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Chang R, Philip J, Javed U, Titus A, Gardezi SK, Kundi H, Yousefzai R, Hyder AA, Mossialos E, Nasir K, Javed Z. Unfavorable social determinants of health and risk of mortality in adults with diabetes: findings from the National Health Interview Survey. BMJ Open Diabetes Res Care 2024; 12:e003710. [PMID: 38290988 PMCID: PMC10828867 DOI: 10.1136/bmjdrc-2023-003710] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/23/2023] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION Understanding the role of social determinants of health as predictors of mortality in adults with diabetes may help improve health outcomes in this high-risk population. Using population-based, nationally representative data, this study investigated the cumulative effect of unfavorable social determinants on all-cause mortality in adults with diabetes. RESEARCH DESIGN AND METHODS We used data from the 2013-2018 National Health Interview Survey, linked to the National Death Index through 2019, for mortality ascertainment. A total of 47 individual social determinants of health were used to categorize participants in quartiles denoting increasing levels of social disadvantage. Poisson regression was used to report age-adjusted mortality rates across increasing social burden. Multivariable Cox proportional hazards models were used to assess the association between cumulative social disadvantage and all-cause mortality in adults with diabetes, adjusting for traditional risk factors. RESULTS The final sample comprised 182 445 adults, of whom 20 079 had diabetes. In the diabetes population, mortality rate increased from 1052.7 per 100 000 person-years in the first quartile (Q1) to 2073.1 in the fourth quartile (Q4). In multivariable models, individuals in Q4 experienced up to twofold higher mortality risk relative to those in Q1. This effect was observed similarly across gender and racial/ethnic subgroups, although with a relatively stronger association for non-Hispanic white participants compared with non-Hispanic black and Hispanic subpopulations. CONCLUSIONS Cumulative social disadvantage in individuals with diabetes is associated with over twofold higher risk of mortality, independent of established risk factors. Our findings call for action to screen for unfavorable social determinants and design novel interventions to mitigate the risk of mortality in this high-risk population.
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Affiliation(s)
- Ryan Chang
- Baylor College of Medicine, Houston, Texas, USA
| | - Jerrin Philip
- Houston Methodist Academic Institute, Houston, Texas, USA
| | - Umair Javed
- Combined Military Hospital Lahore, Lahore, Pakistan
| | - Anoop Titus
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | - Harun Kundi
- Houston Methodist Academic Institute, Houston, Texas, USA
| | - Raman Yousefzai
- AT Still University Kirksville College of Osteopathic Medicine, Kirksville, Missouri, USA
| | - Adnan A Hyder
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Elias Mossialos
- Health Policy, The London School of Economics and Political Science, London, UK
| | - Khurram Nasir
- Houston Methodist Academic Institute, Houston, Texas, USA
- Center for Cardiovascular Computational Health and Precision Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Zulqarnain Javed
- Houston Methodist Academic Institute, Houston, Texas, USA
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Center for Cardiovascular Computational Health and Precision Medicine, Houston Methodist Hospital, Houston, Texas, USA
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Schoonover J, Rossetti A, Jacobs A, Rubin SE. Virtual Music Therapy for Substance Use Disorders in a Federally Qualified Health Center. J Am Board Fam Med 2024; 36:1043-1049. [PMID: 38092435 DOI: 10.3122/jabfm.2022.220316r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/31/2022] [Accepted: 06/12/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Music therapy (MT) is an effective adjunctive treatment for substance use disorders (SUD), which is primarily available in inpatient treatment centers and rarely provided in outpatient primary care. METHODS We evaluated the feasibility and acceptability of a virtual group MT program for SUD in a Federally Qualified Health Center (FQHC), and secondarily assessed patient perceptions of its effect. Feasibility was measured by implementation-related process measures, attendance and use of technology. Qualitative interviews eliciting participant perceptions were conducted to evaluate acceptability and effect. Mood scores, substance use and craving were measured before and after the intervention. RESULTS Onboarding of the music therapist took 3.5 months. All MT sessions were attended by 1 to 5 individuals out of 6. Participants reported that group MT was "soothing" and "calming," gave them tools to treat cravings and stress, and created a sense of community. They reported that during sessions their cravings decreased. Anxiety and depression scores trended down, as did the number of days of substance use. They all stated they would seek out MT again. DISCUSSION Our results suggest that remote group MT is feasible and acceptable to our FQHC patients with SUD. Patients reported an improvement in mood and their ability to manage stress, and a decrease in substance use. CONCLUSION We wish to build on the results of this study to enhance our understanding of the effects of MT in the outpatient setting, and broaden our patients' access to MT in primary care.
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Affiliation(s)
- Julie Schoonover
- From the Institute for Family Health, New York, NY, USA (JS, AJ, SER), The Louis Armstrong Center for Music and Medicine at Mount Sinai Health Center, New York, NY, USA (AR).
| | - Andrew Rossetti
- From the Institute for Family Health, New York, NY, USA (JS, AJ, SER), The Louis Armstrong Center for Music and Medicine at Mount Sinai Health Center, New York, NY, USA (AR)
| | - Ariel Jacobs
- From the Institute for Family Health, New York, NY, USA (JS, AJ, SER), The Louis Armstrong Center for Music and Medicine at Mount Sinai Health Center, New York, NY, USA (AR)
| | - Susan E Rubin
- From the Institute for Family Health, New York, NY, USA (JS, AJ, SER), The Louis Armstrong Center for Music and Medicine at Mount Sinai Health Center, New York, NY, USA (AR)
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Chen Z, Cong Z. Age Differences in Psychological Distress After Multiple Disaster Exposures: The Effect of Multidimensional Negative COVID-19 Impacts. Disaster Med Public Health Prep 2023; 17:e554. [PMID: 38044831 DOI: 10.1017/dmp.2023.207] [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: 12/05/2023]
Abstract
OBJECTIVE This study examined how the multidimensional negative coronavirus disease (COVID-19) impacts contextualized the age differences in psychological distress following exposures to tornadoes and the COVID-19 pandemic. METHODS Data were from a 2-wave panel study conducted at T1 (October 2020-August 2021) and T2 (May-August 2022). Latent class analysis was conducted to explore the patterns of negative COVID-19 impacts based on a sample of 1134 at T1. Negative binomial regressions were performed to examine the age differences in psychological distress at T2, based on the working sample (N = 554), as well as the moderating effect of identified class membership, with baseline psychological distress controlled. RESULTS Three latent classes were identified: class 1 "low overall impacts," class 2 "moderate overall impacts with high emotional distress," and class 3 "severe overall impacts." Individuals ages 65 and over reported lower psychological distress at T2 relative to those ages 18-34 and 35-49. However, compared to people ages 18-34, 35-49, and 50-64, those ages 65 and over reported the greatest increases in T2 psychological distress if they had experienced moderate or severe overall COVID-19 impacts at T1. CONCLUSION There is a pressing need for mental health interventions that are tailored to multi-disaster scenarios and age-related differences in long-term disaster recovery.
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Affiliation(s)
- Zhirui Chen
- Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zhen Cong
- Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Fitzpatrick V, Erwin K, Rivelli A, Shields M, Delfinado L, Cabiya M, Wennerberg K. The potential impact of introducing a cost tool to facilitate cost-of-care conversations in routine OB care: Lessons from the CONTINUE pilot study. PEC Innov 2023; 2:100136. [PMID: 37214536 PMCID: PMC10194338 DOI: 10.1016/j.pecinn.2023.100136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 05/24/2023]
Abstract
Objective The objective of the CONTINUE study is to gather preliminary data on the potential impact of implementing a "Cost Tool" in routine obstetrics (OB) care. It is hypothesized that by providing prenatal patients with an ability to forecast their care plan, they would be better able to anticipate and plan for the costs associated with their prenatal care. Methods Pilot data from interviews and surveys were collected from 71 prenatal patients across three clinics throughout Chicago, IL. Results As compared to privately insured prenatal patients, prenatal patients with public insurance reported the most benefit in Cost Tool use. Specifically, that the Cost Tool helped to navigate insurance more effectively (OR 4.49, p=0.0254), see the "Big Picture" and link it to the family budget (OR 4.25, p=0.0099), and make the financial tradeoffs needed to get through pregnancy (OR 5.50, p=0.0305). Conclusion The CONTINUE study provides preliminary signals of the Cost Tool's potential to help publicly insured prenatal patients better navigate the costs associated with their care plan. Innovations The CONTINUE study contributes valuable preliminary data about the utility of a cost tool in routine OB care, especially as it may benefit low-income prenatal patients navigate prenatal care better.
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Affiliation(s)
- Veronica Fitzpatrick
- Advocate Aurora Research Institute, Downers Grove, IL, USA
- Advocate Aurora Health; Downers Grove, IL, Milwaukee, WI, USA
| | - Kim Erwin
- Illinois Institute of Technology Institute of Design, Chicago, IL, USA
| | - Anne Rivelli
- Advocate Aurora Research Institute, Downers Grove, IL, USA
- Advocate Aurora Health; Downers Grove, IL, Milwaukee, WI, USA
| | - Maureen Shields
- Advocate Aurora Research Institute, Downers Grove, IL, USA
- Advocate Aurora Health; Downers Grove, IL, Milwaukee, WI, USA
| | - Leah Delfinado
- Advocate Aurora Health; Downers Grove, IL, Milwaukee, WI, USA
| | - Marie Cabiya
- Advocate Aurora Health; Downers Grove, IL, Milwaukee, WI, USA
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Vega G, Rivera-Berríos N, Camacho-Martínez V, Marty Lugo R, Albizu-García C. Community Corrections Officers' Perspectives of the Impact of Hurricane Maria on the Participant's Mental Health and Substance Use: A Qualitative Content Analysis. Disaster Med Public Health Prep 2023; 17:e510. [PMID: 37849348 PMCID: PMC10593498 DOI: 10.1017/dmp.2023.153] [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: 10/19/2023]
Abstract
OBJECTIVE This study explored community supervision officers' perceptions of the individual, community, and organizational challenges confronted by program participants after Hurricane María and their recommendations for future emergency management. METHODS A qualitative content analysis was conducted for nine focus group with community supervision officers in Puerto Rico. Participants were asked about their perceptions of how the mental health and drug abuse of persons on parole or probation were affected and the measures taken to address these concerns in disaster response. RESULTS Narratives expose vulnerabilities experienced by those supervised and the aggregated challenges that impact retention in health and rehabilitative services, all of which can detract from successful sentence completion. The disaster response categories call for a more adaptable approach to overseeing procedures in light of the difficulties involved and recognizing the support of the supervised population who have contributed to community initiatives. CONCLUSION Findings will contribute to informing planning, preparedness, and responses that mitigate the adverse consequences this vulnerable population may experience when exposed to future disaster hazards. Addressing emergency preparedness in this setting provides an opportunity to enact reforms in community supervision and improve access to services needed to enable the successful reintegration of individuals into their communities.
