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Bungay V, Dewar L, Schoening M, Guta A, Leiper W, Jiao S. Co-designing an Outreach Intervention for Women Experiencing Street-Involvement and Gender-Based Violence: Community-Academic Partnerships in Action. Violence Against Women 2024; 30:1760-1782. [PMID: 38374653 DOI: 10.1177/10778012241233004] [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: 02/21/2024]
Abstract
Outreach is an important approach to improve health and social care for women experiencing street involvement (SI) or gender-based violence (GBV). Few studies have examined outreach approaches that incorporate SI and GBV. Drawing on feminist theories and principles of community-based research, we detail an inclusive co-design approach for an outreach intervention considering these interrelated contexts. Women with lived experience, researchers, and service leaders drew on research and experiential knowledge to define outreach engagement principles: tackling GBV, personhood and relational engagement, trauma-informed engagement, and harm reduction engagement. The resulting intervention integrates these principles to enable building and sustaining relationships to facilitate care.
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Affiliation(s)
- Vicky Bungay
- University of British Columbia, Vancouver, BC, Canada
| | - Linda Dewar
- Inner-City Women's Initiatives Society, Vancouver, BC, Canada
- Community Advisory Committee, Vancouver, BC, Canada
| | | | | | - Wendy Leiper
- Community Partner Organization, Halifax, NS, Canada
| | - Sunny Jiao
- University of British Columbia, Vancouver, BC, Canada
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Waugh E, Thomas J, Anderson BJ, Lee-Archer P. Pediatric anesthesia in Australia and New Zealand and health inequity among First Nations and Māori children. Paediatr Anaesth 2024. [PMID: 38655874 DOI: 10.1111/pan.14898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
Australia and New Zealand are two countries in the Southern Pacific region. They share many pediatric anesthesia similarities in terms of medical organizational systems, education, training, and research, however there are important differences between the two nations in relation to geography, the First Nations populations and the history of colonization. While the standards for pediatric anesthesia and the specialty training requirements are set by the Australian and New Zealand College of Anesthetists and the Society for Pediatric Anesthesia in New Zealand and Australia, colonization has created distinct challenges that each nation now faces in order to improve the anesthetic care of its pediatric population. Australia generally has a high standard of living and good access to health care; disparities exist for First Nations People and for those living in rural or remote areas. Two influences have shaped training within New Zealand over the past 40 years; establishment of a national children's hospital in 1990 and, more importantly, acknowledgement that the First Nations people of New Zealand (Māori) have suffered because of failure to recognize their rights consequent to establishing a partnership treaty between Māori and the British Crown in 1840. Health inequities among Māori in New Zealand and First Nations People in Australia have implications for the health system, culturally appropriate approaches to treatment, and the importance of having an appreciation of First Nations people's history and culture, language, family structure, and cultural safety. Trainees in both countries need to be adequately supported in these areas in order for the sub-specialty of pediatric anesthesia to develop further and improve the anesthetic and surgical outcomes of our children.
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Affiliation(s)
- Edith Waugh
- Department of Anaesthesia and Perioperative Medicine, Royal Darwin and Palmerston Hospitals, Darwin, Northern Territory, Australia
| | - Jane Thomas
- Department of Anaesthesia, Starship Children's Hospital, Auckland, New Zealand
- The Auckland Regional Pain Service, Auckland, New Zealand
| | - Brian J Anderson
- Department of Anaesthesia, Starship Children's Hospital, Auckland, New Zealand
- Faculty of Medical and Health Sciences, Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Paul Lee-Archer
- Department of Anaesthesia, Children's Health Queensland Clinical Unit, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Hjern A, Lindfors A, Sarkadi A, Bergqvist K, Bergström M. Child behaviour is a main concern for parents of 3-year-olds. Acta Paediatr 2024. [PMID: 38624175 DOI: 10.1111/apa.17233] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/18/2024] [Accepted: 03/27/2024] [Indexed: 04/17/2024]
Abstract
AIM The aim of this study was to describe parental concerns about child health and behaviour and their sociodemographic predictors in 3-year-olds, in relation to the national guidelines of well-baby clinics. METHODS The study included parents of 33 526 children in Stockholm who had completed a questionnaire prior to a routine visit to a well-baby clinic at age 3 years. Multivariate regression was used to analyse predictors for concerns. RESULTS Child behaviour problems, defined as defiance and problem with adherence to daily routines, were the most common parental concerns (36.4%), with poor social skills and relations being second (21.8%). Regarding development, 9.6% had concerns about speech and 4.7% about motor development. Screen use (9.5%) and being underweight (6.3%) were other common parental concerns, while lifestyle concerns regarding physical activity and overweight were rare. Parents raised about twice as many concerns for first-born children compared with younger siblings. Child behaviour and developmental concerns were more frequent in families where the mother had primary education only and attended a well-baby clinic with a high Care Need Index. CONCLUSION Parents' concerns reflected the national guidelines about child development and behaviour, but not its emphasis on a healthy lifestyle.
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Affiliation(s)
- Anders Hjern
- Regional Unit for the Well-baby Clinics, Sachs Children's Hospital, Stockholm, Sweden
- Department of Medicine, Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Anncharlotte Lindfors
- Regional Unit for the Well-baby Clinics, Sachs Children's Hospital, Stockholm, Sweden
| | - Anna Sarkadi
- Department of Public Health and Caring Sciences, CHAP, Uppsala University, Uppsala, Sweden
| | - Kersti Bergqvist
- Regional Unit for the Well-baby Clinics, Sachs Children's Hospital, Stockholm, Sweden
| | - Malin Bergström
- Regional Unit for the Well-baby Clinics, Sachs Children's Hospital, Stockholm, Sweden
- Department of Medicine, Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
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O'Donnell L, Green JJ, Hill EC, O'Donnell MJ. Biocultural and social determinants of ill health and early mortality in a New Mexican paediatric autopsy sample. J Biosoc Sci 2024:1-22. [PMID: 38618934 DOI: 10.1017/s0021932024000129] [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: 04/16/2024]
Abstract
RESULTS. Hispanic children have higher odds of growth stunting than non-Hispanic White children. Native American children die younger and have higher odds of respiratory diseases and porous lesions than Hispanic and non-Hispanic Whites. Rural/urban location does not significantly impact age at death, but housing type does. Individuals who lived in trailers/mobile homes had earlier ages at death. When intersections between housing type and housing location are considered, children who were poor and from impoverished areas lived longer than those who were poor from relatively well-off areas. CONCLUSIONS. Children's health is shaped by factors outside their control. The children included in this study embodied experiences of social and ELS and did not survive to adulthood. They provide the most sobering example of the harm that social factors (structural racism/discrimination, socioeconomic, and political structures) can inflict.
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Affiliation(s)
- Lexi O'Donnell
- College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- Department of Anthropology, University of New Mexico, Albuquerque, NM, USA
| | - John J Green
- Southern Rural Development Center and Department of Agricultural Economics, Mississippi State University, Starkville, USA
| | - Ethan C Hill
- Division of Physical Therapy, Department of Orthopaedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Michael J O'Donnell
- Bureau of Business and Economic Research, University of New Mexico, Albuquerque, NM, USA
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Komene E, Pene B, Gerard D, Parr J, Aspinall C, Wilson D. Whakawhanaungatanga-Building trust and connections: A qualitative study indigenous Māori patients and whānau (extended family network) hospital experiences. J Adv Nurs 2024; 80:1545-1558. [PMID: 37897116 DOI: 10.1111/jan.15912] [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: 07/25/2023] [Revised: 10/06/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
AIMS Investigated the experiences of Māori (the Indigenous peoples of Aotearoa, New Zealand) patients and whānau (extended family network) engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care. DESIGN A qualitative Māori-centred research design using a Thought Space Wānanga (learning through in-depth group discussion, deliberation and consideration) approach. METHODS Two wānanga were conducted between May 2022 and June 2022, with 13 Māori patients who had been acutely hospitalized within the past 12 months and their whānau members. The first wānanga utilized storytelling and journey mapping to collect data. The second wānanga refined the initial themes. Wānanga were audio-recorded and then inductively coded and developed into themes. RESULTS Thirteen patients and whānau attended the first wānanga, while 10 patients and whānau participated in the second wānanga). Four themes were developed: (1) Whakawhanaungatanga (establishing connections and relationships), (2) Whakamana (uplifting the status and esteem of Māori), (3) Whakawhitiwhiti kōrero (the importance of communicating, discussing and deliberating) and (4) Kotahitanga (working together with purpose) all provide insights into the importance of effectively engaging and connecting with Māori patients and whānau when acutely hospitalized. CONCLUSIONS The experiences and priorities of Māori patients and whānau affirm the international literature, suggesting that Indigenous relational concepts are critical to building relationships, connections and trust. Despite existing healthcare models for working with Indigenous peoples, their poor application contributes to sub-optimal healthcare experiences at all points of their healthcare journey. A relational mode of practice focused on engagement and forming connections better meets the needs of Indigenous peoples engaging with inpatient health services. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Despite the existence of Indigenous models of care, Indigenous peoples consistently report a lack of engagement and connection when accessing inpatient health services. Without establishing relationships, applying models of care is challenging. IMPACT (ADDRESSING) What problem did the study address? Internationally, healthcare systems are consistently ill-equipped to deliver culturally safe care for Indigenous and marginalized peoples, evident in ongoing health inequities. Like other reports of Indigenous experiences of health services, Māori express dissatisfaction with care delivery in an acute inpatient setting. This study investigated Māori patients and whānau experiences engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care. What were the main findings? Māori patients and whānau recounted negative experiences with healthcare professionals lacking effective relationships and trust. Satisfaction occurred when engagement with health care professionals resembled Indigenous cultural rituals of encounter that considered their holistic, collective and dynamic worldviews. Previous models of relational care, while helpful, are not Indigenous and so do not address their needs, such as engagement as a mode of practice (how) to achieve this. Where and on whom will the research have an impact? This research impacts Indigenous peoples' health outcomes, particularly Māori, and nurses and clinicians working and interacting within acute inpatient and other hospital settings. Indigenous research methods support co-constructing knowledge for translation into practical outcomes through transformational practices, policies and theory development. REPORTING METHOD We used the Consolidated Criteria for Strengthening the Reporting of Health Research Involving Indigenous Peoples (CONSIDER) statement (see File S2-CONSIDER Checklist) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (see File S3-COREQ Checklist). PATIENT OR PUBLIC CONTRIBUTION Māori patients and their whānau interviewed about their experiences were involved in data interpretation.
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Affiliation(s)
- Ebony Komene
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bobbie Pene
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Northern Region Te Whatu Ora (Health New Zealand), Auckland, New Zealand
| | - Debra Gerard
- Northern Region Te Whatu Ora (Health New Zealand), Auckland, New Zealand
| | - Jenny Parr
- Northern Region Te Whatu Ora (Health New Zealand), Auckland, New Zealand
| | - Cath Aspinall
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Northern Region Te Whatu Ora (Health New Zealand), Auckland, New Zealand
| | - Denise Wilson
- Auckland University of Technology, Auckland, New Zealand
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Acharya H, Sykes KJ, Neira TM, Scott A, Pacheco CM, Sanner M, Ablah E, Oyowe K, Ellerbeck EF, Greiner KA, Corriveau EA, Finocchario-Kessler S. A Novel Electronic Record System for Documentation and Efficient Workflow for Community Health Workers: Development and Usability Study. JMIR Form Res 2024; 8:e52920. [PMID: 38557671 PMCID: PMC11019415 DOI: 10.2196/52920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic added to the decades of evidence that public health institutions are routinely stretched beyond their capacity. Community health workers (CHWs) can be a crucial extension of public health resources to address health inequities, but systems to document CHW efforts are often fragmented and prone to unneeded redundancy, errors, and inefficiency. OBJECTIVE We sought to develop a more efficient data collection system for recording the wide range of community-based efforts performed by CHWs. METHODS The Communities Organizing to Promote Equity (COPE) project is an initiative to address health disparities across Kansas, in part, through the deployment of CHWs. Our team iteratively designed and refined the features of a novel data collection system for CHWs. Pilot tests with CHWs occurred over several months to ensure that the functionality supported their daily use. Following implementation of the database, procedures were set to sustain the collection of feedback from CHWs, community partners, and organizations with similar systems to continually modify the database to meet the needs of users. A continuous quality improvement process was conducted monthly to evaluate CHW performance; feedback was exchanged at team and individual levels regarding the continuous quality improvement results and opportunities for improvement. Further, a 15-item feedback survey was distributed to all 33 COPE CHWs and supervisors for assessing the feasibility of database features, accessibility, and overall satisfaction. RESULTS At launch, the database had 60 active users in 20 counties. Documented client interactions begin with needs assessments (modified versions of the Arizona Self-sufficiency Matrix and PRAPARE [Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences]) and continue with the longitudinal tracking of progress toward goals. A user-specific automated alerts-based dashboard displays clients needing follow-up and upcoming events. The database contains over 55,000 documented encounters across more than 5079 clients. Available resources from over 2500 community organizations have been documented. Survey data indicated that 84% (27/32) of the respondents considered the overall navigation of the database as very easy. The majority of the respondents indicated they were overall very satisfied (14/32, 44%) or satisfied (15/32, 48%) with the database. Open-ended responses indicated the database features, documentation of community organizations and visual confirmation of consent form and data storage on a Health Insurance Portability and Accountability Act-compliant record system, improved client engagement, enrollment processes, and identification of resources. CONCLUSIONS Our database extends beyond conventional electronic medical records and provides flexibility for ever-changing needs. The COPE database provides real-world data on CHW accomplishments, thereby improving the uniformity of data collection to enhance monitoring and evaluation. This database can serve as a model for community-based documentation systems and be adapted for use in other community settings.
