shared patient lists in the electronic health records (Epic). The Health Information Exchange (CRISP) was used to identify additional practice-attributed patients receiving testing elsewhere. RESULTS Compared with white non-Hispanic patients, the odds of COVID-19 detection were higher in black non-Hispanic (odds ratio [OR] = 1.75; 95% CI, 1.18-2.59, P = .0052) and Hispanic patients (OR = 5.40; 95% CI, 3.11-9.38, P < .0001). The latent class analysis revealed additional patterns in health disparities. Patients living in the areas with Area Deprivation Index 8-10 who were predominantly black had higher risk for SARS CoV-2 infection compared with patients living in less socioeconomically deprived areas who were predominantly white (OR = 1.68; 95% CI, 1.25-2.28; P = .0007). CONCLUSION Our data provide insight into the association of COVID-19 with race/ethnic minority patients residing in highly socioeconomically deprived areas. These data could impact outreach and management of ambulatory COVID-19 in the future.
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Rodríguez-García-de-Cortázar A, Leralta-Piñán O, Jiménez-Pernett J, Ruiz-Azarola A. [COVID-19 on migrants and ethnic minorities]. Gac Sanit 2020; 35:499-501. [PMID: 33994254 PMCID: PMC7305882 DOI: 10.1016/j.gaceta.2020.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 12/04/2022]
Abstract
Todavía son escasas las publicaciones que analizan los efectos en migrantes o minorías étnicas de la COVID-19 o de las medidas adoptadas para frenar la pandemia, si bien los primeros estudios apuntan a un mayor impacto en poblaciones negras, asiáticas y de minorías étnicas en Reino Unido o en migrantes en México. Además de en las barreras de acceso a la información y a los servicios sanitarios, consideramos prioritario poner el foco de atención en sus condiciones de vida, particularmente las de quienes se encuentran en situaciones de vulnerabilidad o exclusión social. Nos referimos a personas desempleadas o con trabajos precarizados, sin prestaciones sociales, en condiciones de hacinamiento, que pueden están más expuestas al riesgo de infección y a no recibir un tratamiento adecuado. Previsiblemente el confinamiento ha repercutido más negativamente en migrantes en situación administrativa irregular, en víctimas de violencia de género y en quienes no pueden cumplir con las medidas de distanciamiento físico, como personas refugiadas en campamentos o migrantes en infraviviendas y asentamientos chabolistas, sin condiciones higiénicas adecuadas. Recomendaciones como suspender las deportaciones, prorrogar o facilitar permisos de residencia y trabajo, cerrar los centros de detención de personas extranjeras, evacuar a quienes están en cárceles y en campos de refugiados o asentamientos se han aplicado de manera desigual en diferentes países. Solo una fuerte apuesta política por la equidad sanitaria mundial puede garantizar la salud de poblaciones migrantes y de minorías étnicas y su acceso a medidas de protección, información, pruebas médicas y servicios sanitarios.Palabras clave: Migrantes, COVID-19, Grupos Minoritarios, Vulnerabilidad Social, Determinantes Sociales de la Salud.
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Affiliation(s)
- Ainhoa Rodríguez-García-de-Cortázar
- Escuela Andaluza de Salud Pública, Granada, España; SEPISE Grupo de investigación en trabajo social, Universidad de Granada, Granada, España.
| | | | - Jaime Jiménez-Pernett
- Escuela Andaluza de Salud Pública, Granada, España; Centre de Recherche en Santé Publique (CReSP), Université de Montréal, Canadá
| | - Ainhoa Ruiz-Azarola
- Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, España
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21
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Pruthi R, Robb ML, Oniscu GC, Tomson C, Bradley A, Forsythe JL, Metcalfe W, Bradley C, Dudley C, Johnson RJ, Watson C, Draper H, Fogarty D, Ravanan R, Roderick PJ. Inequity in Access to Transplantation in the United Kingdom. Clin J Am Soc Nephrol 2020; 15:830-842. [PMID: 32467306 PMCID: PMC7274279 DOI: 10.2215/cjn.11460919] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite the presence of a universal health care system, it is unclear if there is intercenter variation in access to kidney transplantation in the United Kingdom. This study aims to assess whether equity exists in access to kidney transplantation in the United Kingdom after adjustment for patient-specific factors and center practice patterns. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this prospective, observational cohort study including all 71 United Kingdom kidney centers, incident RRT patients recruited between November 2011 and March 2013 as part of the Access to Transplantation and Transplant Outcome Measures study were analyzed to assess preemptive listing (n=2676) and listing within 2 years of starting dialysis (n=1970) by center. RESULTS Seven hundred and six participants (26%) were listed preemptively, whereas 585 (30%) were listed within 2 years of commencing dialysis. The interquartile range across centers was 6%-33% for preemptive listing and 25%-40% for listing after starting dialysis. Patient factors, including increasing age, most comorbidities, body mass index >35 kg/m2, and lower socioeconomic status, were associated with a lower likelihood of being listed and accounted for 89% and 97% of measured intercenter variation for preemptive listing and listing within 2 years of starting dialysis, respectively. Asian (odds ratio, 0.49; 95% confidence interval, 0.33 to 0.72) and Black (odds ratio, 0.43; 95% confidence interval, 0.26 to 0.71) participants were both associated with reduced access to preemptive listing; however Asian participants were associated with a higher likelihood of being listed after starting dialysis (odds ratio, 1.42; 95% confidence interval, 1.12 to 1.79). As for center factors, being registered at a transplanting center (odds ratio, 3.1; 95% confidence interval, 2.36 to 4.07) and a universal approach to discussing transplantation (odds ratio, 1.4; 95% confidence interval, 1.08 to 1.78) were associated with higher preemptive listing, whereas using a written protocol was associated negatively with listing within 2 years of starting dialysis (odds ratio, 0.7; 95% confidence interval, 0.58 to 0.9). CONCLUSIONS Patient case mix accounts for most of the intercenter variation seen in access to transplantation in the United Kingdom, with practice patterns also contributing some variation. Socioeconomic inequity exists despite having a universal health care system.