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Affiliation(s)
- Graciela Vega
- School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Nicole Rivera-Berríos
- School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Vilmary Camacho-Martínez
- School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - René Marty Lugo
- School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Carmen Albizu-García
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, San Juan, Puerto Rico
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Medgyesi DN, Mujtaba MN, Yang Q, Abubakari SW, Lee AG, Porter J, Chillrud SN, Kaali S, Jack DW, Asante KP. Geospatial determinants of maternal and child exposure to fine particulate matter in Kintampo, Ghana: Levels within the household and community, by surrounding building density and near roadways. J Expo Sci Environ Epidemiol 2023:10.1038/s41370-023-00606-1. [PMID: 37798345 PMCID: PMC10995107 DOI: 10.1038/s41370-023-00606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Personal exposure to fine particulate matter (PM2.5) from household air pollution is well-documented in sub-Saharan Africa, but spatiotemporal patterns of exposure are poorly characterized. OBJECTIVE We used paired GPS and personal PM2.5 data to evaluate changes in exposure across location-time environments (e.g., household and community, during cooking and non-cooking hours), building density and proximity to roadways. METHODS Our study included 259 sessions of geolocated, gravimetrically-calibrated one-minute personal PM2.5 measurements from participants in the GRAPHS Child Lung Function Study. The household vicinity was defined using a 50-meter buffer around participants' homes. Community boundaries were developed using a spatial clustering algorithm applied to an open-source dataset of building footprints in Africa. For each GPS location, we estimated building density (500 m buffer) and proximity to roadways (100 m buffer). We estimated changes in PM2.5 exposure by location (household, community), time of day (morning/evening cooking hours, night), building density, and proximity to roadways using linear mixed effect models. RESULTS Relative to nighttime household exposure, PM2.5 exposure during evening cooking hours was 2.84 (95%CI = 2.70-2.98) and 1.80 (95%CI = 1.54-2.10) times higher in the household and community, respectively. Exposures were elevated in areas with the highest versus lowest quartile of building density (FactorQ1vsQ4 = 1.60, 95%CI = 1.42-1.80). The effect of building density was strongest during evening cooking hours, and influenced levels in both the household and community (31% and 65% relative increase from Q1 to Q4, respectively). Being proximal to a trunk, tertiary or track roadway increased exposure by a factor of 1.16 (95%CI = 1.07-1.25), 1.68 (95%CI = 1.45-1.95) and 1.27 (95%CI = 1.06-1.53), respectively. IMPACT Household air pollution from cooking with solid fuels in sub-Saharan Africa is a major environmental concern for maternal and child health. Our study advances previous knowledge by quantifying the impact of household cooking activities on air pollution levels in the community, and identifying two geographic features, building density and roadways, that contribute to maternal and child daily exposure. Household cooking contributes to higher air pollution levels in the community especially in areas with greater building density. Findings underscore the need for equitable clean household energy transitions that reach entire communities to reduce health risks from household and outdoor air pollution.
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Affiliation(s)
- Danielle N Medgyesi
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Mohammed Nuhu Mujtaba
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, North Municipality, Ghana
| | - Qiang Yang
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY, USA
- Elsevier Global STM Journals, New York, NY, USA
| | - Sulemana Watara Abubakari
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, North Municipality, Ghana
| | - Alison G Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeremy Porter
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Sociology, School of Humanities and Social Sciences, Brooklyn College, Brooklyn, NY, USA
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY, USA
| | - Seyram Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, North Municipality, Ghana
| | - Darby W Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, North Municipality, Ghana
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Pontes-Silva A, Nunes I, De Miguel-Rubio A, de Souza MC, DeSantana JM, Avila MA. Social variables for replication of studies using mean scores of social support, self-care, and fibromyalgia knowledge: a cross-sectional study. Rheumatol Int 2023; 43:1705-1721. [PMID: 37335339 DOI: 10.1007/s00296-023-05374-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
To investigate biopsychosocial variables that contribute to explaining social support, self-care, and fibromyalgia knowledge in patients with fibromyalgia. A cross-sectional study. We built ten models of predictive variables (schooling, ethnicity, associated diseases, body regions affected by pain, employment status, monthly income, marital status, health level, medication, sports activities, interpersonal relationships, nutrition level, widespread pain, symptom severity, cohabitation, dependent people, number of children, social support, self-care, and fibromyalgia knowledge) and individually tested their explanatory performance to predict mean scores on the Fibromyalgia Knowledge Questionnaire (FKQ), Medical Outcomes Study's Social Support Scale (MOS-SSS), and Appraisal of Self-Care Agency Scale-Revised (ASAS-R). We used analysis of variance to verify the association among all variables of mathematically adjusted models (F-value ≥ 2.20) and we reported only models corrected with p < 0.05 and R2 > 0.20. One hundred and ninety people with fibromyalgia (aged 42.3 ± 9.7 years) participated in the study. Our results show that the variables schooling, ethnicity, body regions affected by pain, frequency of sports activities, dependent people, number of children, widespread pain, social support, and self-care determine 27% of the mean FKQ scores. Marital status, self-care, and fibromyalgia knowledge determine 22% of mean MOS-SSS scores. Schooling, ethnicity, employment status, frequency of sports activities, nutrition level, cohabitation, number of children, social support, and fibromyalgia knowledge determine 30% of the mean ASAS-R scores. Studies using mean scores of social support, self-care, and fibromyalgia knowledge should collect and analyze the social variables described in the present study.
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Affiliation(s)
- André Pontes-Silva
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos, Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil
| | - Isadora Nunes
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos, Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil
| | | | - Marcelo Cardoso de Souza
- Postgraduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Josimari Melo DeSantana
- Department of Physical Therapy, Graduate Program in Health Science and Graduate Program in Physiological Science, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Mariana Arias Avila
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos, Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil.
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Putnam KE, Biel FM, Hoopes M, Templeton AR, Cottrell EK, Darney BG, Hatch BA. Landscape of Pregnancy Care in US Community Health Centers. J Am Board Fam Med 2023; 36:574-582. [PMID: 37562836 DOI: 10.3122/jabfm.2023.230025r1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Community health centers (CHCs) provide critical health care access for people who experience high risks during and after pregnancy, however it is unclear to what extent they provide prenatal care. This study seeks to describe clinic and patient characteristics associated with longitudinal prenatal care delivery in CHC settings. METHODS This retrospective cohort study utilized electronic health record (EHR) data from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) between 2018 to 2019 to describe prenatal care provision among CHCs (n = 408), and pregnant CHC patients (n = 28,578) and compared characteristics of patients who received longitudinal prenatal care at CHCs versus those who did not. RESULTS 41% of CHCs provided longitudinal prenatal care; these CHCs were more likely to be larger, have multidisciplinary teams, and serve higher proportions of nonwhite or non-English speaking patients. Patients who received longitudinal prenatal care at CHCs were racially and ethnically diverse and many had comorbidities. Patients who received longitudinal prenatal care at CHCs (compared with pregnant patients who did not) were more likely to be white or Latinx and more likely to have non-English language preference. CONCLUSIONS Many CHCs in this national network provide prenatal care and serve pregnant patients at high risk of pregnancy-related complications, including people of color, those with low income, and those with comorbidities. CHCs provide critical access to care for vulnerable populations and will be an important partner in work addressing inequities in maternal morbidity and mortality.
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Affiliation(s)
- Katherine E Putnam
- From the Department of Family Medicine, Oregon Health & Science University, Portland, Oregon (KEP, EKC, BAH); OCHIN, Inc, Research Division, Portland, Oregon (FMB, MH, ART, EKC, BAH); Division of Complex Family Planning, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (BGD).
| | - Frances M Biel
- From the Department of Family Medicine, Oregon Health & Science University, Portland, Oregon (KEP, EKC, BAH); OCHIN, Inc, Research Division, Portland, Oregon (FMB, MH, ART, EKC, BAH); Division of Complex Family Planning, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (BGD)
| | - Megan Hoopes
- From the Department of Family Medicine, Oregon Health & Science University, Portland, Oregon (KEP, EKC, BAH); OCHIN, Inc, Research Division, Portland, Oregon (FMB, MH, ART, EKC, BAH); Division of Complex Family Planning, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (BGD)
| | - Anna R Templeton
- From the Department of Family Medicine, Oregon Health & Science University, Portland, Oregon (KEP, EKC, BAH); OCHIN, Inc, Research Division, Portland, Oregon (FMB, MH, ART, EKC, BAH); Division of Complex Family Planning, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (BGD)
| | - Erika K Cottrell
- From the Department of Family Medicine, Oregon Health & Science University, Portland, Oregon (KEP, EKC, BAH); OCHIN, Inc, Research Division, Portland, Oregon (FMB, MH, ART, EKC, BAH); Division of Complex Family Planning, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (BGD)
| | - Blair G Darney
- From the Department of Family Medicine, Oregon Health & Science University, Portland, Oregon (KEP, EKC, BAH); OCHIN, Inc, Research Division, Portland, Oregon (FMB, MH, ART, EKC, BAH); Division of Complex Family Planning, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (BGD)
| | - Brigit A Hatch
- From the Department of Family Medicine, Oregon Health & Science University, Portland, Oregon (KEP, EKC, BAH); OCHIN, Inc, Research Division, Portland, Oregon (FMB, MH, ART, EKC, BAH); Division of Complex Family Planning, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (BGD)
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Khanna N, Klyushnenkova E, Gaynor A, Dark M, Melamed J, Bennett M, Deepak J. Integrating a Systematic, Comprehensive E-Cigarette and Vaping Assessment Tool into the Electronic Health Record. J Am Board Fam Med 2023; 36:405-413. [PMID: 37290827 DOI: 10.3122/jabfm.2022.220410r1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Recently, the use of electronic cigarettes increased sharply, leading to increased e-cigarette, or Vaping Product Use-Associated Lung Injury (EVALI), and other acute pulmonary conditions. There is an urgent need for clinical information about e-cigarette users to identify factors that contribute to EVALI. We developed an e-cigarette/vaping assessment tool (EVAT) that was integrated into the Electronic Health Record (EHR) of a large state-wide medical system and initiated a system-wide dissemination and education to support its use. METHODS EVAT documented current vaping status, history, and e-cigarette content (nicotine, cannabinoids, and/or flavoring). Educational materials and presentations were developed via a comprehensive literature review. EVAT utilization in the EHR was assessed quarterly. Patients' demographic data and clinical site name were also collected. RESULTS The EVAT was built, validated, and integrated with the EHR in July 2020. Live and virtual seminars were conducted for prescribing providers and clinical staff. Asynchronous training was offered using podcasts, e-mails, and Epic tip sheets. Participants were informed about vaping harm and EVALI and instructed on the use of EVAT. As of December 31, 2022, EVAT was used 988,181 times, with 376,559 unique patients evaluated. Overall, 1,063 hospital units and affiliated ambulatory clinics used EVAT, including 64 Primary Care, 95 Pediatrics, and 874 Specialty sites. CONCLUSIONS EVAT was successfully implemented. Continued outreach efforts are needed to further increase its usage. Education materials should be enhanced to help providers to reach youth and vulnerable populations and connect patients to the tobacco treatment resources.