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Affiliation(s)
- Harshdeep Acharya
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ, United States
| | - Kevin J Sykes
- Health and Wellness Center, Baylor Scott and White Health, Dallas, TX, United States
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Ton Mirás Neira
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Angela Scott
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Christina M Pacheco
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Matthew Sanner
- Sanner Software Solutions, Kansas City, KS, United States
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | | | - Edward F Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - K Allen Greiner
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Erin A Corriveau
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah Finocchario-Kessler
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
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Hooper J, Jervis N, Morgan L, Beckett V, Hand P, Higgs K, Munir A, Prinn J, Pritchard DM, Sarker D, Srirajaskanthan R, Ellis CB. Neuroendocrine neoplasms: Consensus on a patient care pathway. J Neuroendocrinol 2024; 36:e13380. [PMID: 38471798 DOI: 10.1111/jne.13380] [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: 08/25/2023] [Revised: 01/30/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
People with neuroendocrine neoplasms (NENs) face a multitude of challenges, including delayed diagnosis, low awareness of the cancer among healthcare professionals and limited access to multidisciplinary care and expert centres. We have developed the first patient care pathway for people living with NENs in England to guide disease management and help overcome these barriers. The pathway was developed in two phases. First, a pragmatic review of the literature was conducted, which was used to develop a draft patient care pathway. Second, the draft pathway was then updated following semi-structured interviews with carefully selected expert stakeholders. After each phase, the pathway was discussed among a multidisciplinary, expert advisory group (which comprised the authors and the Deputy Chief Operating Officer, West Suffolk NHS Foundation Trust), who reached a consensus on the ideal care pathway. This article presents the outputs of this research. The pathway identified key barriers to care and highlighted how these may be addressed, with many of the findings relevant to the rest of the UK and international audiences. NENs are increasing in incidence and prevalence in England, compounding pre-existing inequities in diagnosis and disease management. Effective integration of this pathway within NHS England will help achieve optimal, equitable care provision for all people with NENs, and should be feasible within the existing expert multidisciplinary teams across the country.
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Affiliation(s)
| | | | | | - Vivienne Beckett
- Advanced Accelerators Applications (UK & Ireland) Ltd, a Novartis Company, London, UK
| | - Philippa Hand
- London North West University Healthcare NHS Trust, London, UK
| | | | - Alia Munir
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield Teaching Hospitals European Neuroendocrine Tumor Society Center of Excellence, Sheffield, UK
| | | | - D Mark Pritchard
- University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool Regional NET Service (European Neuroendocrine Tumor Society Center of Excellence), Liverpool, UK
| | - Debashis Sarker
- Guy's, St Thomas' and King's College Hospitals, King's Health Partners NET Centre (European Neuroendocrine Tumor Society Center of Excellence), London, UK
| | - Raj Srirajaskanthan
- King's College Hospital NHS Foundation Trust, King's Health Partners NET Centre (European Neuroendocrine Tumor Society Center of Excellence), London, UK
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Sharma K, Bhat S, Bhat SM. Causes of stillbirth in ethnically diverse women in a Perth metropolitan hospital: A retrospective study. Aust N Z J Obstet Gynaecol 2024; 64:141-146. [PMID: 37905931 DOI: 10.1111/ajo.13761] [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: 04/02/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Most published reports analysing the differences in causation of stillbirth between different ethnic groups focus on stillbirth risk factors, with a paucity of data comparing actual causes of stillbirth. AIMS To determine whether causes of stillbirth differ between Caucasian and non-Caucasian ethnic groups in an Australian context. MATERIALS AND METHODS Data from all stillbirths occurring at 20 or more completed weeks of gestation between 1 January 2010 and 31 December 2020 at a secondary level, outer metropolitan hospital, were analysed in this retrospective case series. Causes of stillbirth as determined by perinatal autopsy and placental histopathology were categorised using the Perinatal Society of Australia and New Zealand Perinatal Death Classification and compared between Caucasian and non-Caucasian groups. RESULTS Ninety-two stillbirths (0.7% of all births) were identified during the study period. A greater proportion of non-Caucasian women had small for gestation age placentas compared to Caucasian women (n = 22/43 (51%) vs n = 12/49 (24%); P = 0.025). A greater proportion of stillbirths were caused by hypoxic peripartum death in non-Caucasian than in Caucasian women (n = 4/43 (9%) vs n = 0/49 (0%); P = 0.044), and a greater prevalence of placental dysfunction was seen in the non-Caucasian cohort compared to Caucasian women (n = 14/43 (33%) vs n = 8/49 (16%); P = 0.057). CONCLUSIONS The differences observed in causes of stillbirth between Caucasian and non-Caucasian women are hypothesis generating and warrant further larger-scale, multi-centred studies using standardised definitions and classification systems to determine whether these differences persist in a more representative sample.
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Affiliation(s)
- Kriti Sharma
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Saiuj Bhat
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Sangeeta Malla Bhat
- Department of Obstetrics and Gynaecology, Armadale Health Service, Perth, Western Australia, Australia
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Mardini A, Shaykhon N, Khan A, Mardini A, Saeed HN. Global Disparities in Access to Vaccine Clinical Trials: A Review of the Literature. Vaccines (Basel) 2024; 12:348. [PMID: 38675731 DOI: 10.3390/vaccines12040348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/06/2024] [Accepted: 03/13/2024] [Indexed: 04/28/2024] Open
Abstract
Vaccines are an effective tool to reduce the disease burden from infectious diseases on a population, infrastructural, and individual level. Before vaccines can be administered to populations at large, they must go through rigorous testing in the form of clinical trials. While vaccine trials can be used to assess the efficacy of interventions on a local populace as well as target local endemic diseases, most clinical trials are sponsored and conducted by companies in high-income countries (HICs). This can lead to vaccines that are not optimized for low- and middle-income countries (LMICs) and that often neglect to address diseases specific to the local population. This narrative review aims to explore the factors leading to discrepancies in the execution of and access to vaccine trials between HICs and LMICs, thus guiding future efforts in confronting them. This review was written using the literature sourced from the PubMed database and supplemented with articles from Google Scholar along with grey literature. Several themes are highlighted including poorly defined regulatory and ethical guidelines, staff shortages, lack of research infrastructure, and logistical barriers. We discuss how these challenges have affected vaccine development in various capacities through case examples of SARS-CoV-2, poliovirus, and malaria. Many challenges remain in equitable vaccine clinical trial development and implementation. Facilitating the implementation of locally sponsored vaccine clinical trials in LMICs may be one avenue to address these challenges. In doing so, LMICs can become active stakeholders in the health of their citizens by addressing endemic diseases, tailoring vaccine specifications based on local needs, and implementing wide-scale vaccine access and delivery.
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Affiliation(s)
- Ali Mardini
- School of Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen 228, Bahrain
| | - Norhan Shaykhon
- School of Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen 228, Bahrain
| | - Asher Khan
- School of Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen 228, Bahrain
- York Hospital, York and Scarborough Teaching Hospital and Foundation Trust, National Health Service (NHS), London SM5 1AA, UK
| | - Ahmad Mardini
- Advocate Christ Medical Center, Chicago, IL 60453, USA
| | - Hajirah N Saeed
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University Illinois Chicago, Chicago, IL 60612, USA
- Department of Ophthalmology, Loyola University Medical Center, Maywood, IL 60153, USA
- Harvard Medical School, Boston, MA 02115, USA
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Linggonegoro D, Williams K, Hlobik M, Huang J. Inequities in Technology Access and Digital Health Literacy Among Patients With Dermatologic Conditions: Cross-Sectional Analysis of the National Health Interview Survey. JMIR Dermatol 2024; 7:e51511. [PMID: 38517468 PMCID: PMC10998172 DOI: 10.2196/51511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 03/23/2024] Open
Abstract
Certain sociodemographic factors are associated with low technology access and digital healthy literacy.
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Affiliation(s)
- Danny Linggonegoro
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Kathryn Williams
- Biostatistics and Research Design Center, ICCTR, Boston Children's Hospital, Boston, MA, United States
| | - Madeline Hlobik
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
| | - Jennifer Huang
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
- Department of Dermatology, Harvard Medical School, Boston, MA, United States
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Alcala-Zermeno JL, Fureman B, Grzeskowiak CL, Potnis O, Taveras M, Logan MW, Rybacki D, Friedman D, Lowenstein D, Kuzniecky R, French J. Racial disparities in the utilization of invasive neuromodulation devices for the treatment of drug-resistant focal epilepsy. Epilepsia 2024. [PMID: 38506370 DOI: 10.1111/epi.17961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
Racial disparities affect multiple dimensions of epilepsy care including epilepsy surgery. This study aims to further explore these disparities by determining the utilization of invasive neuromodulation devices according to race and ethnicity in a multicenter study of patients living with focal drug-resistant epilepsy (DRE). We performed a post hoc analysis of the Human Epilepsy Project 2 (HEP2) data. HEP2 is a prospective study of patients living with focal DRE involving 10 sites distributed across the United States. There were no statistical differences in the racial distribution of the study population compared to the US population using census data except for patients reporting more than one race. Of 154 patients enrolled in HEP2, 55 (36%) underwent invasive neuromodulation for DRE management at some point in the course of their epilepsy. Of those, 36 (71%) were patients who identified as White. Patients were significantly less likely to have a device if they identified solely as Black/African American than if they did not (odds ratio = .21, 95% confidence interval = .05-.96, p = .03). Invasive neuromodulation for management of DRE is underutilized in the Black/African American population, indicating a new facet of racial disparities in epilepsy care.
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Affiliation(s)
- Juan Luis Alcala-Zermeno
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brandy Fureman
- Research and New Therapies, Epilepsy Foundation, Bowie, Maryland, USA
| | | | - Ojas Potnis
- Research and New Therapies, Epilepsy Foundation, Bowie, Maryland, USA
| | - Maria Taveras
- Department of Neurology, Comprehensive Epilepsy Center, NYU Langone Health, New York, New York, USA
| | - Margaret W Logan
- Research and New Therapies, Epilepsy Foundation, Bowie, Maryland, USA
| | - Delanie Rybacki
- Research and New Therapies, Epilepsy Foundation, Bowie, Maryland, USA
| | - Daniel Friedman
- Department of Neurology, Comprehensive Epilepsy Center, NYU Langone Health, New York, New York, USA
| | - Daniel Lowenstein
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Ruben Kuzniecky
- Department of Neurology, Zucker Hofstra School of Medicine, Northwell Health, New York, New York, USA
| | - Jacqueline French
- Research and New Therapies, Epilepsy Foundation, Bowie, Maryland, USA
- Department of Neurology, Comprehensive Epilepsy Center, NYU Langone Health, New York, New York, USA
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12
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Iwundu CN. Impact of COVID-19 on individuals experiencing homelessness: Lessons learned and recommendations for practitioners. Glob Health Promot 2024:17579759241232395. [PMID: 38459655 DOI: 10.1177/17579759241232395] [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: 03/10/2024]
Abstract
The COVID-19 pandemic, which brought about unprecedented changes globally, shed light on the significant disparities faced by persons experiencing homelessness (PEH). These individuals faced an elevated risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to factors such as lack of safe housing, limited access to hygiene and sanitation, and communal living situations. The unique challenges, vulnerabilities, and effects of COVID-19 on PEH is discussed, as well as lessons learned from these experiences, recommendations for practitioners, and the ongoing implications for addressing homelessness.