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Affiliation(s)
- Rishi Pruthi
- Transplant, Renal and Urology Directorate, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom .,Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Matthew L Robb
- Statistics and Clinical Studies, National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Gabriel C Oniscu
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | | | - Andrew Bradley
- Department of Surgery, University of Cambridge and the National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - John L Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Wendy Metcalfe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway, University of London, Egham, United Kingdom
| | | | - Rachel J Johnson
- Statistics and Clinical Studies, National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Christopher Watson
- Department of Surgery, University of Cambridge and the National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Heather Draper
- Department of Social Science and Systems in Health, University of Warwick, Coventry, United Kingdom
| | - Damian Fogarty
- Nephrology Unit, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Rommel Ravanan
- Richard Bright Renal Unit, Southmead Hospital, Bristol, United Kingdom
| | - Paul J Roderick
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Palomares-Cuadros J, Marcos-Marcos J, Marquina-Márquez A. ["Here (in Sydney) we are lost:" An ethnographic study of life satisfaction among urban aboriginal Australians participating in a community outreach program]. Salud Colect 2020; 16:e2553. [PMID: 32574465 DOI: 10.18294/sc.2020.2553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/27/2020] [Indexed: 11/24/2022] Open
Abstract
This ethnographic study was designed to explore living conditions among a group of aboriginal families residing in an urban context, who participated in a recreational social program. The aim of the study was to explore life satisfaction by analyzing their living conditions and cultural capital inscribed in established attitudes, perceptions, and lay knowledge. Fieldwork was carried out in two complementary phases: phase 1, between May 2008 and December 2010, began when the first listed author initiated volunteer work with the organization responsible for the program; in phase 2, which extended from January 2011 to February 2013, participant observation was intensified and semi-structured interviews were carried out. The results indicate that the process of cultural uprooting underscores the experience of social inequality, and suggest a cohort effect that continues to this day. This process of cultural (in)consonance must be taken into account as a key factor when analyzing the living conditions and well-being of ethnic minorities, as well as when developing programs and interventions.
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Friedman SH, Cunningham CO, Lin J, Haramati LB, Levsky JM. Having a Primary Care Provider is the Strongest Predictor of Successful Follow-up of Participants in a Clinical Trial. J Am Board Fam Med 2020; 33:431-9. [PMID: 32430375 DOI: 10.3122/jabfm.2020.03.190018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 02/02/2020] [Accepted: 02/05/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Ethnic minorities, women, and those of low socioeconomic status are widely underrepresented in clinical trials. Few studies have explored factors associated with successful follow-up in these historically difficult-to-reach patients. This study's objective was to identify patient characteristics and methods of contact that predict successful contact for follow-up in an urban, predominantly ethnic minority, majority-women, poor population to help devise strategies to improve retention. METHODS We retrospectively reviewed records from a prospective randomized control trial of 400 hospitalized chest pain patients to determine which characteristics were associated with successful telephone follow-up at 1 year after enrollment. We assessed demographic variables, medical history, and social factors by using bivariate analyses. A multivariate analysis was performed using variables from the bivariate analysis with P ≤ .2. RESULTS The overall successful 1-year follow-up rate was 95% (381/400). Study participants who completed follow-up were significantly more likely to have a primary care physician (PCP) (88% [337/381] versus 68% [13/19]), speak English natively (52% [199/381] versus 26% [5/19]), have a higher Charlson comorbidity index score, and identify as women (64.0% [244/381] versus 42.1% [8/19]). Having a PCP and native English language remained significant at multivariate analysis. Socioeconomic status score, quantity of contact information recorded at recruitment, and insurance status were not significantly associated with successful follow-up. CONCLUSIONS Patients engaged with the health care system by having a PCP are significantly more likely to achieve follow-up. Successful follow-up is also associated with native English speaking. The potential of improving follow-up by facilitating connections with health care providers requires further study.