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Affiliation(s)
- Niharika Khanna
- From the Department of Family and Community Medicine, University of Maryland, Baltimore, (NK, EK, AG, MD); Department of Internal Medicine, Department of Pulmonology and Critical Care, University of Maryland, Baltimore (JM, JD); Department of Psychiatry, University of Maryland, Baltimore (MB)
| | - Elena Klyushnenkova
- From the Department of Family and Community Medicine, University of Maryland, Baltimore, (NK, EK, AG, MD); Department of Internal Medicine, Department of Pulmonology and Critical Care, University of Maryland, Baltimore (JM, JD); Department of Psychiatry, University of Maryland, Baltimore (MB)
| | - Adam Gaynor
- From the Department of Family and Community Medicine, University of Maryland, Baltimore, (NK, EK, AG, MD); Department of Internal Medicine, Department of Pulmonology and Critical Care, University of Maryland, Baltimore (JM, JD); Department of Psychiatry, University of Maryland, Baltimore (MB)
| | - Michael Dark
- From the Department of Family and Community Medicine, University of Maryland, Baltimore, (NK, EK, AG, MD); Department of Internal Medicine, Department of Pulmonology and Critical Care, University of Maryland, Baltimore (JM, JD); Department of Psychiatry, University of Maryland, Baltimore (MB)
| | - Julia Melamed
- From the Department of Family and Community Medicine, University of Maryland, Baltimore, (NK, EK, AG, MD); Department of Internal Medicine, Department of Pulmonology and Critical Care, University of Maryland, Baltimore (JM, JD); Department of Psychiatry, University of Maryland, Baltimore (MB)
| | - Melanie Bennett
- From the Department of Family and Community Medicine, University of Maryland, Baltimore, (NK, EK, AG, MD); Department of Internal Medicine, Department of Pulmonology and Critical Care, University of Maryland, Baltimore (JM, JD); Department of Psychiatry, University of Maryland, Baltimore (MB)
| | - Janaki Deepak
- From the Department of Family and Community Medicine, University of Maryland, Baltimore, (NK, EK, AG, MD); Department of Internal Medicine, Department of Pulmonology and Critical Care, University of Maryland, Baltimore (JM, JD); Department of Psychiatry, University of Maryland, Baltimore (MB)
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Serra É. [Pain in the vulnerable person. The psychological basis of pain]. Rev Prat 2023; 73:447-452. [PMID: 37289165] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Éric Serra
- Centre d'étude et de traitement de la douleur, CHU Amiens-Picardie, 80054 Amiens
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Liang HW, Snyder N, Wang J, Xun X, Yin Q, LeWinn K, Carroll KN, Bush NR, Kannan K, Barrett ES, Mitchell RT, Tylavsky F, Adibi JJ. A study on the association of placental and maternal urinary phthalate metabolites. J Expo Sci Environ Epidemiol 2023; 33:264-272. [PMID: 36114292 PMCID: PMC10101560 DOI: 10.1038/s41370-022-00478-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Phthalate exposure in pregnancy is typically estimated using maternal urinary phthalate metabolite levels. Our aim was to evaluate the association of urinary and placental tissue phthalates, and to explore the role of maternal and pregnancy characteristics that may bias estimates. METHODS Fifty pregnancies were selected from the CANDLE Study, recruited from 2006 to 2011 in Tennessee. Linear models were used to estimate associations of urinary phthalates (2nd, 3rd trimesters) and placental tissue phthalates (birth). Potential confounders and modifiers were evaluated in categories: temporality (time between urine and placenta sample), fetal sex, demographics, social advantage, reproductive history, medication use, nutrition and adiposity. Molar and quantile normalized phthalates were calculated to facilitate comparison of placental and urinary levels. RESULTS Metabolites detectable in >80% of both urine and placental samples were MEP, MnBP, MBzP, MECPP, MEOHP, MEHHP, and MEHP. MEP was most abundant in urine (geometric mean [GM] 7.00 ×102 nmol/l) and in placental tissue (GM 2.56 ×104 nmol/l). MEHP was the least abundant in urine (GM 5.32 ×101 nmol/l) and second most abundant in placental tissue (2.04 ×104 nmol/l). In aggregate, MEHP differed the most between urine and placenta (2.21 log units), and MEHHP differed the least (0.07 log units). MECPP was positively associated between urine and placenta (regression coefficient: 0.31 95% CI 0.09, 0.53). Other urine-placenta metabolite associations were modified by measures of social advantage, reproductive history, medication use, and adiposity. CONCLUSION Phthalates were ubiquitous in 50 full-term placental samples, as has already been shown in maternal urine. MEP and MEHP were the most abundant. Measurement and comparison of urinary and placental phthalates can advance knowledge on phthalate toxicity in pregnancy and provide insight into the validity and accuracy of relying on maternal urinary concentrations to estimate placental exposures. IMPACT STATEMENT This is the first report of correlations/associations of urinary and placental tissue phthalates in human pregnancy. Epidemiologists have relied exclusively on maternal urinary phthalate metabolite concentrations to assess exposures in pregnant women and risk to their fetuses. Even though it has not yet been confirmed empirically, it is widely assumed that urinary concentrations are strongly and positively correlated with placental and fetal levels. Our data suggest that may not be the case, and these associations may vary by phthalate metabolite and associations may be modified by measures of social advantage, reproductive history, medication use, and adiposity.
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Affiliation(s)
- Hai-Wei Liang
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Nathaniel Snyder
- Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Jiebiao Wang
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Xiaoshuang Xun
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Qing Yin
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Kaja LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Kecia N Carroll
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Kurunthachalam Kannan
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Emily S Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, Scotland, UK
| | - Fran Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer J Adibi
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA.
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
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Turjanski S, Musić L, Špiljak B, Bučević Sojčić P, Karlović Z, Zajc I. Analysis of Hospital-Based Dental Procedures Under General Anesthesia in Uncooperative Patients: a Retrospective Study. Acta Stomatol Croat 2023; 57:22-31. [PMID: 37288155 PMCID: PMC10243710 DOI: 10.15644/asc57/1/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/03/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND General anesthesia is a well-documented therapeutic option for the provision of dental treatment, particularly in patients with special healthcare needs and uncooperative pediatric patients. OBJECTIVES This retrospective study aimed to analyze the characteristics of dental general anesthesia (DGA) procedures for uncooperative patients of all ages in a tertiary healthcare facility, Clinical Hospital Dubrava, in Zagreb, Croatia. MATERIAL AND METHODS The hospital records for the patients treated for various dental reasons under GA were obtained at the Clinical Hospital Dubrava in Zagreb, Croatia. RESULTS Between 2014 and 2019, a total of 810 DGA procedures were performed including 607 patients. The median age was 18 years. Almost half of the patients referred to undergo DGA procedures were from the City of Zagreb and Zagreb County, 27.8% (N=225) and 21.0% (N=170), respectively. More than 90% of patients undergoing DGA procedures were referred with 1 to 3 medical conditions. 47.9% of patients had 1 to 3 dental conditions, of which caries was the most common condition (95.7%). The mean waiting time (±SD) was 113.06 (±62.62) days. 90 patients (14.8%) were referred for dental procedures under GA more than once, accounting for 203 procedures (25.1%). CONCLUSIONS DGA remains a single dental treatment option for specific individuals. There is an institutional and, also, an organizational need to address the long waiting times and high repeated DGA rates.
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Affiliation(s)
- Sarah Turjanski
- Resident of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb and University Hospital Centre Zagreb
- Postgraduate doctoral study program, School of Dental Medicine, University of Zagreb
| | - Larisa Musić
- Department of Periodontology, School of Dental Medicine, University of Zagreb
| | - Bruno Špiljak
- Postgraduate doctoral study program, School of Dental Medicine, University of Zagreb
| | - Petra Bučević Sojčić
- Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb
| | - Zoran Karlović
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb and University Hospital Centre Zagreb
| | - Ivan Zajc
- Department of Oral Surgery, School of Dental Medicine, University of Zagreb and Clinical Hospital Dubrava, Zagreb
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Terzi O, Dundar C. The problem of unaccompanied children in the earthquake; insufficient enrollment. Disaster Med Public Health Prep 2023; 17:1-6. [PMID: 36803533 DOI: 10.1017/dmp.2023.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Türkiye experienced two of the most catastrophic earthquakes of the last century on February 6, 2023. The first earthquake with a magnitude of 7.7 occurred at 4.17 a.m. in Kahramanmaraş City. Nine hours later, the second earthquake with a magnitude of 7.6 hit a region, which has 10 cities and over 16 million people. After the earthquakes, the Director-General of the World Health Organization, Hans Kluge, announced that a level 3 emergency was declared.One of the problems that should be solved at the earliest period in earthquakes is the problem of orphans or unaccompanied children. These children, referred to as 'earthquake orphans', can be potential victims of violence, organized crime, organ trafficking, drug addiction, sexual exploitation, or human trafficking. The already low socioeconomic level of the region, the magnitude of the earthquake, and the turmoil in the emergency rescue organization cause concern about the fact that the number of fragile children's population that will be affected will be higher than expected. The problem of orphaned children experienced in previous major destructive earthquakes provides important experiences for earthquake preparation.
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Affiliation(s)
- Ozlem Terzi
- Ondokuz Mayis University Faculty of Medicine, Public Health, Samsun, 55139, TR,
| | - Cihad Dundar
- Ondokuz Mayis University Faculty of Medicine, Samsun, TR,
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Thomas M, Frazier E, Garr D. Managing COVID-19 transmission in long-term care: A qualitative study of high performing facilities. Am J Infect Control 2023; 51:234-7. [PMID: 35839959 DOI: 10.1016/j.ajic.2022.06.023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 01/31/2023]
Abstract
Ever since its emergence, COVID-19 has posed a serious threat to members of the population who are older and have underlying health conditions, with those residing in Long-Term Care Facilities being particularly susceptible. The purpose of this study was to explore initiatives implemented by Long-Term Care Facilities which had lower COVID-19 transmission compared to their regional counterparts. Of the facilities interviewed, the majority implemented a routine testing schedule for residents utilizing both PCR and Rapid Antigen nasal tests, while also separately housing residents who may be at an increased risk. The results of this study could serve as a guidance for other facilities.
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Duque-Molina C, Borrayo-Sánche G, Avilés-Hernández R, Herrera-Reyna P. [PRIISMA Project: Transformation into a more preventive, resilient, comprehensive, innovative, sustainable, modern and accessible IMSS]. Rev Med Inst Mex Seguro Soc 2022; 60:S54-S64. [PMID: 36795956 PMCID: PMC10627496] [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] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/05/2022] [Indexed: 02/18/2023]
Abstract
Two years after the onset of the COVID-19 pandemic, the Mexican Institute for Social Security (IMSS, according to its initials in Spanish) rethought new projects focused on the new needs of the population and social security organizations and institutions. The Institute, as a cornerstone in the search for the wellbeing of Mexicans, aligned with the National Development Plan and the Strategic Health for Wellbeing Program, sought to direct its transformation towards a preventive, resilient, comprehensive, innovative, sustainable, modern and accessible IMSS. For this reason, the Medical Services Director designed the PRIISMA Project, as the one that over the next three years could make possible to innovate and improve its medical care processes, starting with the recovery of medical services and identifying those groups of beneficiaries who experience the most vulnerable circumstances. The PRIISMA project consisted of five sub-projects: 1. Vulnerable groups; 2. Efficient and effective care; 3. Prevent IMSS plus; 4 IMSS University and 5. Recovery of medical services. The strategies of each project seek to improve medical care for all IMSS beneficiaries and users with a human rights perspective and by priority groups; the goal is reducing the gaps in access to health care, leaving no one behind and leaving no one out; and to surpass the goals for medical services provided before the pandemic. This document provides an overview of strategies and progress of the PRIISMA sub-projects achieved during 2022.