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Affiliation(s)
- Chisom N Iwundu
- University of North Texas, Department of Rehabilitation and Health Services, Denton, TX, USA
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13
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Olanlesi-Aliu A, Kemei J, Alaazi D, Tunde-Byass M, Renzaho A, Sekyi-Out A, Mullings DV, Osei-Tutu K, Salami B. COVID-19 among Black people in Canada: a scoping review. Health Promot Chronic Dis Prev Can 2024; 44:112-125. [PMID: 38501682 DOI: 10.24095/hpcdp.44.3.05] [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: 03/20/2024]
Abstract
INTRODUCTION The COVID-19 pandemic exacerbated health inequities worldwide. Research conducted in Canada shows that Black populations were disproportionately exposed to COVID-19 and more likely than other ethnoracial groups to be infected and hospitalized. This scoping review sought to map out the nature and extent of current research on COVID-19 among Black people in Canada. METHODS Following a five-stage methodological framework for conducting scoping reviews, studies exploring the effects of the COVID-19 pandemic on Black people in Canada, published up to May 2023, were retrieved through a systematic search of seven databases. Of 457 identified records, 124 duplicates and 279 additional records were excluded after title and abstract screening. Of the remaining 54 articles, 39 were excluded after full-text screening; 2 articles were manually picked from the reference lists of the included articles. In total, 17 articles were included in this review. RESULTS Our review found higher rates of COVID-19 infections and lower rates of COVID-19 screening and vaccine uptake among Black Canadians due to pre-COVID-19 experiences of institutional and structural racism, health inequities and a mistrust of health care professionals that further impeded access to health care. Misinformation about COVID-19 exacerbated mental health issues among Black Canadians. CONCLUSIONS Our findings suggest the need to address social inequities experienced by Black Canadians, particularly those related to unequal access to employment and health care. Collecting race-based data on COVID-19 could inform policy formulation to address racial discrimination in access to health care, quality housing and employment, resolve inequities and improve the health and well-being of Black people in Canada.
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Affiliation(s)
| | - Janet Kemei
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Dominic Alaazi
- Health and Immigration Policies and Practices Research Program (HIPP), University of Alberta, Edmonton, Alberta, Canada
| | - Modupe Tunde-Byass
- Black Physicians of Ontario, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Ontario, Toronto, Ontario, Canada
| | - Andre Renzaho
- Translational Health Research Institute, School of Medicine, Campbell Town Campus, Western Sydney University, Australia
| | | | - Delores V Mullings
- School of Social Work, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Kannin Osei-Tutu
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Health and Immigration Policies and Practices Research Program (HIPP), University of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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14
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Shawa J, Ehsan Z. Perspective: Women's leadership and salary inequality in sleep medicine. J Clin Sleep Med 2024; 20:475-477. [PMID: 38054468 PMCID: PMC11019220 DOI: 10.5664/jcsm.10934] [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: 09/20/2022] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 12/07/2023]
Abstract
Gender inequity exists within medicine in both compensation and leadership positions. In this perspective, the data on American Academy of Sleep Medicine leadership positions held by women and compensation differences between men and women physicians in an American Academy of Sleep Medicine compensation survey were studied. The results showed significant improvement in the inclusivity of women in senior-level leadership. However, the compensation data showed that women physicians received around 15% less pay than men physicians, even when calculated based on work relative value unit. CITATION Shawa J, Ehsan Z. Perspective: women's leadership and salary inequality in sleep medicine. J Clin Sleep Med. 2024;20(3):475-477.
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Affiliation(s)
| | - Zarmina Ehsan
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
- Division of Pulmonary and Sleep Medicine, Children’s Mercy-Kansas City, Kansas City, Missouri
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15
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Hogg RE, Wickens R, O'Connor S, Gidman E, Ward E, Peto T, Burton BJL, Knox P, Lotery AJ, Sivaprasad S, Donnelly M, Rogers CA, Reeves BC. Inequalities in Uptake and Use of Digital Applications for Home-Monitoring of Neovascular Age-Related Macular Degeneration in an Elderly Visually Impaired Population: The MONARCH Study. Transl Vis Sci Technol 2024; 13:2. [PMID: 38427348 PMCID: PMC10913936 DOI: 10.1167/tvst.13.3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/08/2024] [Indexed: 03/02/2024] Open
Abstract
Purpose To describe inequalities in the Monitoring for Neovascular Age-related Macular Degeneration Reactivation at Home (MONARCH) diagnostic test accuracy study for: recruitment; participants' ability to self-test; and adherence to testing using digital applications during follow-up. Methods Home-monitoring vision tests included two tests implemented as software applications (apps: MyVisionTrack and MultiBit) on an iPod Touch device. Patients were provided with all hardware required to participate (iPod and MIFI device) and trained to use the apps. Regression models estimated associations of age, sex, Index of Multiple Deprivation, strata of time since first diagnosis, and baseline visual acuity at study entry on outcomes of willingness to participate, ability to perform tests, and adherence to weekly testing. Results A minority of patients who were approached were willing-in-principle to participate. Increasing age was associated with being unwilling-in-principle to participate. Patients from the most deprived areas had a 47% decrease in odds of being willing compared to those from the middle quintile deprived areas (odds ratio, 0.53; 95% confidence interval = 0.32, 0.88). Increasing age and worse deprivation were not consistently associated either with ability to self-monitor with the index tests, or adherence to weekly testing. Conclusions Associations of increasing age and worse deprivation index were associated with unwillingness-in-principle to participate despite the provision of hardware' highlighting the potential for inequality with interventions of the kind evaluated. Translational Relevance The clear evidence of inequalities in participation should prompt future research on ways to encourage adoption of mobile health technologies by underserved populations.
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Affiliation(s)
- Ruth E. Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Robin Wickens
- Bristol Trials Centre, University of Bristol, Bristol, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sean O'Connor
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Institute of Nursing and Health Research, Ulster University, Londonderry, UK
| | - Eleanor Gidman
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Elizabeth Ward
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Paul Knox
- University of Liverpool, Liverpool, UK
| | - Andrew J. Lotery
- Department of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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16
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Branion-Calles M, Winters M, Rothman L, Harris MA. Risk Factors and Inequities in Transportation Injury and Mortality in the Canadian Census Health and Environment Cohorts (CanCHECs). Epidemiology 2024; 35:252-262. [PMID: 38290144 PMCID: PMC10836781 DOI: 10.1097/ede.0000000000001696] [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: 04/20/2023] [Accepted: 11/21/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Road traffic injury contributes substantially to morbidity and mortality. Canada stands out among developed countries in not conducting a national household travel survey, leading to a dearth of national transportation mode data and risk calculations that have appropriate denominators. Since traffic injuries are specific to the mode of travel used, these risk calculations should consider travel mode. METHODS Census data on mode of commute is one of the few sources of these data for persons aged 15 and over. This study leveraged a national data linkage cohort, the Canadian Census Health and Environment Cohorts, that connects census sociodemographic and commute mode data with records of deaths and hospitalizations, enabling assessment of road traffic injury associations by indicators of mode of travel (commuter mode). We examined longitudinal (1996-2019) bicyclist, pedestrian, and motor vehicle occupant injury and fatality risk in the Canadian Census Health and Environment Cohorts by commuter mode and sociodemographic characteristics using Cox proportional hazards models within the working adult population. RESULTS We estimated positive associations between commute mode and same mode injury and fatality, particularly for bicycle commuters (hazard ratios for bicycling injury was 9.1 and for bicycling fatality was 11). Low-income populations and Indigenous people had increased injury risk across all modes. CONCLUSIONS This study shows inequities in transportation injury risk in Canada and underscores the importance of adjusting for mode of travel when examining differences between population groups.
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Affiliation(s)
- Michael Branion-Calles
- From the School of Occupational and Public Health, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada
- Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Meghan Winters
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Linda Rothman
- From the School of Occupational and Public Health, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - M. Anne Harris
- From the School of Occupational and Public Health, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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17
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Nguyen H, Lao C, Keenan R, Laking G, Elwood M, McKeage M, Wong J, Aitken D, Chepulis L, Lawrenson R. Ethnic differences in the characteristics of patients with newly diagnosed lung cancer in the Te Manawa Taki region of New Zealand. Intern Med J 2024; 54:421-429. [PMID: 37584463 DOI: 10.1111/imj.16202] [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: 12/16/2022] [Accepted: 07/19/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Māori have three times the mortality from lung cancer compared with non-Māori. The Te Manawa Taki region has a population of 900 000, of whom 30% are Māori. We have little understanding of the factors associated with developing and diagnosing lung cancer and ethnic differences in these characteristics. AIMS To explore the differences in the incidence and characteristics of patients with newly diagnosed lung cancer between Māori and non-Māori. METHODS Patients were identified from the regional register. Incidence rates were calculated based on population data from the 2013 and 2018 censuses. The patient and tumour characteristics of Māori and non-Māori were compared. The analysis used Χ2 tests and logistic models for categorical variables and Student t tests for continuous variables. RESULTS A total of 4933 patients were included, with 1575 Māori and 3358 non-Māori. The age-standardised incidence of Māori (236 per 100 000) was 3.3 times higher than that of non-Māori. Māori were 1.3 times more likely to have an advanced stage of disease and 1.97 times more likely to have small cell lung cancer. Māori were more likely to have comorbidities, chronic obstructive pulmonary disease, cardiovascular disease and diabetes. They also had higher levels of social deprivation and tended to be younger, female and current smokers. CONCLUSIONS The findings point to the need to address barriers to early diagnosis and the need for system change including the need to introduce a lung cancer screening focussing on Māori. There is also the need for preventive programmes to address comorbidities that impact lung cancer outcomes as well as a continued emphasis on creating a smoke-free New Zealand.
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Affiliation(s)
- Ha Nguyen
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Chunhuan Lao
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Rawiri Keenan
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - George Laking
- Faculty of Medical and Health Sciences, University of Auckland and Te Whatu Ora Health New Zealand Te Toka Tumai, Auckland, New Zealand
| | - Mark Elwood
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mark McKeage
- Faculty of Medical and Health Sciences, University of Auckland and Te Whatu Ora Health New Zealand Te Toka Tumai, Auckland, New Zealand
| | - Janice Wong
- Te Whatu Ora Health New Zealand, Hamilton, New Zealand
| | - Denise Aitken
- Te Whatu Ora Health New Zealand, Rotorua, New Zealand
| | - Lynne Chepulis
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
- Te Whatu Ora Health New Zealand, Hamilton, New Zealand
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18
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Stanaway FF, Diaz A, Maddox R. Causal inference, mediation analysis and racial inequities. Int J Epidemiol 2024; 53:dyae038. [PMID: 38514996 DOI: 10.1093/ije/dyae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Affiliation(s)
- Fiona F Stanaway
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Abbey Diaz
- First Nations Cancer and Wellbeing Research Program, School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Raglan Maddox
- Bagumani (Modewa) Clan, Papua New Guinea
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
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19
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Estien CO, Wilkinson CE, Morello-Frosch R, Schell CJ. Historical Redlining Is Associated with Disparities in Environmental Quality across California. Environ Sci Technol Lett 2024; 11:54-59. [PMID: 38371654 PMCID: PMC10867848 DOI: 10.1021/acs.estlett.3c00870] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/20/2024]
Abstract
Historical policies have been shown to underpin environmental quality. In the 1930s, the federal Home Owners' Loan Corporation (HOLC) developed the most comprehensive archive of neighborhoods that would have been redlined by local lenders and the Federal Housing Administration, often applying racist criteria. Our study explored how redlining is associated with environmental quality across eight California cities. We integrated HOLC's graded maps [grades A (i.e., "best" and "greenlined"), B, C, and D (i.e., "hazardous" and "redlined")] with 10 environmental hazards using data from 2018 to 2021 to quantify the spatial overlap among redlined neighborhoods and environmental hazards. We found that formerly redlined neighborhoods have poorer environmental quality relative to those of other HOLC grades via higher pollution, more noise, less vegetation, and elevated temperatures. Additionally, we found that intraurban disparities were consistently worse for formerly redlined neighborhoods across environmental hazards, with redlined neighborhoods having higher pollution burdens (77% of redlined neighborhoods vs 18% of greenlined neighborhoods), more noise (72% vs 18%), less vegetation (86% vs 12%), and elevated temperature (72% vs 20%), than their respective city's average. Our findings highlight that redlining, a policy abolished in 1968, remains an environmental justice concern by shaping the environmental quality of Californian urban neighborhoods.