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Sheffer CE, Webb Hooper M, Ostroff JS. Commentary: Educational and Clinical Training for Addressing Tobacco-Related Cancer Health Disparities. Ethn Dis 2019; 28:187-192. [PMID: 30038480 PMCID: PMC6051502 DOI: 10.18865/ed.28.3.187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/18/2022] Open
Abstract
In the United States, tobacco use is a leading contributor to inequities in cancer health among individuals for many ethnic, racial, sexual minority, and other minority groups as well as individuals in lower socioeconomic groups and other underserved populations. Despite remarkable decreases in tobacco use prevalence rates in the United States over the past 50 years, the benefits of tobacco control efforts are not equitably distributed. Tobacco-related disparities include higher prevalence rates of smoking, lower rates of quitting, less robust responses to standard evidence-based treatments, substandard tobacco treatment delivery by health care providers, and an increased burden of tobacco-related cancers and other diseases. Among the multiple critical barriers to achieving progress in reducing tobacco treatment-related disparities, there are several educational barriers including a unidimensional or essentialist conceptualizations of the disparities; a tobacco treatment workforce unprepared to address the needs of tobacco users from underserved groups; and known research-to-practice gaps in understanding, assessing, and treating tobacco use among underserved groups. We propose the development of competency-based curricula that: 1) use intersectionality as an organizing framework for relevant knowledge; 2) teach interpersonal skills, such as expressing sociocultural respect, a lack of cultural superiority, and empathy as well as skills for developing other-oriented therapeutic relations; and 3) are grounded in the science of the evidence-based treatments for tobacco dependence. These curricula could be disseminated nationally in multiple venues and would represent significant progress toward addressing tobacco-related disparities.
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Affiliation(s)
- Christine E. Sheffer
- Department of Health Behavior; Roswell Park Cancer Institute; Buffalo, NY, Address correspondence to Christine E. Sheffer, PhD; Associate Member and Associate Professor of Oncology, Department of Health Behavior; Carlton House, Room 402; Roswell Park Cancer Institute; Buffalo, NY 14263; 716.845.1186;
| | - Monica Webb Hooper
- Case Comprehensive Cancer Center; Case Western Reserve University; Cleveland, OH
| | - Jamie S. Ostroff
- Department of Psychiatry & Behavioral Sciences; Memorial Sloan Kettering Cancer Center; New York, NY
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Barceló NE, Lopez A, Tang L, Aguilera Nunez MG, Jones F, Miranda J, Chung B, Arevian A, Bonds C, Izquierdo A, Dixon E, Wells K. Community Engagement and Planning versus Resources for Services for Implementing Depression Quality Improvement: Exploratory Analysis for Black and Latino Adults. Ethn Dis 2019; 29:277-286. [PMID: 31057313 PMCID: PMC6478049 DOI: 10.18865/ed.29.2.277] [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: 11/18/2022] Open
Abstract
Objective Racial/ethnic minorities experience disparities in depression1 and there is a paucity of evidence-based interventions to improve depression care access and outcomes. Community Partners in Care (CPIC) is a community-partnered study of depression care quality improvement (QI) in under-resourced, urban communities: Community Engagement and Planning (CEP) for multi-sector coalitions, and Resources for Services (RS) for program technical assistance.2 CEP demonstrated benefits for the overall CPIC study population; effects for Black and Latino sub-populations are unknown. Methods This sub-analysis examines outcomes for 409 Latino and 488 Black (non-Latino) adults recruited from 90 programs who completed baseline or 6-month follow-up. Regression analyses were used to estimate CEP vs RS intervention effects on primary (Mental Health Related Quality of Life [MHRQL], Patient Health Questionnaire-9 [PHQ-9]) and community-prioritized (mental wellness, physical activity, risk for homelessness) outcomes at 6-months. Results Baseline characteristics did not differ significantly by intervention in either group. In the adjusted analysis for Black adults, CEP resulted in decreased odds of poor MHRQL (OR: .62, 95% CI=.41-.94, P=.028) with a trend for reducing homelessness risk (OR: .60, .35-1.05, P=.69). For Latino adults, CEP resulted in greater probability of mental wellness (OR: 1.81, 1.05-3.13, P=.034) and a trend for increased physical activity (OR: 1.52, .93-2.49, P=.091). Conclusions Exploratory analyses of CEP for depression quality improvement suggests significant 6-month benefits in mental health outcomes for Black and Latino participants and trends for improvement in community-prioritized outcomes for both groups. Findings may inform research in multi-sector coalitions to promote equity in depression care.