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Affiliation(s)
- Célida Duque-Molina
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Gabriela Borrayo-Sánche
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, Coordinación de Innovación en Salud. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Ricardo Avilés-Hernández
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, Unidad de Planeación e Innovación en Salud. Ciudad de México, México Instituto Mexicano del Seguro SocialMéxico
| | - Paulina Herrera-Reyna
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, Coordinación de Innovación en Salud. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Johnson PI, Favela K, Jarin J, Le AM, Clark PY, Fu L, Gillis AD, Morga N, Nguyen C, Harley KG. Chemicals of concern in personal care products used by women of color in three communities of California. J Expo Sci Environ Epidemiol 2022; 32:864-876. [PMID: 36323919 PMCID: PMC9628299 DOI: 10.1038/s41370-022-00485-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 05/02/2023]
Abstract
BACKGROUND Personal care products (PCPs) may contain chemicals associated with adverse health effects. Prior studies found differences in product use by race/ethnicity and suggest some women are disproportionately exposed to chemicals of concern (CoCs). OBJECTIVE We quantified chemicals linked to cancer, reproductive or developmental harm, or endocrine disruption in PCPs used by women of color. METHODS We documented PCPs in stores frequented by Black, Latina, and Vietnamese women in their communities in California and CoCs on ingredient labels of 546 unique hair, skin, makeup, nail, deodorant/perfume, and intimate care products. Community partners chose 31 products for a combined targeted and suspect screen (National Institute of Standards and Technology mass spectral library search) two-dimensional gas chromatography time-of-flight mass spectrometry (GCxGC-TOFMS) analysis to detect chemicals not on ingredient labels. RESULTS We found that 65% of labels included CoCs, and 74% of labels had undisclosed ingredients listed as "fragrance." The most prevalent chemicals were parabens, cyclosiloxanes, and formaldehyde releasers. GCxGC-TOFMS found additional CoCs, including fragrances, solvents, preservatives, ultraviolet filters, and contaminants. SIGNIFICANCE These findings contribute to awareness of potentially hazardous chemicals in PCPs, can help estimate disparities in chemical exposure, and complement research on health inequities due to chemical exposures from various contributors. IMPACT STATEMENT This study is one of the first detailed assessments of chemicals of concern found in various types of PCPs used by several racial/ethnic groups. We found that over half of the 546 products selected by community partners as marketed to and/or used by them contained ingredients linked to cancer, reproductive or developmental harm, or endocrine disruption. Laboratory analysis identified additional chemicals in a subset of products, including unlabeled fragrance chemicals and contaminants. Elucidating exposures to chemicals in PCPs is important for risk assessment and health inequity research.
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Affiliation(s)
- Paula I Johnson
- California Safe Cosmetics Program, California Department of Public Health, Richmond, CA, USA.
| | | | - Jennifer Jarin
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Amy M Le
- California Safe Cosmetics Program, California Department of Public Health, Richmond, CA, USA
| | | | - Lisa Fu
- California Healthy Nail Salon Collaborative, Oakland, CA, USA
| | | | - Norma Morga
- The Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) Study at Clinica de Salud del Valle de Salinas, Salinas, CA, USA
| | - Caroline Nguyen
- California Healthy Nail Salon Collaborative, Oakland, CA, USA
| | - Kim G Harley
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California Berkeley, Berkeley, CA, USA
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17
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Morham S, Reichardt A, Toth A, Olin G, Pohlman K, Passmore SR. Patient Characteristics and Clinical Outcomes Associated With Conservative Treatment for Spine Pain in Women Experiencing Socioeconomic Challenges. J Manipulative Physiol Ther 2022; 45:633-640. [PMID: 37294217 DOI: 10.1016/j.jmpt.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/21/2023] [Accepted: 04/08/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The purpose of this study was to describe patient demographics and pain changes for women over the course of care in a chiropractic program. METHODS We performed a retrospective cross-sectional analysis of a prospective quality assurance database from the Mount Carmel Clinic (MCC) in Winnipeg, Manitoba, Canada. Pain scores were reported on an 11-point Numeric Rating Scale. Baseline and discharge Numeric Rating Scale scores were compared for each spinal and extremity region through Wilcoxon signed rank tests to determine if clinically meaningful or statistically significant differences were present. RESULTS The sample population attained was 348 primarily middle-aged (mean = 43.0, SD = 14.96) women with obesity (body mass index = 31.3 kg/m2, SD = 7.89) referred to the MCC chiropractic program by their primary care physician (65.2%) for an average of 15.6 (SD = 18.49) treatments. Clinically meaningful median baseline to discharge changes in pain by spine region were observed (Cervical = -2, Thoracic = -2, Lumbar = -3, Sacroiliac = -3), each of which yielded statistical significance (P < .001). CONCLUSION This retrospective analysis found that the MCC chiropractic program serves middle-aged women with obesity experiencing socioeconomic challenges. Pain reductions were reported, regardless of the region of complaint, temporally associated with a course of chiropractic care.
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Affiliation(s)
- Sophie Morham
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amber Reichardt
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Audrey Toth
- Chiropractic Program, Mount Carmel Clinic, Winnipeg, Manitoba, Canada
| | - Gerald Olin
- Canadian Chiropractic Protective Association, Winnipeg, Manitoba, Canada
| | | | - Steven R Passmore
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
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Razavi SD, Kapiriri L, Abelson J, Wilson M. Barriers to Equitable Public Participation in Health-System Priority Setting Within the Context of Decentralization: The Case of Vulnerable Women in a Ugandan District. Int J Health Policy Manag 2022; 11:1047-1057. [PMID: 33590740 PMCID: PMC9808191 DOI: 10.34172/ijhpm.2020.256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 12/09/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Decentralization of healthcare decision-making in Uganda led to the promotion of public participation. To facilitate this, participatory structures have been developed at sub-national levels. However, the degree to which the participation structures have contributed to improving the participation of vulnerable populations, specifically vulnerable women, remains unclear. We aim to understand whether and how vulnerable women participate in health-system priority setting; identify any barriers to vulnerable women's participation; and to establish how the barriers to vulnerable women's participation can be addressed. METHODS We used a qualitative description study design involving interviews with district decision-makers (n=12), sub-county leaders (n=10), and vulnerable women (n=35) living in Tororo District, Uganda. Data was collected between May and June 2017. The analysis was conducting using an editing analysis style. RESULTS The vulnerable women expressed interest in participating in priority setting, believing they would make valuable contributions. However, both decision-makers and vulnerable women reported that vulnerable women did not consistently participate in decision-making, despite participatory structures that were instituted through decentralization. There are financial (transportation and lack of incentives), biomedical (illness/disability and menstruation), knowledge-based (lack of knowledge and/or information about participation), motivational (perceived disinterest, lack of feedback, and competing needs), socio-cultural (lack of decision-making power), and structural (hunger and poverty) barriers which hamper vulnerable women's participation. CONCLUSION The identified barriers hinder vulnerable women's participation in health-system priority setting. Some of the barriers could be addressed through the existing decentralization participatory structures. Respondents made both short-term, feasible recommendations and more systemic, ideational recommendations to improve vulnerable women's participation. Integrating the vulnerable women's creative and feasible ideas to enhance their participation in health-system decision-making should be prioritized.
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Affiliation(s)
- S. Donya Razavi
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence, and Impact (HEI), Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Michael Wilson
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster Health Forum, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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Wan W, Li V, Chin MH, Faldmo DN, Hoefling E, Proser M, Weir RC. Development of PRAPARE Social Determinants of Health Clusters and Correlation with Diabetes and Hypertension Outcomes. J Am Board Fam Med 2022; 35:668-79. [PMID: 35896473 DOI: 10.3122/jabfm.2022.04.200462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/02/2020] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION PRAPARE is a leading social risk screening tool. No studies yet have simplified the 22 PRAPARE social determinants of health (SDoH) into clusters to analyze associations with chronic disease outcomes. METHODS A federally qualified health center conducted cross-sectional PRAPARE screening on its general adult population. Exploratory and confirmatory factor analyses were used to identify SDoH clusters and construct cluster scores and SDoH total risk scores. Logistic regression assessed relationships between cluster scores and uncontrolled diabetes and/or hypertension. RESULTS Of the 11,773 adults who answered the survey, 716 had diabetes only, 2,388 had hypertension only, 1,477 had both, and 7,192 had neither. We found 3 composite SDoH clusters (social background, social insecurities, insurance/employment) and 3 standalone clusters (housing status, social isolation, poverty). Among patients with diabetes, those at risk in social background, social insecurities, and insurance/employment were more likely to have uncontrolled diabetes. Among patients with hypertension, those at more risk in social insecurities were more likely to have uncontrolled hypertension. CONCLUSIONS We simplified the 22 PRAPARE SDoH into 3 composite clusters and 3 individual clusters and demonstrated the reliability and validity of PRAPARE. The 3 composite clusters were positively associated with uncontrolled diabetes and/or hypertension.
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Jetty A, Hyppolite J, Eden AR, Taylor MK, Jabbarpour Y. Underrepresented Minority Family Physicians More Likely to Care for Vulnerable Populations. J Am Board Fam Med 2022; 35:223-4. [PMID: 35379709 DOI: 10.3122/jabfm.2022.02.210280] [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: 07/08/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 11/08/2022] Open
Abstract
Using data from 2016 to 2020, we found that family physicians who identify as underrepresented minorities in medicine were more likely to have a larger percentage of vulnerable patients in their panels. Increasing access to care for vulnerable patient populations will require a combination of advocating for policies to diversify the physician pipeline and those that encourage all primary care physicians to care for vulnerable patients.
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Monsees J, Öztürk S, Thyrian JR. Dementia and migration: culturally sensitive healthcare services and projects in Germany : A scoping review. Z Gerontol Geriatr 2022. [PMID: 35119527 DOI: 10.1007/s00391-022-02022-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/10/2022] [Indexed: 11/14/2022]
Abstract
Background There are approximately 96,500 people with a migration background (PwM) with dementia in Germany. They and their families face not only dementia-related challenges but also the challenge of having little knowledge about the healthcare system and its services and thus more difficulty in accessing support. Germany’s national dementia strategy recognises these individuals as a risk group and thus aims to expand the provision of culturally sensitive information and healthcare services. Objective To determine the amount of culturally sensitive information and healthcare services as well as projects on dementia and migration. Method With a scoping review the PsycInfo, PsycArticles and Psychology & Behavioral Sciences Collection databases, Google Search, the network map (Netzwerkkarte on the website www.demenz-und-migration.de) and the websites of various research funding bodies were used to find culturally sensitive information and healthcare services as well as current projects on dementia and migration. Results Listed are 45 care services as well as 3 additional projects that deal with dementia and migration at the local level. The geographical distribution of the offers shows that most of the services can be found in federal states where most PwM with dementia live. Discussion It is necessary to provide information and healthcare services in all regions and to adapt them to PwM. Different aspects and culturally sensitive measures are important when informing PwM with dementia, as such information can enable these individuals to access the healthcare system and help to provide them with care. It is important to bring together relevant stakeholders to provide access and services that improve the situation of PwM with dementia and their families.
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Mohamadi E, Olyaeemanesh A, Takian A, Yaftian F, Kiani MM, Larijani B. Short and Long-term Impacts of COVID-19 Pandemic on Health Equity: A Comprehensive Review. Med J Islam Repub Iran 2022; 36:179. [PMID: 36908936 PMCID: PMC9997417 DOI: 10.47176/mjiri.36.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 03/14/2023] Open
Abstract
Background: The impact of the COVID-19 pandemic on human life has led to profound consequences in almost all societies worldwide, and this includes its significant impact on all aspects of health. Health equity has been among the main challenges in any healthcare system. However, with the COVID-19 crisis worsening health inequalities, the need to prioritize health equity in upstream national and international plans must receive scholarly attention. Therefore, this paper reports the findings of a review of the current synthesized evidence about the impact of the COVID-19 pandemic on health equity. Methods: This is a comprehensive review in which we retrieved relevant studies during the period starting from 12/01/2019 to 01/15/2021 are retrieved from various databases. The PRISMA flow diagram and a narrative approach are used for synthesizing the evidence. Results: We initially retrieved 1173 studies, and after a primary quality appraisal process, 40 studies entered the final phase of analysis. The included studies were categorized into five main outcome variables: Accessibility (95%), Utilization (65.8%), Financial protection: 15 (36.5%), Poverty (31.7%), and Racism (21.9%) Conclusion: COVID-19 pandemic has been the most devastating global challenge in recent history. While the COVID-19 crisis is still unfolding, its multidimensional adverse effects are yet to be revealed. Nevertheless, some people, e.g., the elderly, minorities, as well as marginalized and poor persons, have suffered the COVID-19 consequences more than others. In line with the whole government/whole society approach, we advocate that governments need to strengthen their special efforts to reduce the extra burden of the pandemic on the most vulnerable populations.