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Affiliation(s)
- Cesar O. Estien
- Department
of Environmental Science, Policy, and Management, University of California−Berkeley, 130 Mulford Hall, Berkeley, California 94720, United States
| | - Christine E. Wilkinson
- Department
of Environmental Science, Policy, and Management, University of California−Berkeley, 130 Mulford Hall, Berkeley, California 94720, United States
- California
Academy of Sciences, 55 Music Concourse Drive, San Francisco, California 94118, United States
| | - Rachel Morello-Frosch
- Department
of Environmental Science, Policy, and Management, University of California−Berkeley, 130 Mulford Hall, Berkeley, California 94720, United States
- School
of Public Health, University of California−Berkeley, 2121 Berkeley Way, Berkeley, California 94720, United States
| | - Christopher J. Schell
- Department
of Environmental Science, Policy, and Management, University of California−Berkeley, 130 Mulford Hall, Berkeley, California 94720, United States
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20
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Kerr M, Jaure A, Stephens JH, Kim S, Cutler R, Cashmore B, Dickson M, Evangelidis N, Hughes JT, Roberts I, Scholes-Robertson N, Sinka V, Craig JC. Experiences of Indigenous Patients Receiving Dialysis: Systematic Review of Qualitative Studies. Am J Kidney Dis 2024; 83:139-150.e1. [PMID: 37730171 DOI: 10.1053/j.ajkd.2023.07.014] [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: 04/03/2023] [Revised: 06/30/2023] [Accepted: 07/09/2023] [Indexed: 09/22/2023]
Abstract
RATIONALE & OBJECTIVE Indigenous People suffer a high burden of kidney disease. Those receiving maintenance dialysis have worse outcomes compared with similarly treated non-Indigenous patients. We characterized the experiences of Indigenous patients receiving dialysis in British-colonized countries to gain insights into which aspects of kidney care may benefit from improvement. STUDY DESIGN A systematic review of published qualitative interview studies. SETTING & STUDY POPULATIONS Indigenous Peoples aged 18 years and over, receiving hemodialysis or peritoneal dialysis in British-colonized countries. SELECTION CRITERIA FOR STUDIES Search terms for Indigenous Peoples, dialysis, and qualitative research were entered into Medline, Embase, PsycINFO, and CINAHL and searched from inception to January 5, 2023. DATA EXTRACTION Characteristics of each study were extracted into Microsoft Excel for quality assessment. ANALYTICAL APPROACH Data were analyzed using thematic synthesis. RESULTS The analysis included 28 studies involving 471 participants from Australia, New Zealand, Canada, and the United States. We identified four themes: centrality of family and culture (continuing dialysis for family, gaining autonomy through shared involvement, balancing primary responsibility to care for family); marginalization due to structural and social inequities (falling through gaps in primary care intensifying shock, discriminated against and judged by specialists, alienated and fearful of hospitals, overwhelmed by travel, financial and regimental burdens); vulnerability in accessing health care (need for culturally responsive care, lack of language interpreters, without agency in decision-making, comorbidities compounding complexity of self-management); and distress from separation from community (disenfranchisement and sorrow when away for dialysis, inability to perpetuate cultural continuity, seeking a kidney transplant). LIMITATIONS We only included articles published in English. CONCLUSIONS Indigenous patients receiving dialysis experience inequities in health care that compound existing accessibility issues caused by colonization. Improving the accessibility and cultural responsiveness of dialysis and kidney transplant services in collaboration with Indigenous stakeholders holds promise to enhance the experience of Indigenous patients receiving dialysis. PLAIN-LANGUAGE SUMMARY Worldwide Indigenous populations suffer a high incidence of chronic disease leading to lower life expectancy, particularly for kidney disease, an insidious condition requiring long-term dialysis treatment. By listening to Indigenous dialysis patients' stories, we hoped to understand how to improve their experience. We gathered 28 qualitative research studies from four countries reporting Indigenous adults' experiences of dialysis. They described lacking awareness of kidney disease, poor access to health services, systemic racism, inadequate cultural safety, and being dislocated from family, community, and culture. These findings indicate that respectful collaboration with Indigenous Peoples to craft and implement policy changes holds promise to improve prevention, integrate culturally responsive health care practices, and provide better access to local dialysis services and opportunities for kidney transplants.
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Affiliation(s)
- Marianne Kerr
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Allison Jaure
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jacqueline H Stephens
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Richard Cutler
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Brydee Cashmore
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Michelle Dickson
- Poche Centre for Indigenous Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jaquelyne T Hughes
- College of Medicine and Public Health, Rural and Remote Health, Flinders University, Adelaide, Australia
| | - Ieyesha Roberts
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Nicole Scholes-Robertson
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Victoria Sinka
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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21
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Singh A, Purohit BM, Purohit A. Risk factors and associated pathway for rural and urban unmet dental prosthetic needs among older adults in Central India. Spec Care Dentist 2024. [PMID: 38302807 DOI: 10.1111/scd.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Abstract
AIM This study was undertaken to evaluate the risk factors and associated pathways for unmet dental prosthetic needs among older adult population in Central India. METHODS A total of 11,145 randomly selected older adults participated in the study; 4613 from urban region and 6532 form rural region. Oral examinations were conducted at individual households for recording dental caries, periodontal disease, prosthetic status and needs. Structural Equation Modelling (SEM) was used to examine relationship between a set of exogenous variables and unmet dental prosthetic needs with variables that remained significant in the adjusted multilevel logistic model. Path coefficients were calculated for all variables with 95% confidence interval. Goodness of fit of the model was assessed by several indices. RESULTS A total of 8433 (75.7%) participants had never visited a dentist and 9139 (82%) had unmet dental prosthetic needs. Dental caries was observed among 3207 (69.5%) and 4644 (71.1%) study participants from urban and rural regions respectively (p < .05). Low utilization of dental services was associated with high dental prosthetic needs in upper arch and lower arch (PC = -0.05, 0.001) and DMFT was associated with lower utilization of dental services (PC = -0.09, 0.001). DMFT was also associated with age, annual income, level of education, paternal education, type of family, tobacco consumption and CPI score in the hypothesized model. The fit indices used indicated that the model was adequate. CONCLUSIONS Dental prosthetic needs in the proposed pathway model was associated with low utilization of dental services, dental caries, periodontal disease and other socio-demographic factors.
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Affiliation(s)
- Abhinav Singh
- Department of Dentistry, Nodal Officer, Regional Training Centre for Oral Health Promotion, All India Institute of Medical Sciences, Bhopal, India
| | - Bharathi M Purohit
- Division of Public Health Dentistry, Centre for Dental Education and Research, WHO Collaborating Centre for Oral Health Promotion, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Abhishek Purohit
- Department of Dentistry, Regional Training Centre for Oral Health Promotion, All India Institute of Medical Sciences, Bhopal, India
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22
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Girardi G, Bremer AA. Climate and environmental changes exacerbate health disparities in pregnant people and their offspring. How can we protect women and their babies? Birth Defects Res 2024; 116:e2313. [PMID: 38348550 DOI: 10.1002/bdr2.2313] [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: 12/04/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The effects of climate and environmental changes (CEC) are being felt globally and will worsen over the next decade unless significant changes are made on a global level. Climate change is having serious consequences for health, particularly for vulnerable women and their offspring and less resilient individuals in communities with socioeconomic inequalities. To protect human health from CEC effects, efforts need to be directed toward building resilience strategies. Building political and economic power, as well as directly addressing CEC-related challenges, are critical components of climate resilience. Effective communication and tailored methods to engage women in preventive strategies are also necessary to ameliorate the deleterious effects of CEC on women's health. Furthermore, women from marginalized communities face more CEC-associated challenges. CONCLUSIONS Therefore, effective policies and programs targeting these at-risk populations-are crucial to improve the overall state of global health. In closing, it is time to increase awareness of the effects of CECs on women's health and their transgenerational effects in order to ensure that all people, regardless of race, ethnicity, education and income are protected from the detrimental effects of CECs.
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Affiliation(s)
- Guillermina Girardi
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Andrew A Bremer
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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Singh RS, Landes SJ, Willging CE, Abraham TH, McFrederick P, Kauth MR, Shipherd JC, Kirchner JE. Implementation of LGBTQ+ affirming care policies in the Veterans Health Administration: preliminary findings on barriers and facilitators in the southern United States. Front Public Health 2024; 11:1251565. [PMID: 38352130 PMCID: PMC10861648 DOI: 10.3389/fpubh.2023.1251565] [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: 07/01/2023] [Accepted: 12/14/2023] [Indexed: 02/16/2024] Open
Abstract
Background In the United States Department of Veterans Affairs (VA), veterans who are lesbian, gay, bisexual, transgender, queer, and similar gender and sexual minoritized people (LGBTQ+) experience health disparities compared to cisgender, heterosexual veterans. VA's LGBTQ+ Health Program created two healthcare policies on providing LGBTQ+ affirming care (healthcare that is inclusive, validating, and understanding of the LGBTQ+ population). The current project examines providers' barriers and facilitators to providing LGBTQ+ affirming care and LGBTQ+ veterans' barriers and facilitators to receiving LGBTQ+ affirming care. Methods Data collection and analysis were informed by the Consolidated Framework for Implementation Research, which was adapted to include three health equity domains. Data collection involved telephone interviews conducted with 11 VA providers and 12 LGBTQ+ veterans at one rural and one urban VA medical center, and one rural VA community clinic. Qualitative data were rapidly analyzed using template analysis, a data reduction technique. Results Providers described limited education, limited time, lack of experience with the population, and a lack of awareness of resources as barriers. Providers discussed comfort with consulting trusted peers, interest in learning more about providing LGBTQ+ affirming care, and openness and acceptance of the LGBTQ+ community as facilitators. LGBTQ+ veterans described a lack of provider awareness of their needs, concerns related to safety and discrimination, and structural discrimination as barriers. LGBTQ+ veterans described positive relationships with providers, knowledge of their own healthcare needs, and ability to advocate for their healthcare needs as facilitators. Although VA's LGBTQ+ affirming care policies are in place, providers and veterans noted a lack of awareness regarding specific healthcare processes. Conclusion Allowing more time and capacity for education and engaging LGBTQ+ veterans in determining how to improve their healthcare may be the path forward to increase adherence to LGBTQ+ affirming care policies. Engaging patients, especially those from marginalized backgrounds, in strategies focused on the uptake of policy may be a path to improve policy implementation. It is possible that creating truly collaborative structures in which patients, staff, providers, leadership, and policymakers can work together towards policy implementation may be a useful strategy. In turn, improved policy implementation would result in increased physical and mental health for LGBTQ+ veterans.
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Affiliation(s)
- Rajinder Sonia Singh
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- VA Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
| | - Sara J. Landes
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- VA Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
| | - Cathleen E. Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, NM, United States
| | - Traci H. Abraham
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
- Clinical Outcome Assessments, Clinical Outcomes Solutions, Chicago, IL, United States
| | - Pamela McFrederick
- South Central VA Health Care Network, Ridgeland, MS, United States
- LGBTQ+ Health Program, Department of Veterans Affairs, Washington, DC, United States
| | - Michael R. Kauth
- LGBTQ+ Health Program, Department of Veterans Affairs, Washington, DC, United States
- Baylor College of Medicine, Houston, TX, United States
| | - Jillian C. Shipherd
- LGBTQ+ Health Program, Department of Veterans Affairs, Washington, DC, United States
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - JoAnn E. Kirchner
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- VA Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
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Taylor-Robinson SD, Taylor-Robinson AW. Are growing inequities leaving Africa behind in the post-pandemic public health landscape? Pan Afr Med J 2024; 47:16. [PMID: 38524111 PMCID: PMC10957726 DOI: 10.11604/pamj.2024.47.16.41653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/30/2023] [Indexed: 03/26/2024] Open
Affiliation(s)
- Simon David Taylor-Robinson
- Department of Medicine, Busitema University, Mbale, Uganda
- Department of Public Health, Busitema University, Mbale, Uganda
- Faculty of Engineering, Imperial College London, London, United Kingdom
| | - Andrew William Taylor-Robinson
- College of Health Sciences, VinUniversity, Hanoi, Vietnam
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Cobert J, Mills H, Lee A, Gologorskaya O, Espejo E, Jeon SY, Boscardin WJ, Heintz TA, Kennedy CJ, Ashana DC, Chapman AC, Raghunathan K, Smith AK, Lee SJ. Measuring Implicit Bias in ICU Notes Using Word-Embedding Neural Network Models. Chest 2024:S0012-3692(24)00007-2. [PMID: 38199323 DOI: 10.1016/j.chest.2023.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Language in nonmedical data sets is known to transmit human-like biases when used in natural language processing (NLP) algorithms that can reinforce disparities. It is unclear if NLP algorithms of medical notes could lead to similar transmissions of biases. RESEARCH QUESTION Can we identify implicit bias in clinical notes, and are biases stable across time and geography? STUDY DESIGN AND METHODS To determine whether different racial and ethnic descriptors are similar contextually to stigmatizing language in ICU notes and whether these relationships are stable across time and geography, we identified notes on critically ill adults admitted to the University of California, San Francisco (UCSF), from 2012 through 2022 and to Beth Israel Deaconess Hospital (BIDMC) from 2001 through 2012. Because word meaning is derived largely from context, we trained unsupervised word-embedding algorithms to measure the similarity (cosine similarity) quantitatively of the context between a racial or ethnic descriptor (eg, African-American) and a stigmatizing target word (eg, nonco-operative) or group of words (violence, passivity, noncompliance, nonadherence). RESULTS In UCSF notes, Black descriptors were less likely to be similar contextually to violent words compared with White descriptors. Contrastingly, in BIDMC notes, Black descriptors were more likely to be similar contextually to violent words compared with White descriptors. The UCSF data set also showed that Black descriptors were more similar contextually to passivity and noncompliance words compared with Latinx descriptors. INTERPRETATION Implicit bias is identifiable in ICU notes. Racial and ethnic group descriptors carry different contextual relationships to stigmatizing words, depending on when and where notes were written. Because NLP models seem able to transmit implicit bias from training data, use of NLP algorithms in clinical prediction could reinforce disparities. Active debiasing strategies may be necessary to achieve algorithmic fairness when using language models in clinical research.