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Affiliation(s)
- Nicolás E. Barceló
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Alma Lopez
- David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Maria Gabriela Aguilera Nunez
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Felica Jones
- Healthy African American Families Phase II, Los Angeles, CA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Bowen Chung
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA; Los Angeles County Department of Mental Health, Los Angeles CA
| | - Armen Arevian
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Curley Bonds
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Adriana Izquierdo
- Department of Medicine, David Geffen School of Medicine at UCLA; VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | - Kenneth Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA; Department of Health Policy and Management, Fielding School of Public Health; RAND Health Program; Greater Los Angeles Veteran Affairs Health Care System, Los Angeles CA
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Barceló NE, Lopez A, Tang L, Aguilera Nunez MG, Jones F, Miranda J, Chung B, Arevian A, Bonds C, Izquierdo A, Dixon E, Wells K. Community Engagement and Planning versus Resources for Services for Implementing Depression Quality Improvement: Exploratory Analysis for Black and Latino Adults. Ethn Dis 2019; 29. [PMID: 31057313 PMCID: PMC6478049 DOI: 10.18865/ed.29.2.277 10.18865/ed.29.2.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/30/2023] Open
Abstract
OBJECTIVE Racial/ethnic minorities experience disparities in depression1 and there is a paucity of evidence-based interventions to improve depression care access and outcomes. Community Partners in Care (CPIC) is a community-partnered study of depression care quality improvement (QI) in under-resourced, urban communities: Community Engagement and Planning (CEP) for multi-sector coalitions, and Resources for Services (RS) for program technical assistance.2 CEP demonstrated benefits for the overall CPIC study population; effects for Black and Latino sub-populations are unknown. METHODS This sub-analysis examines outcomes for 409 Latino and 488 Black (non-Latino) adults recruited from 90 programs who completed baseline or 6-month follow-up. Regression analyses were used to estimate CEP vs RS intervention effects on primary (Mental Health Related Quality of Life [MHRQL], Patient Health Questionnaire-9 [PHQ-9]) and community-prioritized (mental wellness, physical activity, risk for homelessness) outcomes at 6-months. RESULTS Baseline characteristics did not differ significantly by intervention in either group. In the adjusted analysis for Black adults, CEP resulted in decreased odds of poor MHRQL (OR: .62, 95% CI=.41-.94, P=.028) with a trend for reducing homelessness risk (OR: .60, .35-1.05, P=.69). For Latino adults, CEP resulted in greater probability of mental wellness (OR: 1.81, 1.05-3.13, P=.034) and a trend for increased physical activity (OR: 1.52, .93-2.49, P=.091). CONCLUSIONS Exploratory analyses of CEP for depression quality improvement suggests significant 6-month benefits in mental health outcomes for Black and Latino participants and trends for improvement in community-prioritized outcomes for both groups. Findings may inform research in multi-sector coalitions to promote equity in depression care.
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Affiliation(s)
- Nicolás E. Barceló
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
- Address correspondence to Nicolás E. Barceló, MD; 10920 Wilshire
Blvd., Suite 300; Los Angeles, CA 90024; 310.794.2051;
| | - Alma Lopez
- David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Maria Gabriela Aguilera Nunez
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Felica Jones
- Healthy African American Families Phase II, Los Angeles, CA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Bowen Chung
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA; Los Angeles County Department of Mental Health, Los Angeles CA
| | - Armen Arevian
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Curley Bonds
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Adriana Izquierdo
- Department of Medicine, David Geffen School of Medicine at UCLA; VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | - Kenneth Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA; Department of Health Policy and Management, Fielding School of Public Health; RAND Health Program; Greater Los Angeles Veteran Affairs Health Care System, Los Angeles CA
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Lee S, Fredriksen-Goldsen KI, McClain C, Kim HJ, Suzer-Gurtekin ZT. Are Sexual Minorities Less Likely to Participate in Surveys? An Examination of Proxy Nonresponse Measures and Associated Biases with Sexual Orientation in a Population-Based Health Survey. Field methods 2018; 30:208-224. [PMID: 31105471 PMCID: PMC6519959 DOI: 10.1177/1525822x18777736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
One of the implicit assumptions in survey research is lower response rates by sexual minorities than non-minorities. With rapidly changing public attitudes towards same-sex marriage, we reconsider this assumption. We used data from the 2013 and 2014 National Health Interview Survey (NHIS) that include contact history data for all sample families (n=117,589) as well as sexual orientation information about adults sampled from responding families (n=71,110). We created proxy nonresponse indicators based on contact efforts and reluctance from contact history data and linked them to sexual orientation of the sample adult and simulated nonresponse. The data did not support the assumption: straight adults were more difficult to get cooperation from than non-straights. With female sexual minorities showing higher nonresponse than the male counterpart, special considerations are required. Replication analyses may provide insights into what factors influence study participation decisions, which will inform how nonresponse may impact the accuracy of research findings.