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Affiliation(s)
- Efat Mohamadi
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.,National Center for Health Insurance Research, Health Insurance Organization, Tehran, Iran
| | - Alireza Olyaeemanesh
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.,National Institute of Health Research, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Amirhossein Takian
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,National Center for Health Insurance Research, Health Insurance Organization, Tehran, Iran
| | - Fateme Yaftian
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Mehdi Kiani
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Rose SW, Anesetti-Rothermel A, Westneat S, van de Venne J, Folger S, Rahman B, Azam T, Zhou Y, Debnam C, Ribisl K, Cohn AM. Inequitable distribution of FTP marketing by neighborhood characteristics: further evidence for targeted marketing. Nicotine Tob Res 2021; 24:484-492. [PMID: 34687204 PMCID: PMC8887586 DOI: 10.1093/ntr/ntab222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/11/2020] [Accepted: 10/19/2021] [Indexed: 12/18/2022]
Abstract
Introduction Flavored tobacco products (FTPs) are disproportionately used among young people and racial/ethnic minority populations. However, few studies have examined the retail distribution of such product marketing beyond menthol cigarettes. This study created geographic-based predictions about marketing of FTPs (overall, cigarettes, cigars, e-cigarettes, and smokeless) in stores across Washington, DC neighborhoods. We examined neighborhood-level demographic correlates of the amount of FTP and non-FTP marketing. Methods We conducted photographic audits of interior and exterior tobacco marketing in 96 Washington, DC tobacco retailers visited by 149 young adult respondents between 2018–2019. We created a geographic predictive surface of overall and product-specific tobacco marketing and then estimated the average predicted amount of marketing at the census-tract level using zonal statistics. Using linear regression, we examined neighborhood demographic correlates (race/ethnicity, family poverty, and youth population under 18) of FTP and non-FTP marketing. Results The predicted amount of non-FTP ads/displays were evenly distributed with no neighborhood variability (Range 8.46–8.46). FTP marketing overall was geographically concentrated with greater range across neighborhoods (Range 6.27–16.77). Greater FTP marketing overall and flavored cigar marketing was available in neighborhoods with higher percentages of Black residents. Flavored cigar marketing was less available in neighborhoods with more Hispanic residents, but there was greater flavored smokeless tobacco marketing. Nonflavored marketing overall and by product did not vary across neighborhoods. Conclusions This study provides evidence of disproportionate distribution of FTP marketing in Black neighborhoods, especially for flavored cigars, at the point-of-sale. Policies that restrict the sale of FTPs may enhance health equity. Implications Tobacco marketing has frequently been shown to be more prevalent in neighborhoods with lower household income and more Black residents. Using geographic-based predictions, we find that greater flavored tobacco marketing in these neighborhoods, not decreased marketing for nonflavored tobacco, is driving this disparity. Targeting Black neighborhoods with increased marketing of flavored tobacco products, which has been found to be more appealing, easier to use, and harder to quit is a social justice issue.
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Affiliation(s)
- Shyanika W Rose
- University of Kentucky College of Medicine Department of Behavioral Science and Center for Health Equity Transformation, Lexington, KY.,Markey Cancer Center, Lexington, KY
| | - Andrew Anesetti-Rothermel
- University of Kentucky College of Medicine Department of Behavioral Science and Center for Health Equity Transformation, Lexington, KY.,Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Susan Westneat
- University of Kentucky College of Medicine Department of Behavioral Science and Center for Health Equity Transformation, Lexington, KY
| | - Judy van de Venne
- University of Kentucky College of Medicine Department of Behavioral Science and Center for Health Equity Transformation, Lexington, KY
| | | | - Basmah Rahman
- Truth Initiative Schroeder Institute, Washington, DC
| | - Tofial Azam
- University of Kentucky College of Medicine Department of Behavioral Science and Center for Health Equity Transformation, Lexington, KY.,University of Kentucky, College of Public Health, Department of Biostatistics, Lexington, KY
| | - Yitong Zhou
- Truth Initiative Schroeder Institute, Washington, DC
| | | | - Kurt Ribisl
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, Chapel Hill, NC
| | - Amy M Cohn
- University of Oklahoma Health Sciences Center, TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK.,Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences, Oklahoma City, OK
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24
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Nguyen KH, Fields JD, Cemballi AG, Desai R, Gopalan A, Cruz T, Shah A, Akom A, Brown W 3rd, Sarkar U, Lyles CR. The Role of Community-Based Organizations in Improving Chronic Care for Safety-Net Populations. J Am Board Fam Med 2021; 34:698-708. [PMID: 34312263 DOI: 10.3122/jabfm.2021.04.200591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/12/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Social determinants of health (SDoH) influence health outcomes and contribute to disparities in chronic disease in vulnerable populations. To inform health system strategies to address SDoH, we conducted a multi-stakeholder qualitative study to capture the multi-level influences on health for those living in socio-economically deprived contexts. METHODS Varied qualitative inquiry methods - in-depth interviews, participant-led neighborhood tours, and clinic visit observations - involving a total of 23 participants (10 patients with chronic illnesses in San Francisco neighborhoods with high chronic disease rates, 10 community leaders serving the same neighborhoods, and 3 providers from San Francisco's public health care delivery system). Qualitative analyses were guided by the Chronic Care Model (CCM). RESULTS Several key themes emerged from this study. First, we enumerated a large array, neighborhood resources such as food pantries, parks/green spaces, and financial assistance services that interact with patients' self-management. Health service providers leveraged these resources to address patients' social needs but suggested a clear need for expanding this work. Second, analyses uncovered multiple essential mechanisms by which community-based organizations (CBOs) provided and navigated among many neighborhood health resources, including social support and culturally aligned knowledge. Finally, many examples of how structural issues such as institutional racism, transportation, and housing inequities are intertwined with health and social service delivery were elucidated. CONCLUSION The results contribute new evidence toward the community domain of the CCM. Health care systems must intentionally partner with CBOs to address SDoH and improve community resources for chronic care management, and directly address structural issues to make progress.
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25
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Murta FLG, Marques LLG, Santos APC, Batista TSB, Mendes MO, Silva ED, Neto AVS, Fabiano M, Rodovalho SR, Monteiro WM, Lacerda MVG. Perceptions about malaria among Brazilian gold miners in an Amazonian border area: perspectives for malaria elimination strategies. Malar J 2021; 20:286. [PMID: 34174880 PMCID: PMC8236171 DOI: 10.1186/s12936-021-03820-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/30/2021] [Accepted: 06/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background Mining in the Amazon exposes gold miners to various diseases, including malaria, whose control is still a major challenge. The environment of the mines contributes to the proliferation of vector mosquitoes and the precarious housing conditions facilitate transmission of the disease. Understanding gold miners’ perceptions is essential for the formulation of strategies to fight malaria. A qualitative study was carried out in the municipality of Calçoene, state of Amapá, Brazilian Amazon adjointining the municipality of Oiapoque, that is in the border area with French Guiana and Suriname. Methods A semi-structured interview was applied to an intentional sample of 29 miners, a number determined by the theoretical saturation criterion. Thematic analysis was adopted to obtain the results and the Cohen's Kappa index was calculated to verify the agreement between observers during coding. Results The agreement between observers was verified by a Cohen's Kappa index of 0.82. Analysis of the interviews showed that gold miners were subjected to prejudice from the community due to forest diseases that they can transmit, and their activities are often associated with crime. When the miners return to their hometown after a period of mining, the urban population blames them for the onset of diseases such as malaria. Most participants in the survey did not know how malaria transmission occurs, and associated its occurrence with contaminated water and food. Participants reported not being afraid of the disease, trusting the diagnosis and available treatment, though this depends on where they are treated. The use of therapeutic resources, such as medicinal plants and medicines acquired in the illegal market, is very common in this population. Despite the challenges identified by the research subjects, they believe that the disease can be controlled, or the cases reduced, but there was low acceptability for a possible mass drug administration (MDA) intervention. Conclusion Despite a recent reduction in malaria prevalence in Brazil, there are still vulnerable populations, such as gold miners, who help to perpetuate the existence of the disease in the Amazon. The lack of knowledge regarding how the transmission of malaria occurs, associated with myths regarding this and the use of traditional health practices and illegal drugs for the treatment of the disease without a specific diagnosis, jeopardizes the country’s efforts to eliminate malaria. It is necessary to implement control programmes in these populations, especially those who frequently travel around the border region and to remote locations, which are difficult regions for health teams to access, thus hindering diagnostic and treatment actions. For this reason, understanding the perceptions of these individuals as well as their customs, beliefs and lifestyle, can assist in the production of targeted educational material and adoption of strategies in the elimination of malaria in the country. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03820-0.
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Affiliation(s)
- Felipe L G Murta
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil. .,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil.
| | - Leonardo L G Marques
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Alicia P C Santos
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Talita S B Batista
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Maxwell O Mendes
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Elair D Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Alexandre V S Neto
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Marcio Fabiano
- Fundação Para o Desenvolvimento Científico e Tecnológico em Saúde, Rio de Janeiro, Brazil
| | - Sheila R Rodovalho
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil.,Pan American Health Organization - PAHO, World Health Organization, Brasilia, Brazil
| | - Wuelton M Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil.,Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane (FIOCRUZ-Amazonas), Manaus, Brazil
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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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Gotlieb EG, Rhodes KV, Candon MK. Disparities in Primary Care Wait Times in Medicaid versus Commercial Insurance. J Am Board Fam Med 2021; 34:571-8. [PMID: 34088817 DOI: 10.3122/jabfm.2021.03.200496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/21/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Timely access to primary care is important, particularly among patients with acute conditions and patients seeking gateways to specialty care. Due to concerns that expanded Medicaid eligibility would compromise access to primary care among new Medicaid beneficiaries, an experimental study was conducted to test the ability to obtain timely appointments. Although access to primary care appointments for simulated Medicaid patients significantly increased, wait times also increased. This study explores the determinants of wait times and whether they pose greater barriers to Medicaid beneficiaries. METHODS We conducted linear regressions to determine the association between the number of days to scheduled appointments and the simulated patient's clinical scenario, practice-level characteristics, and county-level measures of primary care supply. RESULTS Simulated Medicaid patients faced 1.3 days longer wait times than commercially insured ones. Participation in accountable care organizations and integrated health systems was associated with longer wait times but did not seem to reduce wait time disparities across insurance types. Notably, the presence of Federally Qualified Health Centers in a given county was associated with lower wait times for simulated Medicaid patients. CONCLUSIONS These findings highlight the complexity of access disparities for Medicaid patients and provide insight for future waves of health care reform.
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Binagwaho A, Mathewos K, Davis S. Equitable and Effective Distribution of the COVID-19 Vaccines - A Scientific and Moral Obligation. Int J Health Policy Manag 2021; 11:100-102. [PMID: 33949818 PMCID: PMC9278601 DOI: 10.34172/ijhpm.2021.49] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022] Open
Abstract
The rapid development of coronavirus disease 2019 (COVID-19) vaccines has not been met with the assurance of an effective and equitable global distribution mechanism. Low-income countries are especially at-risk, with the price of the vaccines and supply shortages limiting their ability to procure and distribute the vaccines. While the COVAX initiative is one of the solutions to these challenges, vaccine nationalism has resulted in the hoarding of vaccines and the signing of parallel bilateral deals, undermining this formerly promising initiative. Moreover, inequity in local distribution also remains a problem, with clear discrimination of minorities and lack of logistical preparation in some countries. As we continue to distribute the COVID-19 vaccines, pharmaceutical companies should share their technology to increase supply and reduce prices, governments should prioritize equitable distribution to the most at-risk in all nations and low-income countries should bolster their logistical capacity in preparation for mass vaccination campaigns.