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Affiliation(s)
- Julien Cobert
- Anesthesia Service, San Francisco VA Health Care System, University of California, San Francisco, San Francisco, CA; Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA.
| | - Hunter Mills
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA
| | - Albert Lee
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA
| | - Oksana Gologorskaya
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA
| | - Edie Espejo
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - Sun Young Jeon
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - W John Boscardin
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - Timothy A Heintz
- School of Medicine, University of California, San Diego, San Diego, CA
| | - Christopher J Kennedy
- Department of Psychiatry, Harvard Medical School, Boston, MA; Center for Precision Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Deepshikha C Ashana
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, NC
| | - Allyson Cook Chapman
- Department of Medicine, the Division of Critical Care and Palliative Medicine, University of California, San Francisco, San Francisco, CA; Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Karthik Raghunathan
- Department of Anesthesia and Perioperative Care, Duke University, Durham, NC
| | - Alex K Smith
- Department of Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA; Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - Sei J Lee
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA
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26
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Peralta C, Strafella AP, Kim H. Covering Basic Needs on Molecular Imaging. Mov Disord Clin Pract 2024; 11:10-13. [PMID: 38291843 PMCID: PMC10828620 DOI: 10.1002/mdc3.13905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/08/2023] [Accepted: 06/18/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Cecilia Peralta
- Movement Disorders Clinic, Neuroscience DepartmentHospital Universitario CEMIC, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”Buenos AiresArgentina
| | - Antonio P. Strafella
- Morton and Gloria Shulman Movement Disorder Unit & E.J. Safra Parkinson Disease Program, Division of Neurology/Department of MedicineToronto Western Hospital, University Health NetworkTorontoONCanada
| | - Han‐Joon Kim
- Department of Neurology and Movement Disorder CenterSeoul National University HospitalSeoulKorea
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Tortosa F, Perre F, Carrasco G, De Lusarreta G, Artola N, Prandi D, Bustamante R, Guaresti G, Izcovich A. [Geographic variability, health inequities and lethality due to COVID-19 in Bariloche, Río Negro, 2020-2021]. Medicina (B Aires) 2024; 84:29-46. [PMID: 38271930] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION The objective of this study was to analyze the geographic variability and the relationship between social determinants of health and COVID-19 lethality in Bariloche. METHODS A database from the National Epidemiological Surveillance System was used to analyze COVID-19 positive cases from January 2020 to December 2021. The data were geocoded and incorporated into a geographic information system (GIS). A three-step analytical framework was applied to measure health inequity, using socioeconomic indicators and access to services. A multivariate analysis was conducted to predict fatality. RESULTS A total of 25 020 COVID-19 cases were diagnosed in Bariloche during the study period. The fatality rate was 2.1%. Significant variability in socioeconomic indicators was observed among different territorial delegations of the city. DISCUSSION The results showed health inequities and an association between social determinants and COVID-19 lethality in Bariloche. Individuals living in areas with higher socioeconomic vulnerability had a higher risk of mortality. These findings highlight the importance of addressing health inequities in a pandemic response.
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Affiliation(s)
- Fernando Tortosa
- Carrera de Medicina, Universidad Nacional de Río Negro, Argentina. E-mail:
| | | | - Gabriela Carrasco
- Red Argentina Pública de Evaluación de Tecnologías Sanitarias, Argentina
| | | | - Natalia Artola
- Carrera de Medicina, Universidad Nacional de Río Negro, Argentina
| | - Dana Prandi
- Hospital área Programa Bariloche Ramón Carrillo, Argentina
| | | | - German Guaresti
- Carrera de Medicina, Universidad Nacional de Río Negro, Argentina
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Wendt A, Knuth AG, Nunes BP, de Azevedo MR, Gonçalves H, Hallal PC, Crochemore-Silva I. Leisure-Time Physical Activity in a Southern Brazilian City (2004-2021): Applying an Equity Lens to Time-Trend Analyses. J Phys Act Health 2024; 21:94-102. [PMID: 37922898 DOI: 10.1123/jpah.2023-0259] [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: 06/06/2023] [Revised: 07/18/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND This study aimed to verify leisure-time physical activity trends over 15 years and monitor inequalities according to gender, self-reported skin color, and socioeconomic position in a Southern Brazilian city. A secondary aim is to evaluate intersectionalities in physical activity. METHODS Trend analysis using 3 population-based surveys carried out in 2004, 2010, and 2021. Main outcome assessed was the prevalence of physical activity according to recommendations (150 min/wk). Inequalities dimensions measured were sex, self-reported skin color, and wealth. Intersectionalities were evaluated using Jeopardy index combining all inequality dimensions. Trend analysis was performed using least-squares weighted regression. RESULTS We included data from 3090, 2656, and 5696 adults in 2004, 2010, and 2021, respectively. Prevalence of physical activity remains stable around 25% in the 3 years. In the 3 periods evaluated, men presented a prevalence in average 10 percentage points higher than women (SII2004 = -11.1 [95% confidence interval, CI, -14.4 to -7.8], SII2021 = -10.7 [95% CI, -13.7 to -7.7]). Skin color inequalities did not present a clear pattern. Richest individuals, in general presented a prevalence of leisure-time physical activity level 20pp higher than poorest ones (SII2004 = 20.5 [95% CI, 13.7 to 27.4]; SII2021 = 16.7 [95% CI, 11.3 to 22.0]). Inequalities were widely marked, comparing the most privileged group (represented by men, the wealthiest, and White) and the most socially vulnerable group (represented by women, the poorest, and Black/Brown). The Slope Index of Inequality for intersectionalities was -24.5 (95% CI, -31.1 to -17.9) in 2004 and -18.8 in 2021 (95% CI, -24.2 to -13.4). CONCLUSIONS Our analysis shows that women, Black/Brown, and poor present lower leisure-time physical activity level. This group is often neglected regarding other health and social outcomes.
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Affiliation(s)
- Andrea Wendt
- Programa de Pós-Graduação em Tecnologia em Saúde, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Alan G Knuth
- Post-Graduate program in Public Health, Federal University of Rio Grande, Rio Grande, RS, Brazil
| | - Bruno P Nunes
- Post-Graduate program in Nursing, Federal University of Pelotas, Pelotas, RS, Brazil
- Post-Graduate program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Mario Renato de Azevedo
- Post-Graduate program in Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Helen Gonçalves
- Post-Graduate program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Pedro C Hallal
- Post-Graduate program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
- Post-Graduate program in Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil
- College of Applied Health Sciences, Department of Kinesiology and Community Health, University of Illinois, Urbana, IL, USA
| | - Inácio Crochemore-Silva
- Post-Graduate program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
- Post-Graduate program in Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil
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Nkole P, Alice F, Stoljar Gold A, Yang L, Matendawafa AW, Johnson T. From Ports2Arms: reimagining demand creation for the African context. Front Health Serv 2023; 3:1257990. [PMID: 38174214 PMCID: PMC10762779 DOI: 10.3389/frhs.2023.1257990] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Affiliation(s)
| | | | - Alex Stoljar Gold
- Pandemic Emergency Readiness Lab, McGill University, Montreal, QC, Canada
| | - Lily Yang
- Pandemic Emergency Readiness Lab, McGill University, Montreal, QC, Canada
| | | | - Tian Johnson
- The African Alliance, Johannesburg, South Africa
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30
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Camilleri SF, Kerr GH, Anenberg SC, Horton DE. All-Cause NO 2-Attributable Mortality Burden and Associated Racial and Ethnic Disparities in the United States. Environ Sci Technol Lett 2023; 10:1159-1164. [PMID: 38106529 PMCID: PMC10720462 DOI: 10.1021/acs.estlett.3c00500] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/19/2023]
Abstract
Nitrogen dioxide (NO2) is a regulated pollutant that is associated with numerous health impacts. Recent advances in epidemiology indicate high confidence linking NO2 exposure with increased mortality, an association that recent studies suggest persists even at concentrations below regulatory thresholds. While large disparities in NO2 exposure among population subgroups have been reported, U.S. NO2-attributable mortality rates and their disparities remain unquantified. Here we provide the first estimate of NO2-attributable all-cause mortality across the contiguous U.S. (CONUS) at the census tract-level. We leverage fine-scale, satellite-informed, land use regression model NO2 concentrations and census tract-level baseline mortality data to characterize the associated disparities among different racial/ethnic subgroups. Across CONUS, we estimate that the NO2-attributable all-cause mortality is ∼170,850 (95% confidence interval: 43,970, 251,330) premature deaths yr-1 with large variability across census tracts and within individual cities. Additionally, we find that higher NO2 concentrations and underlying susceptibilities for predominately Black communities lead to NO2-attributable mortality rates that are ∼47% higher compared to CONUS-wide average rates. Our results highlight the substantial U.S. NO2 mortality burden, particularly in marginalized communities, and motivate adoption of more stringent standards to protect public health.
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Affiliation(s)
- Sara F Camilleri
- Department
of Earth and Planetary Sciences, Northwestern
University, Evanston, Illinois 60208, United States
| | - Gaige Hunter Kerr
- Department
of Environmental and Occupational Health, The George Washington University, Washington, DC 20052, United States
| | - Susan C Anenberg
- Department
of Environmental and Occupational Health, The George Washington University, Washington, DC 20052, United States
| | - Daniel E Horton
- Department
of Earth and Planetary Sciences, Northwestern
University, Evanston, Illinois 60208, United States
- Trienens
Institute for Sustainability and Energy, Northwestern University, Evanston, Illinois 60208, United States
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31
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Folayan MO, Ramos-Gomez F, Sabbah W, El Tantawi M. Corrigendum: Editorial: Country profile of the epidemiology and clinical management of early childhood caries, volume II. Front Oral Health 2023; 4:1242565. [PMID: 38152409 PMCID: PMC10752596 DOI: 10.3389/froh.2023.1242565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fpubh.2023.1201899.].