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Affiliation(s)
- Sunghee Lee
- Institute for Social Research, University of Michigan, Ann
Arbor, MI, USA
| | | | - Colleen McClain
- Institute for Social Research, University of Michigan, Ann
Arbor, MI, USA
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle,
WA, USA
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Basu M, Petgrave-Nelson L, Smith KD, Perryman JP, Clark K, Pastan SO, Pearson TC, Larsen CP, Paul S, Patzer RE. Transplant Center Patient Navigator and Access to Transplantation among High-Risk Population: A Randomized, Controlled Trial. Clin J Am Soc Nephrol 2018; 13:620-627. [PMID: 29581107 PMCID: PMC5968906 DOI: 10.2215/cjn.08600817] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 08/10/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Barriers exist in access to kidney transplantation, where minority and patients with low socioeconomic status are less likely to complete transplant evaluation. The purpose of this study was to examine the effectiveness of a transplant center-based patient navigator in helping patients at high risk of dropping out of the transplant evaluation process access the kidney transplant waiting list. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS We conducted a randomized, controlled trial of 401 patients (n=196 intervention and n=205 control) referred for kidney transplant evaluation (January 2013 to August 2014; followed through May 2016) at a single center. A trained navigator assisted intervention participants from referral to waitlisting decision to increase waitlisting (primary outcome) and decrease time from referral to waitlisting (secondary outcome). Time-dependent Cox proportional hazards models were used to determine differences in waitlisting between intervention and control patients. RESULTS At study end, waitlisting was not significantly different among intervention (32%) versus control (26%) patients overall (P=0.17), and time from referral to waitlisting was 126 days longer for intervention patients. However, the effectiveness of the navigator varied from early (<500 days from referral) to late (≥500 days) follow-up. Although no difference in waitlisting was observed among intervention (50%) versus control (50%) patients in the early period (hazard ratio, 1.03; 95% confidence interval, 0.69 to 1.53), intervention patients were 3.3 times more likely to be waitlisted after 500 days (75% versus 25%; hazard ratio, 3.31; 95% confidence interval, 1.20 to 9.12). There were no significant differences in intervention versus control patients who started evaluation (85% versus 79%; P=0.11) or completed evaluation (58% versus 51%; P=0.14); however, intervention patients had more living donor inquiries (18% versus 10%; P=0.03). CONCLUSIONS A transplant center-based navigator targeting disadvantaged patients improved waitlisting but not until after 500 days of follow-up. However, the absolute effect was relatively small.
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Affiliation(s)
- Mohua Basu
- Division of Transplantation, Department of Surgery and
| | | | - Kayla D. Smith
- Division of Transplantation, Department of Surgery and
- Emory Transplant Center, Atlanta, Georgia; and
| | | | - Kevin Clark
- Emory Transplant Center, Atlanta, Georgia; and
| | - Stephen O. Pastan
- Renal Division, Emory University School of Medicine, Atlanta, Georgia
- Emory Transplant Center, Atlanta, Georgia; and
| | - Thomas C. Pearson
- Division of Transplantation, Department of Surgery and
- Emory Transplant Center, Atlanta, Georgia; and
| | - Christian P. Larsen
- Division of Transplantation, Department of Surgery and
- Emory Transplant Center, Atlanta, Georgia; and
| | - Sudeshna Paul
- Office of Nursing Research, Nell Hodgson Woodruff School of Nursing and
| | - Rachel E. Patzer
- Division of Transplantation, Department of Surgery and
- Emory Transplant Center, Atlanta, Georgia; and
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Trinh E, Na Y, Sood MM, Chan CT, Perl J. Racial Differences in Home Dialysis Utilization and Outcomes in Canada. Clin J Am Soc Nephrol 2017; 12:1841-1851. [PMID: 28835369 PMCID: PMC5672971 DOI: 10.2215/cjn.03820417] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/17/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Data on racial disparities in home dialysis utilization and outcomes are lacking in Canada, where health care is universally available. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We studied patients starting maintenance dialysis between 1996 and 2012 in the Canadian Organ Replacement Register, stratified by race: white, Asian, black, Aboriginal, Indian subcontinent, and other. The association between race and treatment with home dialysis was examined using generalized linear models. Secondary outcomes assessed racial differences in all-cause mortality and technique failure using a Fine and Gray competing risk model. RESULTS 66,600 patients initiated chronic dialysis between 1996 and 2012. Compared with whites (n=46,092), treatment with home dialysis was lower among Aboriginals (n=3866; adjusted relative risk, RR, 0.71; 95% confidence interval, CI, 0.66 to 0.76) and higher in Asians (n=4157; adjusted RR, 1.28; 95% CI, 1.22 to 1.35) and others (n=2170; adjusted RR, 1.12; 95% CI, 1.04 to 1.20) but similar in blacks (n=2143) and subcontinent Indians (n=2809). Black (adjusted hazard ratio, HR, 1.31; 95% CI, 1.16 to 1.48) and Aboriginal (adjusted HR, 1.19; 95% CI, 1.06 to 1.33) patients treated with peritoneal dialysis had a significantly higher adjusted risk of technique failure compared with whites, whereas Asians had a lower risk (adjusted HR, 0.89; 95% CI, 0.82 to 0.99). In patients on peritoneal dialysis, the risk of death was significantly lower in Asians (adjusted HR, 0.83; 95% CI, 0.75 to 0.92), blacks (adjusted HR, 0.71; 95% CI, 0.59 to 0.85), and others (adjusted HR, 0.79; 95% CI, 0.68 to 0.92) but higher in Aboriginals (adjusted HR, 1.16; 95% CI, 1.02 to 1.32) compared with whites. Among patients on home hemodialysis, no significant racial differences in patient and technique survival were observed, which may be limited by the low number of events among each subgroups. CONCLUSIONS With the exception of Aboriginals, all racial minority groups in Canada were as likely to be treated with home dialysis compared with whites. However, significant racial differences exist in outcomes.