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Affiliation(s)
- Agnes Binagwaho
- Vice Chancellor's Office, University of Global Health Equity, Kigali, Rwanda
| | - Kedest Mathewos
- Vice Chancellor's Office, University of Global Health Equity, Kigali, Rwanda
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Jetty A, Petterson S, Jabbarpour Y. Proportion of Family Physicians in Solo and Small Practices is on the Decline. J Am Board Fam Med 2021; 34:266-7. [PMID: 33832995 DOI: 10.3122/jabfm.2021.02.200457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/31/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 11/08/2022] Open
Abstract
Although solo and small practices are a vital part of primary care, the proportion of family physicians reporting working in practices with 5 or fewer providers declined from 15% to 11% for solo and 37% to 34% for small (2 to 5 providers) practices from 2014 to 2018. These decreasing trends are concerning, mainly when a low proportion of family physicians have solo practices in rural locations given the access to care challenges in these underserved populations.
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Taylor NK, Aboelata N, Mahoney M, Seay-Morrison T, Singh B, Chang SI, Asch SM, Shaw JG. Building Bridges Between Community Health Centers and Academic Medical Centers in a COVID-19 Pandemic. J Am Board Fam Med 2021; 34:S229-32. [PMID: 33622844 DOI: 10.3122/jabfm.2021.S1.200182] [Citation(s) in RCA: 3] [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: 04/30/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 11/08/2022] Open
Abstract
The threat to the public health of the United States from the COVID-19 pandemic is causing rapid, unprecedented shifts in the health care landscape. Community health centers serve the patient populations most vulnerable to the disease yet often have inadequate resources to combat it. Academic medical centers do not always have the community connections needed for the most effective population health approaches. We describe how a bridge between a community health center partner (Roots Community Health Center) and a large academic medical center (Stanford Medicine) brought complementary strengths together to address the regional public health crisis. The 2 institutions began the crisis with an overlapping clinical and research faculty member (NKT). Building on that foundation, we worked in 3 areas. First, we partnered to reach underserved populations with the academic center's newly developed COVID test. Second, we developed and distributed evidence-based resources to these same communities via a large community health navigator team. Third, as telemedicine became the norm for medical consultation, the 2 institutions began to research how reducing the digital divide could help improve access to care. We continue to think about how best to create enduring partnerships forged through ongoing deeper relationships beyond the pandemic.
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O'Gurek DT. Designing and Evaluating COVID-19 Protocols for an Office-Based Opioid Treatment Program in an Urban Underserved Setting. J Am Board Fam Med 2021; 34:S136-40. [PMID: 33622828 DOI: 10.3122/jabfm.2021.S1.200207] [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: 05/08/2020] [Revised: 07/25/2020] [Accepted: 07/30/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Despite changing federal regulations for providing telehealth services and provision of controlled substances during the COVID-19 pandemic, there is little guidance available for office-based opioid treatment (OBOT) programs integrated into primary care settings. PURPOSE (1) Develop disaster-preparedness protocols specific to the COVID-19 pandemic for an urban OBOT program, and (2) evaluate the impacts of the protocol and telehealth on care. METHODS Disaster-preparedness protocols specific to the COVID-19 pandemic were developed for an urban OBOT program, implemented on March 16, 2020. Retrospective chart review compared patients from January 1, 2020 to March 13, 2020, to patients from March 16, 2020 to April 30, 2020, abstracting patient demographics and comparing show and no-show rates between studied groups. RESULTS The disaster-preparedness protocol was developed under a deliberative process to address social issues of the urban underserved population. Of 852 visits conducted between Jan 1, 2020, and April 30, 2020, a 91.7% show rate (n = 166/181) was documented for telemedicine visits after protocol implementation compared with a 74.1% show rate (n = 497/671) for routine in-person care (P = .06) without significant differences between the study populations. The no-show rate was significantly lower after protocol implementation (8.3% vs 25.9%; P <0.05). CONCLUSIONS OBOTs require organized workflows to continue to provide services during the COVID-19 pandemic. Telemedicine, in the face of relaxed federal regulations, has the opportunity to enhance addiction care, creating a more convenient as well as an equally effective mechanism for OBOTs to deliver care that should inform future policy.
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Goupil K, Kinsinger FS. Pro Bono Services in 4 Health Care Professions: A Discussion of Exemplars. J Chiropr Humanit 2020; 27:21-28. [PMID: 33324133 PMCID: PMC7729119 DOI: 10.1016/j.echu.2020.10.001] [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: 08/29/2019] [Revised: 09/13/2020] [Accepted: 10/08/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The purpose of this article is to discuss exemplars of pro bono and charity activities in health care professions. METHODS We searched PubMed and Google Scholar from inception to August 2019 using search terms "pro bono healthcare," "medical volunteerism," "pro bono clinics OR free clinics OR organizations," "pro bono curriculum OR education," "underserved OR uninsured OR underinsured OR disadvantaged OR poor populations." Inclusion criteria were that practitioners, students, or volunteers be involved in pro bono care or education and in any discipline, including medicine, physical therapy, chiropractic, or dentistry. RESULTS We selected 5 exemplars to review, and determined that students can benefit from participation in pro bono or charity health care such as through a student administered clinic model. Academic curricula can play a role in building confidence and create positive attitudes and behaviors regarding pro bono and charity activities, and nonprofit organizations can help build sustainable models. CONCLUSION We conclude that the implementation and delivery of health care pro bono or charity services can fill a health care gap and can be applied successfully in the health professions.
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Affiliation(s)
| | - F. Stuart Kinsinger
- Corresponding author: F. Stuart Kinsinger, Canadian Memorial Chiropractic College (ret.), 412-7811 Yonge Street, Thornhill, ON, Canada
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Parente DJ. BRCA-Related Cancer Genetic Counseling is Indicated in Many Women Seeking Primary Care. J Am Board Fam Med 2020; 33:885-93. [PMID: 33219067 DOI: 10.3122/jabfm.2020.06.190461] [Citation(s) in RCA: 4] [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: 12/20/2019] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Guidelines updated by the United States Preventive Services Task Force (USPSTF) in 2019 recommend referral to genetic counseling for asymptomatic women that have a family history of cancers potentially associated with variants in the breast cancer type 1 and 2 susceptibility genes (BRCA1 and BRCA2). METHODS I performed a needs assessment for BRCA-related cancer genetic counseling among undifferentiated women seeking primary care at an urban, academic medical center with an underserved population. Adult, English-speaking women with outpatient primary care appointments were surveyed. Questions included personal and family history of potentially BRCA-related malignancies, history of genetic counseling and/or testing, and a version of the USPSTF-recommended 7-Question Family History Screening (FHS-7) tool, modified to promote accessibility among women with low health literacy. RESULTS Out of 397 women, 97 women (24.4% ± 4.2%, 95% CI) met criteria for referral to genetic counseling. Among women with referral indications, 80 women (82.4% ± 7.6%) had no prior contact with genetic counseling and/or testing services (comprising 20.1% ± 3.9% of all women surveyed). The most common indication for BRCA-related genetic counseling referral was family history of female breast cancer before age 50 years. CONCLUSIONS The rate that undifferentiated women seeking primary care met 2019 USPSTF criteria for BRCA-related cancer genetic counseling referral (24.4% ± 4.2%) exceeds earlier estimates (4 to 5%) but agrees with later, population-level estimates (24.1%). Health systems will need to appropriately allocate capacity to genetic counseling services and/or reconsider the appropriateness of FHS-7 as a primary care risk-stratification tool.
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Valois-Santos NT, Niquini RP, Sperandei S, Bastos LS, Bertoni N, Brito AM, Bastos FI. Reassessing geographic bottlenecks in a respondent-driven sampling based multicity study in Brazil. Salud Colect 2020; 16:e2524. [PMID: 33147401 DOI: 10.18294/sc.2020.2524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 07/15/2020] [Indexed: 11/24/2022] Open
Abstract
This study analyzes the spatial dynamics of drug users' recruitment chains in the context of a respondent-driven sampling (RDS) study in the city of Recife, Brazil. The purpose is to understand the geographic bottlenecks, influenced by social geography, which have been a major challenge for RDS-based studies. Temporo-spatial analysis was used. Sequential maps depicted the dynamics of the recruiting process, considering neighborhood of residence and/or places of drug use. Poisson regression was fitted to model the recruiting rate by neighborhood of residence and/or places of drug use, and the different neighborhoods' demographics. The distance between neighborhood of residence and/or places of drug use and the assessment center was negatively associated with recruitment. There was a positive association between the proportion of the population living in informal settings and the recruiting rate per neighborhood of residence and/or places of drug use. Recruitment chains depend on the social geography and demographics of the population. Studies should incorporate seeds from as many neighborhoods as possible, and more than one assessment center should be utilized.
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Sterling MR, Cho J, Ringel JB, Avgar AC. Heart Failure Training and Job Satisfaction: A Survey of Home Care Workers Caring for Adults with Heart Failure in New York City. Ethn Dis 2020; 30:575-582. [PMID: 32989357 PMCID: PMC7518527 DOI: 10.18865/ed.30.4.575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/11/2022] Open
Abstract
Background Home care workers (HCWs), who include home health aides and personal care attendants, frequently care for adults with heart failure (HF). Despite substantial involvement in HF care, prior qualitative studies have found that HCWs lack training and confidence, which creates challenges for this workforce and potentially for patient care. Herein, we quantified the prevalence of HF training among HCWs and determined its association with job satisfaction. Methods We conducted a cross-sectional survey of agency-employed HCWs caring for HF patients across New York, NY from 2018-2019. HF training was assessed with, "Have you received prior HF training?" Job satisfaction was assessed with, "How satisfied are you with your job?" The association between HF training and job satisfaction was determined with robust poisson regression. Results 323 HCWs from 23 agencies participated; their median age was 50 years (IQR: 37,58), 94% were women, 44% were non-Hispanic Black, 23% were Hispanic, 78% completed ≥ high school education, and 72% were foreign-born. They had been caregiving for a median of 8.5 years (IQR: 4,15) and 73% had cared for 1-5 HF patients. Two-thirds received none/a little HF training and 82% felt satisfied with their job. In a fully adjusted model, HCWs with some/a lot of HF training had 14% higher job satisfaction than those with none/a little HF training (aPR 1.14; 95% CI 1.03-1.27). Conclusions The majority of HCWs have not received HF training. HF training was associated with higher job satisfaction, suggesting that HF training programs may improve HCWs' experience caring for this patient population.
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Affiliation(s)
- Madeline R. Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Jacklyn Cho
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Joanna Bryan Ringel
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Ariel C. Avgar
- College of Industrial Labor Relations, Cornell University, Ithaca, NY
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Krist AH, Hochheimer CJ, Sabo RT, Puro J, Peele E, Lail-Kashiri P, Vernon SW. Patient, Clinician, and Communication Factors Associated with Colorectal Cancer Screening. J Am Board Fam Med 2020; 33:779-84. [PMID: 32989073 DOI: 10.3122/jabfm.2020.05.190378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/15/2019] [Revised: 05/01/2020] [Accepted: 05/09/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Screening for colorectal cancer is beneficial. Yet, screening remains suboptimal, and underserved populations are at greater risk for not being appropriately screened. Although many barriers to screening are understood, less is known about how the decision-making process on whether to receive colonoscopy or stool testing influences screening. METHODS As part of a randomized controlled trial to test engaging underserved populations in preventive care through online, personalized, educational material, 2417 patients aged 50 to 74 years were randomly selected from the 70,998 patients with an office visit the year prior and mailed a survey to assess decision-making for colorectal cancer screening. Twenty practices in practice-based research networks from 5 diverse states participated. Survey data were supplemented with electronic health record data. RESULTS Among respondents, 64% were or became up to date with screening within 3 months of their office visit. The main factor associated with being up to date was the length of the patient-clinician relationship (<6 months vs 5+ years: odds ratio [OR], 0.49; 95% CI, 0.30-0.80). Sharing the decision about screening options with the clinician was a predictor for being up to date compared with patients who made the decision for themselves (OR, 1.75; 95% CI, 1.27-2.44). Only 36% of patients reported being given a choice about screening options. Traditional factors like race, employment, insurance, and education were not associated with screening. CONCLUSIONS Having a long-term relationship with a primary care clinician and sharing decisions may be key drivers to ensure evidence-based preventive care for underserved populations.