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Affiliation(s)
- Morenike Oluwatoyin Folayan
- Early Childhood Caries Advocacy Group, Winnipeg, MB, Canada
- Africa Oral Health Network, Alexandria, Egypt
- Oral Health Initiative, Nigerian Institute of Medical Research, Lagos, Nigeria
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Francisco Ramos-Gomez
- Early Childhood Caries Advocacy Group, Winnipeg, MB, Canada
- SOD-Division of Preventive and Restorative Oral Health Sciences, University of California, Los Angeles, CA, United States
| | - Wael Sabbah
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom
| | - Maha El Tantawi
- Early Childhood Caries Advocacy Group, Winnipeg, MB, Canada
- Africa Oral Health Network, Alexandria, Egypt
- Oral Health Initiative, Nigerian Institute of Medical Research, Lagos, Nigeria
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Shukla S, Castro Torres AF, Satish RV, Shenderovich Y, Abejirinde IOO, Steinert JI. Factors associated with adolescent pregnancy in Maharashtra, India: a mixed-methods study. Sex Reprod Health Matters 2023; 31:2249284. [PMID: 37712990 PMCID: PMC10506432 DOI: 10.1080/26410397.2023.2249284] [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: 09/16/2023] Open
Abstract
Reducing the adolescent birth rate is paramount in achieving the health-related Sustainable Development Goals, given that pregnancy and childbirth are the leading cause of mortality among young women aged 15-19. This study aimed to explore predictors of adolescent pregnancy among girls aged 13-18 years in Maharashtra, India, during the COVID-19 pandemic. Using a mixed-methods approach, primary data were gathered from two regions in Maharashtra between February and April 2022. Quantitative data from face-to-face interviews with 3049 adolescent girls assessed various household, social, and behavioural factors, as well as the socioeconomic and health impacts of COVID-19. Qualitative data from seven in-depth interviews were analysed thematically. The findings reveal that girls from low socioeconomic backgrounds face a higher likelihood of adolescent pregnancy. Multivariable analysis identified several factors associated with increased risk, including older age, being married, having more sexual partners, and experiencing COVID-19-related economic vulnerability. On the other hand, rural residence, secondary and higher secondary education of the participants, and higher maternal education were associated with a decreased likelihood of adolescent pregnancy. In the sub-sample of 565 partnered girls, partner's emotional abuse also correlated with higher rates of adolescent pregnancy. Thematic analysis of qualitative data identified four potential pathways leading to adolescent pregnancy: economic hardships and early marriage; personal safety, social norms, and early marriage; social expectations; and lack of knowledge on contraceptives. The findings underscore the significance of social position and behavioural factors and the impact of external shocks like the COVID-19 pandemic in predicting adolescent pregnancy in Maharashtra, India.Plain Language Summary: Adolescent pregnancy is an important health issue for young girls. In South Asia, one out of every five adolescent girls becomes a mother before turning 18, and in India, around 9% of girls aged 15-19 get pregnant yearly. This study focused on understanding the factors associated with adolescent pregnancy in Maharashtra, India, especially after the COVID-19 pandemic. We collected information from both urban and rural areas in Maharashtra. A total of 3049 adolescent girls participated in a survey, and seven girls participated in detailed interviews. Our analysis showed that factors like older age, being married, having multiple sexual partners, and experiencing economic difficulties due to COVID-19 increased the chances of adolescent pregnancy. On the other hand, living in rural areas, higher education for both the girls and their mothers reduced the likelihood of adolescent pregnancy. Qualitative analysis revealed that economic challenges, concerns about safety and societal norms, early marriage, societal expectations, and lack of knowledge about contraceptives could contribute to adolescent pregnancy in Maharashtra.
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Affiliation(s)
- Shruti Shukla
- PhD Candidate and Research Associate, TUM School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
| | | | - Rucha Vasumati Satish
- Field Coordinator and Freelance Researcher based in Pune, Maharashtra, TUM School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
| | - Yulia Shenderovich
- Senior Lecturer, Wolfson Centre for Young People’s Mental Health, Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Ibukun-Oluwa Omolade Abejirinde
- Assistant Professor, Division of Social & Behavioural Health Sciences, University of Toronto, Dalla Lana School of Public Health and Women’s College Hospital Research Institute, Toronto, Canada
| | - Janina Isabel Steinert
- Principal Investigator, TUM School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
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Ewuoso C, Cordeiro-Rodrigues L, Wonkam A, de Vries J. Addressing exploitation and inequities in open science: A relational perspective. Dev World Bioeth 2023; 23:331-343. [PMID: 36256961 DOI: 10.1111/dewb.12378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022]
Abstract
There are concerns that participation in open science will lead to various forms of exploitation - of researchers and scholars in low-income countries and under-resourced institutions. This article defends a contrary thesis and demonstrates the exact ways the underexplored notions of communal relationships, human dignity and social justice - and the normative principles to which they give rise - grounded in African philosophy can usefully address critical concerns regarding exploitation in the sharing of research resources to facilitate open partnership/collaboration and reuse. Further research is required to study the specific roles different institutions can play in facilitating open practice and contribute towards establishing effective structures that can enhance equity and balance unfavourable power asymmetries.
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34
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Denis RL, Hasan RK, Post WS, Resar JR, Zimmerman SL, Czarny MJ. Racial Differences in Aortic Valve Calcium Volume Among Patients With Severe Aortic Stenosis Who Underwent Transcatheter Aortic Valve Replacement. Am J Cardiol 2023; 208:116-117. [PMID: 37832207 PMCID: PMC10842499 DOI: 10.1016/j.amjcard.2023.09.018] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 10/15/2023]
Abstract
“No difference observed in aortic valve calcium volume in patients with severe AS undergoing TAVR.”
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Affiliation(s)
- Rimsky L Denis
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rani K Hasan
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jon R Resar
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stefan L Zimmerman
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew J Czarny
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Roberts E, Copeland C, Humphreys K, Shover CL. Drug-related deaths among housed and homeless individuals in the UK and the USA: comparative retrospective cohort study. Br J Psychiatry 2023; 223:562-568. [PMID: 37665046 PMCID: PMC10727910 DOI: 10.1192/bjp.2023.111] [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: 04/28/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND The UK and USA currently report their highest number of drug-related deaths since records began, with higher rates among individuals experiencing homelessness. AIMS Given that overdose prevention in homeless populations may require unique strategies, we evaluated whether substances implicated in death differed between (a) housed decedents and those experiencing homelessness and (b) between US and UK homeless populations. METHOD We conducted an internationally comparative retrospective cohort study utilising multilevel multinomial regression modelling of coronial/medical examiner-verified drug-related deaths from 1 January 2012 to 31 December 2021. UK data were available for England, Wales and Northern Ireland; US data were collated from eight county jurisdictions. Data were available on decedent age, sex, ethnicity, housing status and substances implicated in death. RESULTS Homeless individuals accounted for 16.3% of US decedents versus 3.4% in the UK. Opioids were implicated in 66.3 and 50.4% of all studied drug-related deaths in the UK and the USA respectively. UK homeless decedents had a significantly increased risk of having only opioids implicated in death compared with only non-opioids implicated (relative risk ratio RRR = 1.87, 95% CI 1.76-1.98, P < 0.001); conversely, US homeless decedents had a significantly decreased risk (RRR = 0.37, 95% CI 0.29-0.48, P < 0.001). Methamphetamine was implicated in two-thirds (66.7%) of deaths among US homeless decedents compared with 0.4% in the UK. CONCLUSIONS Both the rate and type of drug-related deaths differ significantly between homeless and housed populations in the UK and USA. The two countries also differ in drugs implicated in death. Targeted programmes for country-specific implicated drug profiles appear warranted.
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Affiliation(s)
- Emmert Roberts
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Caroline Copeland
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Keith Humphreys
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA; and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Chelsea L. Shover
- David Geffen School of Medicine, Division of General Internal Medicine and Health Services Research, University of California – Los Angeles (UCLA), Los Angeles, California, USA
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Waters AR, Turner C, Easterly CW, Tovar I, Mulvaney M, Poquadeck M, Johnston H, Ghazal LV, Rains SA, Cloyes KG, Kirchhoff AC, Warner EL. Exploring Online Crowdfunding for Cancer-Related Costs Among LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer, Plus) Cancer Survivors: Integration of Community-Engaged and Technology-Based Methodologies. JMIR Cancer 2023; 9:e51605. [PMID: 37902829 PMCID: PMC10644187 DOI: 10.2196/51605] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Cancer survivors frequently experience cancer-related financial burdens. The extent to which Lesbian, Gay, Bisexual, Transgender, Queer, Plus (LGBTQ+) populations experience cancer-related cost-coping behaviors such as crowdfunding is largely unknown, owing to a lack of sexual orientation and gender identity data collection and social stigma. Web-scraping has previously been used to evaluate inequities in online crowdfunding, but these methods alone do not adequately engage populations facing inequities. OBJECTIVE We describe the methodological process of integrating technology-based and community-engaged methods to explore the financial burden of cancer among LGBTQ+ individuals via online crowdfunding. METHODS To center the LGBTQ+ community, we followed community engagement guidelines by forming a study advisory board (SAB) of LGBTQ+ cancer survivors, caregivers, and professionals who were involved in every step of the research. SAB member engagement was tracked through quarterly SAB meeting attendance and an engagement survey. We then used web-scraping methods to extract a data set of online crowdfunding campaigns. The study team followed an integrated technology-based and community-engaged process to develop and refine term dictionaries for analyses. Term dictionaries were developed and refined in order to identify crowdfunding campaigns that were cancer- and LGBTQ+-related. RESULTS Advisory board engagement was high according to metrics of meeting attendance, meeting participation, and anonymous board feedback. In collaboration with the SAB, the term dictionaries were iteratively edited and refined. The LGBTQ+ term dictionary was developed by the study team, while the cancer term dictionary was refined from an existing dictionary. The advisory board and analytic team members manually coded against the term dictionary and performed quality checks until high confidence in correct classification was achieved using pairwise agreement. Through each phase of manual coding and quality checks, the advisory board identified more misclassified campaigns than the analytic team alone. When refining the LGBTQ+ term dictionary, the analytic team identified 11.8% misclassification while the SAB identified 20.7% misclassification. Once each term dictionary was finalized, the LGBTQ+ term dictionary resulted in a 95% pairwise agreement, while the cancer term dictionary resulted in an 89.2% pairwise agreement. CONCLUSIONS The classification tools developed by integrating community-engaged and technology-based methods were more accurate because of the equity-based approach of centering LGBTQ+ voices and their lived experiences. This exemplar suggests integrating community-engaged and technology-based methods to study inequities is highly feasible and has applications beyond LGBTQ+ financial burden research.
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Affiliation(s)
- Austin R Waters
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
| | - Cindy Turner
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Caleb W Easterly
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Ida Tovar
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Megan Mulvaney
- Crowdfunding Cancer Costs LGBT Study Advisory Board, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
- School of Public Health, Indiana University Bloomington, Bloomington, IN, United States
| | - Matt Poquadeck
- Crowdfunding Cancer Costs LGBT Study Advisory Board, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Hailey Johnston
- Crowdfunding Cancer Costs LGBT Study Advisory Board, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
| | - Lauren V Ghazal
- Crowdfunding Cancer Costs LGBT Study Advisory Board, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Stephen A Rains
- Department of Communication, University of Arizona, Tucson, AZ, United States
| | - Kristin G Cloyes
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
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Janevic T, Tomalin LE, Glazer KB, Boychuk N, Kern-Goldberger A, Burdick M, Howell F, Suarez-Farinas M, Egorova N, Zeitlin J, Hebert P, Howell EA. Development of a prediction model of postpartum hospital use using an equity-focused approach. Am J Obstet Gynecol 2023:S0002-9378(23)00769-X. [PMID: 37879386 PMCID: PMC11035486 DOI: 10.1016/j.ajog.2023.10.033] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Racial inequities in maternal morbidity and mortality persist into the postpartum period, leading to a higher rate of postpartum hospital use among Black and Hispanic people. Delivery hospitalizations provide an opportunity to screen and identify people at high risk to prevent adverse postpartum outcomes. Current models do not adequately incorporate social and structural determinants of health, and some include race, which may result in biased risk stratification. OBJECTIVE This study aimed to develop a risk prediction model of postpartum hospital use while incorporating social and structural determinants of health and using an equity approach. STUDY DESIGN We conducted a retrospective cohort study using 2016-2018 linked birth certificate and hospital discharge data for live-born infants in New York City. We included deliveries from 2016 to 2017 in model development, randomly assigning 70%/30% of deliveries as training/test data. We used deliveries in 2018 for temporal model validation. We defined "Composite postpartum hospital use" as at least 1 readmission or emergency department visit within 30 days of the delivery discharge. We categorized diagnosis at first hospital use into 14 categories based on International Classification of Diseases-Tenth Revision diagnosis codes. We tested 72 candidate variables, including social determinants of health, demographics, comorbidities, obstetrical complications, and severe maternal morbidity. Structural determinants of health were the Index of Concentration at the Extremes, which is an indicator of racial-economic segregation at the zip code level, and publicly available indices of the neighborhood built/natural and social/economic environment of the Child Opportunity Index. We used 4 statistical and machine learning algorithms to predict "Composite postpartum hospital use", and an ensemble approach to predict "Cause-specific postpartum hospital use". We simulated the impact of each risk stratification method paired with an effective intervention on race-ethnic equity in postpartum hospital use. RESULTS The overall incidence of postpartum hospital use was 5.7%; the incidences among Black, Hispanic, and White people were 8.8%, 7.4%, and 3.3%, respectively. The most common diagnoses for hospital use were general perinatal complications (17.5%), hypertension/eclampsia (12.0%), nongynecologic infections (10.7%), and wound infections (8.4%). Logistic regression with least absolute shrinkage and selection operator selection retained 22 predictor variables and achieved an area under the receiver operating curve of 0.69 in the training, 0.69 in test, and 0.69 in validation data. Other machine learning algorithms performed similarly. Selected social and structural determinants of health features included the Index of Concentration at the Extremes, insurance payor, depressive symptoms, and trimester entering prenatal care. The "Cause-specific postpartum hospital use" model selected 6 of the 14 outcome diagnoses (acute cardiovascular disease, gastrointestinal disease, hypertension/eclampsia, psychiatric disease, sepsis, and wound infection), achieving an area under the receiver operating curve of 0.75 in training, 0.77 in test, and 0.75 in validation data using a cross-validation approach. Models had slightly lower performance in Black and Hispanic subgroups. When simulating use of the risk stratification models with a postpartum intervention, identifying high-risk individuals with the "Composite postpartum hospital use" model resulted in the greatest reduction in racial-ethnic disparities in postpartum hospital use, compared with the "Cause-specific postpartum hospital use" model or a standard approach to identifying high-risk individuals with common pregnancy complications. CONCLUSION The "Composite postpartum hospital use" prediction model incorporating social and structural determinants of health can be used at delivery discharge to identify persons at risk for postpartum hospital use.