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Affiliation(s)
- Emilie Trinh
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Yingbo Na
- Division of Nephrology, St. Michael’s Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; and
| | - Manish M. Sood
- Division of Nephrology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Jeffrey Perl
- Division of Nephrology, St. Michael’s Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; and
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Lee JA, Nguyen H, Park J, Tran L, Nguyen T, Huynh Y. Usages of Computers and Smartphones to Develop Dementia Care Education Program for Asian American Family Caregivers. Healthc Inform Res 2017; 23:338-342. [PMID: 29181245 PMCID: PMC5688035 DOI: 10.4258/hir.2017.23.4.338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/21/2017] [Accepted: 10/21/2017] [Indexed: 12/05/2022] Open
Abstract
Objectives Families of ethnic minority persons with dementia often seek help at later stages of the disease. Little is known about the effectiveness of various methods in supporting ethnic minority dementia patients' caregivers. The objective of the study was to identify smartphone and computer usage among family caregivers of dementia patients (i.e., Korean and Vietnamese Americans) to develop dementia-care education programs for them. Methods Participants were asked various questions related to their computer or smartphone usage in conjunction with needs-assessment interviews. Flyers were distributed at two ethnic minority community centers in Southern California. Snowball recruitment was also utilized to reach out to the families of dementia patients dwelling in the community. Results Thirty-five family caregivers, including 20 Vietnamese and 15 Korean individuals, participated in this survey. Thirty participants (30 of 35, 85.7%) were computer users. Among those, 76.7% (23 of 30) reported daily usage and 53% (16 of 30) claimed to use social media. A majority of the participants (31 of 35, 88.6%) reported that they owned smartphones. More than half of smartphone users (18 of 29, 62%) claimed to use social media applications. Many participants claimed that they could not attend in-class education due to caregiving and/or transportation issues. Conclusions Most family caregivers of dementia patients use smartphones more often than computers, and more than half of those caregivers communicate with others through social media apps. A smartphone-app-based caregiver intervention may serve as a more effective approach compared to the conventional in-class method. Multiple modalities for the development of caregiver interventions should be considered.
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Affiliation(s)
- Jung-Ah Lee
- The Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA
| | - Hannah Nguyen
- Division of Human Development, College of Health, Human Services, and Nursing, California State University Dominguez Hills, Dominguez Hills, CA, USA
| | - Joan Park
- The Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA
| | - Linh Tran
- The Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA
| | - Trang Nguyen
- The Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA
| | - Yen Huynh
- The Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA
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Xierali IM, Nivet MA, Gaglioti AH, Liaw WR, Bazemore AW. Increasing Family Medicine Faculty Diversity Still Lags Population Trends. J Am Board Fam Med 2017; 30:100-3. [PMID: 28062824 DOI: 10.3122/jabfm.2017.01.160211] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/31/2016] [Accepted: 09/06/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Faculty diversity has important implications for medical student diversity. The purpose of this analysis is to describe trends in racial, ethnic, and gender diversity in family medicine (FM) departments and compare these trends to the diversity of matriculating medical students, the diversity of all medical school faculty, and the population in general. METHODS We used the Association of American Medical Colleges Faculty Roster to describe trends in proportions of female and minorities under-represented in medicine (URM) in FM department full-time faculty in U.S. MD-granting medical schools. RESULTS Among FM faculty, the proportions of female and URM faculty have grown more than 2-fold between 1980 and 2015. Increasing faculty rank was associated with lower diversity across the study period. FM departments had higher female and URM proportions than the average of all other specialties, but URM representation still lagged population trends. CONCLUSION Although FM faculty diversity is growing over time, continued attention to URM representation should remain a priority.
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Brown EA, Bekker HL, Davison SN, Koffman J, Schell JO. Supportive Care: Communication Strategies to Improve Cultural Competence in Shared Decision Making. Clin J Am Soc Nephrol 2016; 11:1902-1908. [PMID: 27510456 PMCID: PMC5053803 DOI: 10.2215/cjn.13661215] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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: 11/23/2022]
Abstract
Historic migration and the ever-increasing current migration into Western countries have greatly changed the ethnic and cultural patterns of patient populations. Because health care beliefs of minority groups may follow their religion and country of origin, inevitable conflict can arise with decision making at the end of life. The principles of truth telling and patient autonomy are embedded in the framework of Anglo-American medical ethics. In contrast, in many parts of the world, the cultural norm is protection of the patient from the truth, decision making by the family, and a tradition of familial piety, where it is dishonorable not to do as much as possible for parents. The challenge for health care professionals is to understand how culture has enormous potential to influence patients' responses to medical issues, such as healing and suffering, as well as the physician-patient relationship. Our paper provides a framework of communication strategies that enhance crosscultural competency within nephrology teams. Shared decision making also enables clinicians to be culturally competent communicators by providing a model where clinicians and patients jointly consider best clinical evidence in light of a patient's specific health characteristics and values when choosing health care. The development of decision aids to include cultural awareness could avoid conflict proactively, more productively address it when it occurs, and enable decision making within the framework of the patient and family cultural beliefs.