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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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Purkey E, Davison C, MacKenzie M, Beckett T, Korpal D, Soucie K, Bartels S. Experience of emergency department use among persons with a history of adverse childhood experiences. BMC Health Serv Res 2020; 20:455. [PMID: 32448175 PMCID: PMC7245948 DOI: 10.1186/s12913-020-05291-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 12/24/2019] [Accepted: 05/04/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are associated with increased morbidity and mortality, lower levels of distress tolerance, and greater emotional dysregulation, as well as with increased healthcare utilization. All these factors may lead to an increased use of emergency department (ED) services. Understanding the experience of ED utilization among a group of ED users with high ACE scores, as well as their experiences as viewed through the lens of a trauma and violence informed care (TVIC) framework, could be important to their provision of care. METHODS This is the qualitative portion of a larger mixed methods study. Twenty-five ED users with high ACE scores completed in depth interviews. Thematic analysis of the interview transcripts was undertaken and directed content analysis was used to examine the transcripts against a TVIC framework. RESULTS The majority of participants experienced excellent care although challenges to this experience were faced by many in the areas of registration and triage. Some participants did identify negative experiences of care and stigma when presenting with mental health conditions and pain crises, as did participants who perceived that they were considered "different" (dressed differently, living in poverty, young parents, etc.). Participants were thoughtful about their reasons for seeking ED care including lack of timely access to their family doctor, perceived urgency of their condition, or needs that fell outside the scope of primary care. Participants' experiences mapped onto a TVIC framework such that their needs and experiences could be framed using a TVIC lens. CONCLUSIONS While the ED care experience was excellent for most participants, even those with a trauma history, there existed a subset of vulnerable patients for whom the principles of TVIC were not met, and for whom implementation of trauma informed care might have a positive impact on the overall experience of care. Recommendations include training around TVIC for ED leadership, staff and physicians, improved access to semi-urgent primary care, ED patient care plans integrating TVIC principles, and improved support for triage nurses and registration personnel.
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Affiliation(s)
- Eva Purkey
- Queen's University Department of Family Medicine, 220, Bagot street, Kingston, Ontario, K7L 5E9, Canada.
| | - Colleen Davison
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - Tracey Beckett
- Family Violence and Crisis Team, Department of National Defense, Kingston, Ontario, Canada
| | - Daniel Korpal
- Department of Emergency Medicine, Western University, London, Ontario, Canada
| | - Katherine Soucie
- Department of Emergency Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Susan Bartels
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
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McKinney M, Smith KE, Dong KA, Babenko O, Ross S, Kelly MA, Salvalaggio G. Development of the Inner City attitudinal assessment tool (ICAAT) for learners across Health care professions. BMC Health Serv Res 2020; 20:174. [PMID: 32143705 PMCID: PMC7059309 DOI: 10.1186/s12913-020-5000-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/14/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many health professions learners report feeling uncomfortable and underprepared for professional interactions with inner city populations. These learners may hold preconceptions which affect therapeutic relationships and provision of care. Few tools exist to measure learner attitudes towards these populations. This article describes the development and validity evidence behind a new tool measuring health professions learner attitudes toward inner city populations. METHODS Tool development consisted of four phases: 1) Item identification and generation informed by a scoping review of the literature; 2) Item refinement involving a two stage modified Delphi process with a national multidisciplinary team (n = 8), followed by evaluation of readability and response process validity with a focus group of medical and nursing students (n = 13); 3) Pilot testing with a cohort of medical and nursing students; and 4) Analysis of psychometric properties through factor analysis and reliability. RESULTS A 36-item online version of the Inner City Attitudinal Assessment Tool (ICAAT) was completed by 214 of 1452 undergraduate students (67.7% from medicine; 32.3% from nursing; response rate 15%). The resulting tool consists of 24 items within a three-factor model - affective, behavioural, and cognitive. Reliability (internal consistency) values using Cronbach alpha were 0.87, 0.82, and 0.82 respectively. The reliability of the whole 24-item ICAAT was 0.90. CONCLUSIONS The Inner City Attitudinal Assessment Tool (ICAAT) is a novel tool with evidence to support its use in assessing health care learners' attitudes towards caring for inner city populations. This tool has potential to help guide curricula in inner city health.
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Affiliation(s)
- Mark McKinney
- Inner City Health and Wellness Program, Edmonton, AB Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON Canada
| | - Katherine E. Smith
- Alberta Health Services, Edmonton, AB Canada
- Department of Emergency Medicine, University of Alberta, Edmonton, AB Canada
| | - Kathryn A. Dong
- Inner City Health and Wellness Program, Edmonton, AB Canada
- Alberta Health Services, Edmonton, AB Canada
- Department of Emergency Medicine, University of Alberta, Edmonton, AB Canada
| | - Oksana Babenko
- Department of Family Medicine, University of Alberta, Edmonton, AB Canada
| | - Shelley Ross
- Department of Family Medicine, University of Alberta, Edmonton, AB Canada
| | - Martina A. Kelly
- Department of Family Medicine, University of Calgary Cumming School of Medicine, Calgary, AB Canada
| | - Ginetta Salvalaggio
- Inner City Health and Wellness Program, Edmonton, AB Canada
- Department of Family Medicine, University of Alberta, Edmonton, AB Canada
- Department of Family Medicine, University of Alberta Faculty of Medicine & Dentistry, 610 University Terrace, Edmonton, AB T6G 2T4 Canada
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Patel SS, Zvinchuk O, Erickson TB. The Conflict in East Ukraine: A Growing Need for Addiction Research and Substance Use Intervention for Vulnerable Populations. Forensic Sci Addict Res 2020; 5:406-408. [PMID: 32363331 PMCID: PMC7194209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Security and trauma challenges in Ukraine have been constantly evolving since the 2014 Russian military incursion of Crimea and War in Donbass. One long-term consequence of the conflict in East Ukraine is the toll of substance and alcohol use and addictions that may have been triggered by the conflict among the veterans, internally displaced peoples, and civilian survivors. Further funding and research on substance and alcohol addiction with these vulnerable populations affected by the ongoing Ukrainian conflict should be examined. Are people from fragile states and conflict zones more susceptible to co-morbidity with substance abuse and addiction?
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Affiliation(s)
- Sonny S. Patel
- NIH Fogarty Global Health Scholar, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA
| | - Oleksandr Zvinchuk
- Fulbright Visiting Scholar, UIC Center for Global Health, Chicago, IL, USA
| | - Timothy B. Erickson
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham Health, Harvard Medical School, Boston, MA, USA
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Crego N, Douglas C, Bonnabeau E, Earls M, Eason K, Merwin E, Rains G, Tanabe P, Shah N. Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use. J Am Board Fam Med 2020; 33:91-105. [PMID: 31907250 DOI: 10.3122/jabfm.2020.01.190143] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 04/18/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Sickle-cell disease (SCD) causes significant morbidity, premature mortality, and high disease burden, resulting in frequent health care use. Comanagement may improve utilization and patient adherence with treatments such as Hydroxyurea. The purpose of this study was to describe acute-care utilization in Medicaid-enrolled patients with SCD, patient factors associated with comanagement, and adherence to Hydroxyurea. METHODS Data from 2790 patients diagnosed with SCD, age 1 to 65+ years, enrolled at least 1 month in North Carolina Medicaid between March 2016 and February 2017, were analyzed. Outpatient visits were categorized as primary care, hematologist, and nonhematologist specialist. Nurse practitioners or physician assistants with unidentified specialty type or family practice were categorized separately. Comanagement was defined as a minimum of 1 primary care and 1 hematologist visit/patient during the study period. RESULTS There were notable age-related differences in utilization of health care services. Only 34.82% of the sample was comanaged. Comanagement was higher in the 1-to-9-year-old (44.88%) and 10-to-17-year-old groups (39.22%) versus the 31-to-45-year-old (30.26%) and 65+-year-old (18.75%) age groups. Age had the greatest influence (AUC = 0.599) on whether or not a patient was comanaged. Only a third of the sample (32.24%) had at least 1 Hydroxyurea (HU) prescription. Age was the most predictive factor of good HUadherence (AUC = 0.6503). Prediction by comanagement was minimal with an AUC = 0.5615. CONCLUSION Comanagement was a factor in predicting HUadherence, but further studies are needed to identify the frequency and components of comanagement needed to increase adherence and reduce acute care utilization.
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Wagner JK. Ethical and Legal Considerations for the Inclusion of Underserved and Underrepresented Immigrant Populations in Precision Health and Genomic Research in the United States. Ethn Dis 2019; 29:641-650. [PMID: 31889769 DOI: 10.18865/ed.29.s3.641] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
There has been growing recognition of the importance of diversity and inclusion of underrepresented minority populations, including immigrants, in genomic research and precision medicine. Achieving diversity has been difficult and has led some scholars to question whether the law is a help or a threat to the inclusion of underserved and underrepresented immigrant populations. In this commentary, I provide an overview of some of the many relevant legal issues affecting the inclusion of immigrants in genomic research and precision health initiatives, such as the All of Us SM Research Program. Development of research recruitment, retention, and data collection plans without also considering the legal and sociopolitical context within which such efforts are to be carried out is risky. Advancing health policy with a goal of eliminating health disparities (or, at a minimum, ensuring that health disparities are not exacerbated by genomic or precision health technologies) requires us to acknowledge the negative effects that immigration policy and criminal justice policy have on the involvement of immigrants in such research and on their health directly. I conclude that it is not a question of whether the law is a help or a threat but, rather, whether we collectively will prioritize authentic diversity and inclusion policies and also insist on compliance with the laws intended to ensure the human right of every individual - regardless of immigration status or national origin - to share in the advancement of science.
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Affiliation(s)
- Jennifer K Wagner
- Center for Translational Bioethics & Health Care Policy, Geisinger; Danville, PA
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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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Kaasbøll J, Paulsen V. What is known about the LGBTQ perspective in child welfare services? A scoping review protocol. BMJ Open 2019; 9:e030675. [PMID: 31501125 PMCID: PMC6738672 DOI: 10.1136/bmjopen-2019-030675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/13/2019] [Accepted: 08/21/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In previous studies, it is estimated that sexual minorities (eg, lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals) are overrepresented in the child welfare system. However, the numbers are unclear, and there are limited studies in this field. No systematic review of LGBTQ issues across a broader context (ie, youth, foster parents and service providers) of child welfare services exists. The overall objective of this scoping review is to systematically scope the existing research on LGBTQ issues in the context of child welfare services, including policy, practice, service providers and users' perspectives. METHODS AND ANALYSIS The scoping review framework outlined by the Joanna Briggs Institute (JBI) based on previous work by Arksey and O'Malley and Levac and colleagues will guide this review. In addition, the PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation will be used throughout the process. We will search electronic databases (PubMed, EMBASE, PsycINFO, Web of Science and Idunn) and grey literature sources to identify studies that are appropriate for inclusion in this review. Using inclusion and exclusion criteria based on the 'Population-Concept-Context' framework, two researchers will independently screen titles, abstracts and full-text articles considered for inclusion. Any qualitative, quantitative and mixed-method study of LGBTQ issues in the child welfare context will be described and synthesised using a thematic synthesis approach. ETHICS AND DISSEMINATION A scoping review is a secondary analysis of published literature and does not require ethics approval. This scoping review is meant to provide an overview of the existing literature, aiming to expand policy-makers' and practitioners' knowledge of LGBTQ issues in a child welfare context and identify research gaps that can be used as a basis for further research. The results will be disseminated through a peer-reviewed publication, a conference presentation and a presentation to the key stakeholders.