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Affiliation(s)
- Teresa Janevic
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY.
| | - Lewis E Tomalin
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kimberly B Glazer
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalie Boychuk
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Adina Kern-Goldberger
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Micki Burdick
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Frances Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Mayte Suarez-Farinas
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Research in Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Paul Hebert
- School of Public Health, University of Washington, Seattle, WA
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Bonney A, Steinfort D, Manser R. Are current lung cancer screening guidelines and programs racially biased? Transl Lung Cancer Res 2023; 12:1834-1837. [PMID: 37854162 PMCID: PMC10579830 DOI: 10.21037/tlcr-23-444] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/07/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Asha Bonney
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Daniel Steinfort
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Renee Manser
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
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Valentin G, Nielsen CV, Nielsen ASM, Tonnesen M, Bliksted KL, Jensen KT, Ingerslev K, Maribo T, Oestergaard LG. Bridging Inequity Gaps in Healthcare Systems While Educating Future Healthcare Professionals-The Social Health Bridge-Building Programme. Int J Environ Res Public Health 2023; 20:6837. [PMID: 37835107 PMCID: PMC10572531 DOI: 10.3390/ijerph20196837] [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] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
Social inequity in healthcare persists even in countries with universal healthcare. The Social Health Bridge-Building Programme aims to reduce healthcare inequities. This paper provides a detailed description of the programme. The Template for Intervention Description and Replication (TIDieR) was used to structure the description. The programme theory was outlined using elements from the British Medical Research Council's framework, including identifying barriers to healthcare, synthesising evidence, describing the theoretical framework, creating a logic model, and engaging stakeholders. In the Social Health Bridge-Building Programme, student volunteers accompany individuals to healthcare appointments and provide social support before, during, and after the visit. The programme is rooted in a recovery-oriented approach, emphasising personal resources and hope. The programme finds support in constructs within the health literacy framework. Student volunteers serve as health literacy mediators, supporting individuals in navigating the healthcare system while gaining knowledge and skills. This equips students for their forthcoming roles as healthcare professionals, and potentially empowers them to develop and implement egalitarian initiatives within the healthcare system, including initiatives that promote organisational health literacy responsiveness. The Social Health Bridge-Building Programme is a promising initiative that aims to improve equity in healthcare by addressing individual, social, and systemic barriers to healthcare. The programme's description will guide forthcoming evaluations of its impact.
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Affiliation(s)
- Gitte Valentin
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
| | - Claus Vinther Nielsen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Regional Hospital, 7400 Herning, Denmark
| | - Anne-Sofie Meldgaard Nielsen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
- Social Sundhed (Social Health), 8000 Aarhus, Denmark; (K.L.B.); (K.T.J.); (K.I.)
| | - Merete Tonnesen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
| | | | - Katrine Tranberg Jensen
- Social Sundhed (Social Health), 8000 Aarhus, Denmark; (K.L.B.); (K.T.J.); (K.I.)
- Department of Public Health, Copenhagen University, 1353 Copenhagen, Denmark
| | - Karen Ingerslev
- Social Sundhed (Social Health), 8000 Aarhus, Denmark; (K.L.B.); (K.T.J.); (K.I.)
| | - Thomas Maribo
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | - Lisa Gregersen Oestergaard
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
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Clune R, Das A, Jasrasaria D, Rossomme E, Cohen O, Baranger AM. Development of a Week-Long Mathematics Intervention for Incoming Chemistry Graduate Students. J Chem Educ 2023; 100:3291-3301. [PMID: 37720520 PMCID: PMC10501113 DOI: 10.1021/acs.jchemed.2c00915] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 08/05/2023] [Indexed: 09/19/2023]
Abstract
A student-led mathematics bootcamp has been designed and implemented to help foster community building, improve confidence in mathematical skills, and provide mathematical resources for incoming physical chemistry doctoral students. The bootcamp is held immediately before the start of the first semester of graduate school and uses an active learning approach to review and practice undergraduate-level mathematics problems over 5 days in small student groups. This work includes the development and presentation of a new, publicly available mathematics curriculum for the bootcamp on select mathematics topics, including calculus, linear algebra, functions, differential equations, statistics, and coding in Python, aiming at improving students' confidence and learning experiences in graduate quantum mechanics and statistical physics courses. Surveys before and after the bootcamp showed an increase in students' confidence in problem-solving in key mathematical areas and social aspects of peer-led group learning. Qualitative and quantitative analyses demonstrate that the bootcamp reduced prior inequities in students' confidence metrics based on gender and mathematical background.
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Affiliation(s)
- Rachel Clune
- Kenneth
S. Pitzer Center for Theoretical Chemistry, University of California, Berkeley, California 94720, United States
- Department
of Chemistry, University of California, Berkeley, California 94720, United States
| | - Avishek Das
- Kenneth
S. Pitzer Center for Theoretical Chemistry, University of California, Berkeley, California 94720, United States
- Department
of Chemistry, University of California, Berkeley, California 94720, United States
| | - Dipti Jasrasaria
- Department
of Chemistry, University of California, Berkeley, California 94720, United States
| | - Elliot Rossomme
- Kenneth
S. Pitzer Center for Theoretical Chemistry, University of California, Berkeley, California 94720, United States
- Department
of Chemistry, University of California, Berkeley, California 94720, United States
- Chemical
Sciences Division, Lawrence Berkeley National
Laboratory, Berkeley, California 94720, United States
| | - Orion Cohen
- Department
of Chemistry, University of California, Berkeley, California 94720, United States
- Materials
Science Division, Lawrence Berkeley National
Laboratory, Berkeley, California 94720, United States
| | - Anne M. Baranger
- Department
of Chemistry, University of California, Berkeley, California 94720, United States
- Graduate
Group in Science and Mathematics Education, University of California, Berkeley, California 94720, United States
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Tomori O, Blumberg L. Response to the multi-country monkeypox outbreak: a view from Africa. J Travel Med 2023; 30:taad110. [PMID: 37615490 DOI: 10.1093/jtm/taad110] [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: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 08/25/2023]
Abstract
Human monkeypox was first reported in Africa in 1970. However, the disease has only entered notoriety since the current public health emergency of international concern in Europe and the Americas in 2022. At present there is significant inequality in access to diagnostics, vaccinations and therapeutics, due to which African nations are being completely left behind.
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Affiliation(s)
- Oyewale Tomori
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | - Lucille Blumberg
- National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa. Right to Care. University of Pretoria, Pretoria, South Africa
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Hjern A, Nyberg C, Burström B. Did the choice reform in Stockholm change social disparities in use of outpatient health services for children? Acta Paediatr 2023; 112:1973-1981. [PMID: 37271941 DOI: 10.1111/apa.16864] [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: 11/28/2022] [Revised: 04/20/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
AIM The aim of this study was to investigate whether the choice reforms in healthcare in Stockholm county in 2008 and 2013 changed the sociodemographic user patterns of outpatient healthcare services for children. METHODS The study used regional data on healthcare use linked to sociodemographic data from national registers in the total population of children 0-15 years in the Stockholm county. Change in use of healthcare services was analysed in multiple linear regression in a difference in differences approach of socio-economic indicators. RESULTS The choice reform of 2013 increased children's overall use of specialised care by around 30% until 2017 while primary care use decreased by the same degree. The mean number of physician visits in specialised care for children with severe asthma increased from 3.9 to 5.2 per year. Overall, children in families with low maternal education, low disposable income and a non-Western background increased their use of specialised care more than children from families with a more privileged socio-economic situation. CONCLUSION There was no indication that the choice reform in Stockholm county increased the social disparities in use of primary and specialised outpatient care for children, rather the opposite.
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Affiliation(s)
- Anders Hjern
- Centre for Health Equity Studies (CHESS), Karolinska Institutet/Stockholm University, Stockholm, Sweden
- Clinical Epidemiology/Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Anderson LC, Jacobson T. Providing the choice of in-person or videoconference attendance in a clinical physiology course may harm learning outcomes for the entire cohort. Adv Physiol Educ 2023; 47:548-556. [PMID: 37318999 DOI: 10.1152/advan.00160.2022] [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] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
Clinical Physiology 1 and 2 are flipped classes in which students watch prerecorded videos before class. During the 3-h class, students take practice assessments, work in groups on critical thinking exercises, work through case studies, and engage in drawing exercises. Due to the COVID pandemic, these courses were transitioned from in-person classes to online classes. Despite the university's return-to-class policy, some students were reluctant to return to in-person classes; therefore during the 2021-2022 academic year, Clinical Physiology 1 and 2 were offered as flipped, hybrid courses. In a hybrid format, students either attended the synchronous class in person or online. Here we evaluate the learning outcomes and the perceptions of the learning experience for students who attended Clinical Physiology 1 and 2 either online (2020-2021) or in a hybrid format (2021-2022). In addition to exam scores, in-class surveys and end of course evaluations were compiled to describe the student experience in the flipped hybrid setting. Retrospective linear mixed-model regression analysis of exam scores revealed that a hybrid modality (2021-2022) was associated with lower exam scores when controlling for sex, graduate/undergraduate status, delivery method, and the order in which the courses were taken (F test: F = 8.65, df1 = 2, df2 = 179.28, P = 0.0003). In addition, being a Black Indigenous Person of Color (BIPOC) student is associated with a lower exam score, controlling for the same previous factors (F test: F = 4.23, df1 = 1, df2 = 130.28, P = 0.04), albeit with lower confidence; the BIPOC representation in this sample is small (BIPOC: n = 144; total: n = 504). There is no significant interaction between the hybrid modality and race, meaning that BIPOC and White students are both negatively affected in a hybrid flipped course. Instructors should consider carefully about offering hybrid courses and build in extra student support.NEW & NOTEWORTHY The transition from online to in-person teaching has been as challenging as the original transition to remote teaching with the onset of the pandemic. Since not all students were ready to return to the classroom, students could choose to take this course in person or online. This arrangement provided flexibility and opportunities for innovative class activities for students but introduced tradeoffs in lower test scores from the hybrid modality than fully online or fully in-person modalities.
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Affiliation(s)
- Lisa Carney Anderson
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Tate Jacobson
- Department of Statistics, University of Minnesota, Minneapolis, Minnesota, United States
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Bonney E, Elison JT. Confronting Epistemic Injustice and Inequity in IDD Research: The Value of Theorizing Beyond Dominant Culture's Perspective. Am J Intellect Dev Disabil 2023; 128:375-378. [PMID: 37644860 DOI: 10.1352/1944-7558-128.5.375] [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] [Indexed: 08/31/2023]
Abstract
This commentary highlights pervasive challenges related to the science of intellectual and developmental disabilities (IDD), which we often take for granted. We argue that social power asymmetry and entrenched patterns of epistemic injustices undermine our science and call attention to the need to maximize our efforts to undo these unfair practices to enhance future care and research in IDD.