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Affiliation(s)
- Edwina A. Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Hilary L. Bekker
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Sara N. Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, United Kingdom; and
| | - Jane O. Schell
- Section of Palliative Care and Medical Ethics, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Abstract
BACKGROUND Recruitment and retention of a diverse ethnic workforce in healthcare settings contribute to the provision of culturally competent care in multicultural contexts. Nevertheless, the work experiences of ethnic minority nurses, which impact the attractiveness of the occupation, job burnout and turnover intentions, are not well understood. The present exploratory research seeks to examine the work experiences of ethnic minority Arab nurses in Israeli public hospitals. Israel is an interesting case study as the number of Arab nurses operating in the Israeli workforce has risen significantly over recent decades; many of them work in mixed Jewish-Arab environments, which are affected by the Israeli-Palestinian conflict. METHODS In-depth interviews with 13 Arab nurses working in Israeli public hospitals. RESULTS The interviewed Arab nurses mentioned various benefits associated with the nursing profession, as well as various difficulties they encounter during their daily work, which are specific to them as ethnic minority nurses. They describe nursing as an occupation that offers numerous employment opportunities, job security, professional development and promotion. They believe that their work as a nurse contributes to the health of the Arab family and community and enhances culturally competent healthcare in Israeli hospitals. However, Arab nurses also feel they are stereotyped; they face disapproving looks, refusal to be treated by them, and incidences of hostility toward them. The dual experience of both integration and rejection shapes their coping strategies. CONCLUSIONS The findings can inform a more systematic study that could potentially examine both nurses' and patients' conceptions of multicultural care. Action should be taken to ensure optimal working conditions for Arab healthcare professionals. Institutional policies and actions are needed to cope with their unique difficulties, such as the appointment of a functionary responsible for minimizing and coping with stereotypical and hostile attitudes.
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Affiliation(s)
- Yael Keshet
- />Western Galilee Academic College, Acre, Israel
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Hill EV, Wake M, Carapinha R, Normand SL, Wolf RE, Norris K, Reede JY. Rationale and Design of the Women and Inclusion in Academic Medicine Study. Ethn Dis 2016; 26:245-54. [PMID: 27103776 DOI: 10.18865/ed.26.2.245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Women of color (WOC) (African American, Hispanic, Native American/Alaskan Native, and Asian American) faculty remain disproportionately underrepresented among medical school faculty and especially at senior ranks compared with White female faculty. The barriers or facilitators to the career advancement of WOC are poorly understood. The Women and Inclusion in Academic Medicine (WIAM) study was developed to characterize individual, institutional and sociocultural factors that influence the entry, progression and persistence, and advancement of women faculty in academic medical careers with a focus on WOC. METHODS Using a purposive sample of 13 academic medical institutions, we collected qualitative interview data from 21 WOC junior faculty and quantitative data from 3,127 (38.9% of 8,053 eligible women) respondents via an online survey. To gather institutional data, we used an online survey and conducted 23 key administrative informant interviews from the 13 institutions. Grounded theory methodology will be used to analyze qualitative data. Multivariable analysis including hierarchical linear modeling will be used to investigate outcomes, such as the inclusiveness of organizational gender climate and women faculty's intent to stay. CONCLUSION We describe the design, methods, rationale and limitations of one of the largest and most comprehensive studies of women faculty in academic medicine with a focus on WOC. This study will enhance our understanding of challenges that face women, and, especially WOC, faculty in academic medicine and will provide solutions at both the individual and institutional levels.
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Affiliation(s)
- Emorcia V Hill
- Office for Diversity Inclusion and Community Partnership, Harvard Medical School
| | - Michael Wake
- Dana Farber Cancer Institute Clinical Trials Office, Boston, Massachusetts
| | - René Carapinha
- Office for Diversity Inclusion and Community Partnership, Harvard Medical School; Department of Global Health and Social Medicine, Harvard Medical School
| | - Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School; Department of Biostatistics, Harvard School of Public Health
| | - Robert E Wolf
- Department of Health Care Policy, Harvard Medical School
| | - Keith Norris
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles
| | - Joan Y Reede
- Office for Diversity Inclusion and Community Partnership, Harvard Medical School; Department of Social and Behavioral Sciences, Harvard School of Public Health
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Gaveras EM, Kristiansen M, Worth A, Irshad T, Sheikh A. Social support for South Asian Muslim parents with life-limiting illness living in Scotland: a multiperspective qualitative study. BMJ Open 2014; 4:e004252. [PMID: 24503303 PMCID: PMC3918973 DOI: 10.1136/bmjopen-2013-004252] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/07/2014] [Accepted: 01/14/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To explore experiences of social support needs among South Asian Muslim patients with life-limiting illness, living in Scotland, who are parents of young children. DESIGN Secondary analysis of data from a multiperspective, longitudinal Scottish study involving in-depth semistructured interviews with patients, their nominated carers and healthcare professionals. Data were analysed using interpretive phenomenological analysis. SETTING Edinburgh, Scotland. PARTICIPANTS South-Asian Muslim patients with life-limiting illness with children under the age of 18 (n=8), their carer (n=6) and their healthcare professional. MAIN OUTCOME MEASURES Access and provision of social support in palliative care. RESULTS Open-ended qualitative interviews identified four main themes: (1) parental sadness over being unable to provide tangible support; (2) parental desire to continue to provide emotional support; (3) limited availability of informal social support networks; and (4) differing perspectives between healthcare professionals and patients on patient access to social support sources, with a subtheme being the capacity of male carers to provide social support. South-Asian parents at the end of life had limited access to extended-network support. Gender roles appeared as challenging for healthcare providers who at times overestimated the amount of support a female carer could provide and underestimated the amount of support male carers provided. Implications for practice include the need for greater awareness by healthcare providers of the social support needs of ethnic minority and migrant parents with life-limiting illnesses and especially an awareness of the importance of the role of male and female carers. Further research is needed to explore how the timing of migration impacts the need for and availability of tangible and emotional informal social support among ethnic minority parents with life-limiting illness.