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Affiliation(s)
- Jannike Kaasbøll
- Department of Mental Health, NTNU, Trondheim, Norway
- Department of Health Research, SINTEF, Trondheim, Norway
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Rivera CP, Quesada J, Holmes SM. Structural vulnerability and new perspectives in social medicine on the health of immigrants: Interview with James Quesada and Seth M. Holmes. Salud Colect 2019; 15:e2146. [PMID: 31829398 DOI: 10.18294/sc.2019.2146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/07/2019] [Accepted: 04/15/2019] [Indexed: 11/24/2022] Open
Abstract
A decade ago, a number of English-speaking authors focused mainly on the analysis and intervention of processes of social determination of health of migrants developed the concept of structural vulnerability as a way to combat individualism, biologism, the invisibilization of processes of structural determination and the blaming of victims. As part of the historical contributions of social medicine, the current developments of the structural vulnerability approach have been disconnected from the discussions of the collective health movement and Latin American social medicine in general, among other reasons due to linguistic barriers associated with the scarcity of publications in Spanish. The present interview, conducted with two of the primary representatives of the structural vulnerability approach, investigates its historical origins and seeks to explore the specific contributions that are being made today, as a way to bring them closer to Spanish-speaking readers and so enable dialogue with the proposals of Latin American social medicine.
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Affiliation(s)
- Carlos Piñones Rivera
- Psicólogo, Doctor en Antropología Médica. Investigador del Instituto de Estudios Internacionales, Universidad Arturo Prat, quique, Chile.
| | - James Quesada
- Doctor en Antropología Médica. Profesor, César Chavez Institute, Department of Anthropology, San Francisco State University, San Francisco, California, EEUU.
| | - Seth M Holmes
- Médico, Doctor en Antropología Médica. Profesor Asociado UC Berkeley's Division of Society and Environment, UCSF-Berkeley's Joint Program in Medical Anthropology, University of California, California, EEUU.
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Kenny DJ, Yoder LH. A picture of the older homeless female veteran: A qualitative, case study analysis. Arch Psychiatr Nurs 2019; 33:400-406. [PMID: 31280786 DOI: 10.1016/j.apnu.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/25/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Homelessness among female veterans is increasing and expected to rise further as more women enter the military. Very few studies qualitatively describe female homeless veterans' needs from their own perspective. PURPOSE Homeless female veterans' perceptions of their homelessness and what they believe is needed for independence and self-sustenance was examined. METHODS OA qualitative interpretive interview design was used and findings are reported as a case study. RESULTS A definitive picture emerged of a homeless female veteran, bounded by several factors they all had in common including age, family upheaval, mental health diagnoses, substance abuse, trauma, and need for information and networking.
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Affiliation(s)
- Deborah J Kenny
- Helen and Arthur E. Johnson College of Nursing and Health Sciences, University of Colorado, Colorado Springs, 1420 Austin Bluffs Parkway, Colorado Springs, CO 80918, USA.
| | - Linda H Yoder
- University of Texas at Austin School of Nursing, 1710 Red River, Austin, TX 78712, USA.
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Mangurian C, Giwa A, Brosey E, Shumway M, Dilley J, Fuentes-Afflick E, Pérez-Stable EJ, Schillinger D. Opinions of Primary Care Clinicians and Psychiatrists on Monitoring the Metabolic Effects of Antipsychotics. J Am Board Fam Med 2019; 32:418-23. [PMID: 31068407 DOI: 10.3122/jabfm.2019.03.180176] [Citation(s) in RCA: 8] [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: 06/19/2018] [Revised: 01/04/2019] [Accepted: 01/05/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Although people with severe mental illness (SMI) have high rates of diabetes and other metabolic disorders, adherence to recommended screening guidelines is low. This study aimed to compare primary care clinicians' and psychiatrists' attitudes toward metabolic monitoring and treatment of patients with SMI. METHODS Primary care clinicians and psychiatrists within 1 large urban integrated public health system were recruited to participate in this online survey study. Multivariate logistic regression analyses were used to examine if clinician characteristics were associated with attitudes or perceived barriers toward metabolic monitoring and treatment. RESULTS Response rates were 77% (164/214) of primary care providers and 69% (56/81) of psychiatrists completing the survey. There were no significant differences in age or race/ethnicity between provider groups, although primary care clinicians were more likely to be women when compared with the psychiatrists (69% vs 39%, P < .001). Psychiatrists were more likely than primary care clinicians to believe that psychiatrists should conduct metabolic monitoring even if patients had a primary care provider (80% vs 60%, P = .011) However, fewer psychiatrists than primary care clinicians believed that psychiatrists should treat identified cardiometabolic abnormalities (15% vs 42%, P < .001). CONCLUSION Systemic problems with care coordination and these varying expectations likely contribute to poor cardiometabolic outcomes in this vulnerable population.
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Satterwhite S, Knight KR, Miaskowski C, Chang JS, Ceasar R, Zamora K, Kushel M. Sources and Impact of Time Pressure on Opioid Management in the Safety-Net. J Am Board Fam Med 2019; 32:375-82. [PMID: 31068401 DOI: 10.3122/jabfm.2019.03.180306] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/15/2018] [Revised: 12/20/2018] [Accepted: 01/06/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This study sought to understand clinicians' and patients' experience managing chronic noncancer pain (CNCP) and opioids in safety-net primary care settings. This article explores the time requirements of safer opioid prescribing for medically and socially complex patients in the context of safety-net primary care. METHODS We qualitatively interviewed 23 primary care clinicians and 46 of their patients with concurrent CNCP and substance use disorder (past or current). We also conducted observations of clinical interactions between the clinicians and patients. We transcribed, coded, and analyzed interview and clinical observation recordings using grounded theory methodology. RESULTS Clinicians reported not having enough time to assess patients' CNCP, functional status, and risks for opioid misuse. Inadequate assessment of CNCP contributed to tension and conflicts during visits. Clinicians described pain conversations consuming a substantial portion of primary care visits despite patients' other serious health concerns. System-level constraints (eg, changing insurance policies, limited access to specialty and integrative care) added to the perceived time burden of CNCP management. Clinicians described repeated visits with little progress in patients' pain or functional status due to these barriers. Patients acknowledged clinical time constraints and reported devoting significant time to following new opioid management protocols for CNCP. CONCLUSIONS Time pressure was identified as a major barrier to safer opioid prescribing. Efforts, including changes to reimbursement structures, are needed to relieve time stress on primary care clinicians treating medically and socially complex patients with CNCP in safety-net settings.
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Momper JD, Yang J, Gockenbach M, Vaida F, Nigam SK. Dynamics of Organic Anion Transporter-Mediated Tubular Secretion during Postnatal Human Kidney Development and Maturation. Clin J Am Soc Nephrol 2019; 14:540-548. [PMID: 30885911 PMCID: PMC6450358 DOI: 10.2215/cjn.10350818] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/30/2018] [Accepted: 02/08/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES The neonatal and juvenile human kidney can be exposed to a variety of potentially toxic drugs (e.g., nonsteroidal anti-inflammatory drugs, antibiotics, antivirals, diuretics), many of which are substrates of the kidney organic anion transporters, OAT1 (SLC22A6, originally NKT) and OAT3 (SLC22A8). Despite the immense concern about the consequences of drug toxicity in this vulnerable population, the developmental regulation of OATs in the immature postnatal kidney is poorly understood. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Recognizing that today it is difficult to obtain rich data on neonatal kidney handling of OAT probes due to technical, logistic, and ethical considerations, multiple older physiologic studies that used the prototypical organic anion substrate para-aminohippurate (PAH) were reanalyzed in order to provide a quantitative description of OAT-mediated tubular secretion across the pediatric age continuum. Parametric and semiparametric models were evaluated for kidney function outcome variables of interest (maximum tubular secretory capacity of PAH [TmPAH], effective renal plasma flow [ERPF], and GFR). RESULTS Data from 119 neonates, infants, and children ranging in age from 1 day to 11.8 years were used to fit TmPAH, ERPF, and GFR as functions of postnatal age. TmPAH is low in the immediate postnatal period and increases markedly after birth, reaching 50% of the adult value (80 mg/min) at 8.3 years of age. During the first 2 years of life, TmPAH is lower than that of GFR when viewed as the fraction of the adult value. CONCLUSIONS During postnatal human kidney development, proximal tubule secretory function-as measured using PAH, a surrogate for OAT-mediated secretion of organic anion drugs, metabolites, and toxins-is low initially but increases rapidly. Despite developmental differences between species, this overall pattern is roughly consistent with animal studies. The human data raise the possibility that the acquisition of tubular secretory function may not closely parallel glomerular filtration.
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Affiliation(s)
- Jeremiah D Momper
- Division of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences,
| | - Jin Yang
- Division of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences
| | - Mary Gockenbach
- Division of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences
| | - Florin Vaida
- Division of Biostatistics and Bioinformatics, Department of Family and Preventive Medicine, School of Medicine, and
| | - Sanjay K Nigam
- Department of Pediatrics and Medicine (Nephrology), School of Medicine, University of California, San Diego, La Jolla, California
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Ylitalo KR, Camp BG, Umstattd Meyer MR, Barron LA, Benavidez G, Hess B, Laschober R, Griggs JO. Barriers and Facilitators of Colorectal Cancer Screening in a Federally Qualified Health Center (FQHC). J Am Board Fam Med 2019; 32:180-90. [PMID: 30850454 DOI: 10.3122/jabfm.2019.02.180205] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 07/20/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Colorectal cancer is a leading cause of cancer-related mortality in the United States. Current screening recommendations for individuals aged 50 to 75 years include colonoscopy every 10 years, flexible sigmoidoscopy every 5 years, or annual stool-based testing. Stool-based testing, including fecal immunochemical tests (FITs), are cost effective, easy to perform at home, and noninvasive, yet many patients fail to return testing kits and go unscreened. The purpose of the study was to identify patient characteristics and perceived barriers and facilitators of FIT return. METHODS Patients in a large, federally qualified health center who received a FIT kit order between January 1 and July 1, 2017 were identified. We compared sociodemographic and health characteristics between patients who returned and did not return FITs. We used telephone surveys to nonreturners to identify potential barriers (cost, knowledge, psychosocial factors) and facilitators (prepaid postage, outreach) of FIT kit return. An online survey of clinicians assessed perceived patient barriers and facilitators of colorectal cancer screening. RESULTS Of the 875 patients who received a FIT order, 435 (49.7%) did not return the kit and 121 of the nonreturners completed a telephone survey. Current smokers had an increased risk of FIT nonreturn compared with never smokers (RR = 1.32; 95% CI, 1.13-1.54). Forgetfulness and lack of motivation were the most common FIT return barriers perceived by both patients and clinicians. Prepaid postage with return address on FIT return envelopes and live call reminders were the most commonly reported facilitators. Barriers and facilitators varied greatest between English- and Spanish-speaking patients. CONCLUSION In this study, the most common perceived barriers to return of screening fecal test kits were forgetfulness and lack of motivation. The most common perceived facilitators were live call reminders and postage-paid return envelopes. Understanding barriers and facilitators to FITs may be necessary to enhance cancer screening rates in underserved patient populations.
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