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Affiliation(s)
- Emmanuel Bonney
- Emmanuel Bonney and Jed T. Elison, Institute of Child Development, University of Minnesota & Masonic Institute for the Developing Brain, University of Minnesota
| | - Jed T Elison
- Emmanuel Bonney and Jed T. Elison, Institute of Child Development, University of Minnesota & Masonic Institute for the Developing Brain, University of Minnesota
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Marciano D, Staveland BR, Lin JJ, Saez I, Hsu M, Knight RT. Electrophysiological signatures of inequity-dependent reward encoding in the human OFC. Cell Rep 2023; 42:112865. [PMID: 37494185 DOI: 10.1016/j.celrep.2023.112865] [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: 07/19/2022] [Revised: 06/12/2023] [Accepted: 07/10/2023] [Indexed: 07/28/2023] Open
Abstract
Social decision making requires the integration of reward valuation and social cognition systems, both dependent on the orbitofrontal cortex (OFC). How these two OFC functions interact is largely unknown. We recorded intracranial activity from the OFC of ten patients making choices in a social context where reward inequity with a social counterpart varied and could be either advantageous or disadvantageous. We find that OFC high-frequency activity (HFA; 70-150 Hz) encodes self-reward, consistent with previous reports. We also observe encoding of the social counterpart's reward, as well as the type of inequity being experienced. Additionally, we find evidence of inequity-dependent reward encoding: depending on the type of inequity, electrodes rapidly and reversibly switch between different reward-encoding profiles. These results provide direct evidence for encoding of self- and other rewards in the human OFC and highlight the dynamic nature of encoding in the OFC as a function of social context.
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Affiliation(s)
- Deborah Marciano
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA 94720, USA; Haas School of Business, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Brooke R Staveland
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Jack J Lin
- Department of Neurology, University of California, Davis, Davis, CA 95616, USA; Center for Mind and Brain, University of California, Davis, Davis, CA 95616, USA
| | - Ignacio Saez
- Departments of Neuroscience, Neurosurgery and Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Ming Hsu
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA 94720, USA; Haas School of Business, University of California, Berkeley, Berkeley, CA 94720, USA.
| | - Robert T Knight
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA 94720, USA; Department of Psychology, University of California, Berkeley, Berkeley, CA 94720, USA.
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Yang J, McClymont H, Warne DJ, Wang L, Hu W. Comparative Analysis of Vaccine Inequity and COVID-19 Transmission Amid the Omicron Variant Among Countries - Six Countries, Asia-Pacific Region, 2022. China CDC Wkly 2023; 5:731-736. [PMID: 37663898 PMCID: PMC10468375 DOI: 10.46234/ccdcw2023.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
What is already known about this topic? The coronavirus disease 2019 (COVID-19) persists as a significant global public health crisis. The predominant strain, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), notably the Omicron variant, continues to undergo mutations. While vaccination is heralded as the paramount solution to cease the pandemic, challenges persist in providing equitable access to COVID-19 vaccines. What is added by this report? The distribution of vaccine coverage exhibited disparities between high-income and middle-income countries, with middle-income countries evidencing lower levels of vaccination. The data further suggested that countries with lesser vaccination levels tended to display a higher case fatality rate. Findings indicated that an increase in population-wide vaccination was effective in mitigating COVID-19 related mortalities. What are the implications for public health practice? The findings of this research underscore the pressing necessity for equitable access to vaccines to effectively mitigate the COVID-19 pandemic within the Asia-Pacific region.
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Affiliation(s)
- Jingli Yang
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Hannah McClymont
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - David J. Warne
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
- Centre for Data Science, Queensland University of Technology, Brisbane, Australia
| | - Liping Wang
- Division of Infectious Diseases, Chinese Center for Diseases Control and Prevention, Beijing, China
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Campaña C, Cabieses B, Obach A, Vezzani F. " Healthcare should be the same for everyone": perceived inequities in therapeutic trajectories of adult patients with lung cancer in Chile, a qualitative study. Front Public Health 2023; 11:1228304. [PMID: 37663832 PMCID: PMC10468573 DOI: 10.3389/fpubh.2023.1228304] [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: 06/01/2023] [Accepted: 07/19/2023] [Indexed: 09/05/2023] Open
Abstract
Background Globally, it has been reported that different social determinants of health affect health outcomes in lung cancer (LC). Research on the therapeutic trajectories of patients (TTP) is a novel field for identifying barriers and facilitators in health. The objective of this study was to reveal perceived differences in TTP with LC in Chile according to selected social determinants of health (SDH) and the experiences of patients, health professionals, and civil society leaders. Methods This is a qualitative paradigm, one case-study design. Online semi-structured interviews were conducted with patients with LC, health professionals, and civil society leaders. The strategies for the recruitment process included social networks, civil society organizations, health professionals, and the snowball technique. A thematic analysis was carried out. Results Selected SDH impact LC's TTP in Chile, particularly concerning health system access, health services, information, and patient navigation experiences. The analysis of the experiences of the participants allowed us to identify barriers related to the selected SDH in three stages of the TTP: initiation, examinations, and diagnosis and treatment. Individuals with limited education, those residing outside the capital, women, and those in the public health system encountered more barriers throughout their TTP. Discussion Study findings suggest that being a woman with low education, from the public health system, and not from the capital might represent one of the most powerful intersections for experiencing barriers to effective healthcare in LC in Chile. It is necessary to monitor the TTP from an SDH perspective to guarantee the rights of access, opportunity, quality, and financial protection.
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Affiliation(s)
- Carla Campaña
- Centre of Global Intercultural Health (CeSGI) ICIM, Universidad del Desarrollo, Santiago, Chile
- Programa de Doctorado en Ciencias e Innovación en Medicina (DCIM), Universidad del Desarrollo, Santiago, Chile
| | - Báltica Cabieses
- Centre of Global Intercultural Health (CeSGI) ICIM, Universidad del Desarrollo, Santiago, Chile
- Center for Cancer Prevention and Control (CECAN), ANID FONDAP 152220002, Santiago, Chile
| | - Alexandra Obach
- Centre of Global Intercultural Health (CeSGI) ICIM, Universidad del Desarrollo, Santiago, Chile
- Center for Cancer Prevention and Control (CECAN), ANID FONDAP 152220002, Santiago, Chile
| | - Francisca Vezzani
- Centre of Global Intercultural Health (CeSGI) ICIM, Universidad del Desarrollo, Santiago, Chile
- Center for Cancer Prevention and Control (CECAN), ANID FONDAP 152220002, Santiago, Chile
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Norman K, Burrows L, Chepulis L, Mullins H, Lawrenson R. 'They're all individuals, none of them are on the same boat': barriers to weight management in general practice from the rural nurse perspective. Prim Health Care Res Dev 2023; 24:e50. [PMID: 37522349 PMCID: PMC10466201 DOI: 10.1017/s1463423623000439] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 04/25/2023] [Accepted: 06/13/2023] [Indexed: 08/01/2023] Open
Abstract
AIM To explore nurses' experiences with, and barriers to, obesity healthcare in rural general practice. BACKGROUND Obesity is a significant health risk worldwide, which can lead to many other physical and psychosocial health issues that contribute to a poor quality of life. Primary care is considered the most suitable context to deliver obesity management healthcare across the world, including New Zealand, which reportedly has 34% of all adults (and 51% Indigenous Māori) classed as obese. Nurses in primary care have a significant role in the multidisciplinary team and deliver obesity healthcare in general practice contexts. Yet, there is little focus on the nurse perspective of weight management, specifically in rural areas where medical staff and resources are limited, and obesity rates are high. METHODS This was a qualitative research design. Semi-structured interviews with 10 rural nurses from indigenous and non-indigenous health providers were analyzed guided by Braun and Clarke () approach to thematic analysis. FINDINGS Three themes were identified: limitations of a nurse role; patient-level barriers; and cultural barriers. Nurses reported experiencing significant barriers to delivering effective weight management in their practice due to factors outside the scope of their practice such as patient-level factors, social determinants of health, rural locality restrictions, and limitations to their role. While this study highlights that practice nurses are versatile with an invaluable skill repertoire, it also demonstrates the near impossibility for rural nurses to meet their rural patient's complex weight management needs, as there are many social determinants of health, sociocultural, and rural locality factors acting as barriers to effective weight management. Nurses experienced a lack of systemic support in the form of time, resources, funding, and effective weight management referral options. Future investigation should look to address the unique rural weight management healthcare needs that experience many barriers.
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Affiliation(s)
| | | | | | | | - Ross Lawrenson
- University of Waikato, Hamilton, New Zealand
- Waikato District Health Board, Hamilton, New Zealand
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Vergunst F, Berry HL, Minor K, Chadi N. Climate Change and Substance-Use Behaviors: A Risk-Pathways Framework. Perspect Psychol Sci 2023; 18:936-954. [PMID: 36441663 PMCID: PMC10336608 DOI: 10.1177/17456916221132739] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Climate change is undermining the mental and physical health of global populations, but the question of how it is affecting substance-use behaviors has not been systematically examined. In this narrative synthesis, we find that climate change could increase harmful substance use worldwide through at least five pathways: psychosocial stress arising from the destabilization of social, environmental, economic, and geopolitical support systems; increased rates of mental disorders; increased physical-health burden; incremental harmful changes to established behavior patterns; and worry about the dangers of unchecked climate change. These pathways could operate independently, additively, interactively, and cumulatively to increase substance-use vulnerability. Young people face disproportionate risks because of their high vulnerability to mental-health problems and substance-use disorders and greater number of life years ahead in which to be exposed to current and worsening climate change. We suggest that systems thinking and developmental life-course approaches provide practical frameworks for conceptualizing this relationship. Further conceptual, methodological, and empirical work is urgently needed to evaluate the nature and scope of this burden so that effective adaptive and preventive action can be taken.
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Affiliation(s)
- Francis Vergunst
- Department of Special Needs Education, University of Oslo
- Department of Social and Preventive Medicine, University of Montreal
- Ste-Justine University Hospital Research Center, Montreal, Québec, Canada
| | - Helen L Berry
- Australian Institute of Health Innovation, Macquarie University
| | - Kelton Minor
- Center for Social Data Science, University of Copenhagen
- Data Science Institute, Columbia University
| | - Nicholas Chadi
- Ste-Justine University Hospital Research Center, Montreal, Québec, Canada
- Department of Pediatrics, Faculty of Medicine, University of Montreal
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Manku B, Saffari TM, Sandhu V, Khajuria A. A Cross-Sectional Study on Inequity and Unmet Needs in Conducting Systematic Reviews (SRMA) and Meta-Analysis Among Medical Students and Junior Doctors. Adv Med Educ Pract 2023; 14:647-655. [PMID: 37360839 PMCID: PMC10290472 DOI: 10.2147/amep.s401483] [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] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/02/2023] [Indexed: 06/28/2023]
Abstract
Background Systematic reviews and meta-analyses allow a transparent, rigorous, and replicable analysis to summarize the results of multiple related studies and are considered top of the evidence-based medicine study hierarchy. The COVID-19 pandemic has shed light on the unmet educational needs of students worldwide, notably those from underprivileged backgrounds. This cross-sectional study aimed to ascertain students' and junior doctors' attitudes on their current knowledge, confidence and preparedness of appraising and conducting systematic reviews and meta-analysis internationally. Methods A free online webinar was held in May 2021 by the senior author and a pre-event questionnaire was distributed. Responses collected were used for analysis anonymously to ascertain students' knowledge, experience, and confidence in preparing a systematic review and meta-analysis using a 1-5 Likert scale using IBM SPSS 26.0. Associations were examined using Chi-square and crosstabs analysis. Results Out of 2004 responses from 104 countries included in the analysis, the majority of delegates were from lower middle-income countries and were not familiar with the PRISMA checklist (59.2% and 81.1% respectively of the total number of participants). The majority had never attended any formal training (83%) and felt their medical institute gave them minimal advice (72.5%) in preparing systematic reviews. Among those who had attended formal training, the proportion was significantly higher in those belonging to high and upper middle-income countries combined (20.3%) than lower and lower-middle-income countries combined (15%). Conclusion This study highlights gaps that need addressing to enhance the knowledge of medical students and junior doctors performing systematic reviews and meta-analyses. Clear disparities are found in country income and the level of education. Future large-scale studies are needed to understand the rationale of working on online research projects and the opportunities available to medical students and junior doctors that may lead to medical curriculum changes.
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Affiliation(s)
- Bhagat Manku
- Department of Surgery, South Warwickshire NHS Foundation Trust, Warwickshire, UK
| | - Tiam Mana Saffari
- Department of Plastic and Reconstructive Surgery, Ohio State University, Columbus, OH, USA
| | - Vinesh Sandhu
- University College London Division of Medicine, University College London, London, UK
| | - Ankur Khajuria
- Kellogg College, University of Oxford, Oxford, UK
- Department of Surgery & Cancer, Imperial College London, London, UK
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