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Affiliation(s)
- Eleni Margareta Gaveras
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Maria Kristiansen
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
- Health Sciences Department, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Allison Worth
- Primary Palliative Care Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Tasneem Irshad
- Primary Palliative Care Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Primary Palliative Care Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
- Harkness Fellow in Health Care Policy and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
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Palmgren PJ, Chandratilake M, Nilsson GH, Laksov KB. Is there a chilly climate? An educational environmental mixed method study in a chiropractic training institution. J Chiropr Educ 2013; 27:11-20. [PMID: 23518905 PMCID: PMC3604959 DOI: 10.7899/jce-12-015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 09/14/2012] [Accepted: 09/22/2012] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The attitude towards gender in an educational environment has a significant impact on a student's behavior, sense of well-being, and academic performance. Our study aimed to explore the presence and extent of gender-related issues in a chiropractic undergraduate learning environment, which has been a scarcely researched topic in the literature. METHODS The Perceived Chilly Climate Scale (PCCS) was used as the initial tool for screening the gender issues among undergraduates. The issues identified were explored further with a series of focus group interviews. RESULTS The PCCS had an 83% response rate. The PCCS score (105/196) indicated the nonexistence of alarming gender-related issues. However, the PCCS score was significantly higher among female than male subjects, immigrants than nonimmigrants, and minorities than majority ethnic groups. Despite high ratings on the questionnaire quantitative findings, the focus groups indicated a good sense of equality, oppression-free environment, and no obvious signs of discrimination. CONCLUSION The educational environment of the institution concerned was conducive to equality. However, subtle but important gender-, ethnic-, and minority-related issues could be addressed to provide an enhanced educational environment to learners.
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Ackerhans M. Multicultural health promotion: are we getting it right? HIV - STDs. Entre Nous Cph Den 2002:15. [PMID: 12222294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Blagoev V. Bulgaria, the challenge: new approach for minority issues. Entre Nous Cph Den 2002:11. [PMID: 12222313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Sullivan TA. The occupational prestige of women immigrants: a comparison of Cubans and Mexicans. Int Migr Rev 2002; 18:1045-62. [PMID: 12340228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Cyprus. Act No. 95/89, 1989. Annu Rev Popul Law 1989; 16:56. [PMID: 12344467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Jin Y, Su L, Chang P, Wang H. A study on patterns in the average life expectancies and mortality rates of 56 nationalities in China in 1990. Chin J Popul Sci 2002; 6:263-79. [PMID: 12319168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Gurak DT. Assimilation and fertility: a comparison of Mexican American and Japanese women. Hisp J Behav Sci 2002; 2:219-39. [PMID: 12340209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Boyd M. At a disadvantage: the occupational attainments of foreign born women in Canada. Int Migr Rev 2002; 18:1091-119. [PMID: 12340230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Loo CM. The 'biliterate' ballot controversy: language acquisition and cultural shift among immigrants. Int Migr Rev 2002; 19:493-515. [PMID: 12341061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Tienda M, Jensen L, Bach RL. Immigration, gender and the process of occupational change in the United States, 1970-1980. Int Migr Rev 2002; 18:1021-44. [PMID: 12340227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Kossoudji SA, Ranney SI. The labor market experience of female migrants: the case of temporary Mexican migration to the U.S. Int Migr Rev 2002; 18:1120-43. [PMID: 12340232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Schoorl JJ. Fertility and age at marriage of Turkish women in the Netherlands. Nufusbil Derg 2002; 6:27-47. [PMID: 12159446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Elekes D. The problems of the terminology and recording of the minorities. Rev Hist Demogr 2002:30-58. [PMID: 12158117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Berti B. The position of Slovaks in truncated Hungary in the interwar years. Rev Hist Demogr 2002:117-32. [PMID: 12158118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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