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1
Alsan, Marcella, Owen Garrick, and Grant Graziani. "Does Diversity Matter for Health? Experimental Evidence from Oakland." American Economic Review 109, no. 12 (December 1, 2019): 4071–111. http://dx.doi.org/10.1257/aer.20181446.
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We study the effect of physician workforce diversity on the demand for preventive care among African American men. In an experiment in Oakland, California, we randomize black men to black or non-black male medical doctors. We use a two-stage design, measuring decisions before (pre-consultation) and after (post-consultation) meeting their assigned doctor. Subjects select a similar number of preventives in the pre-consultation stage, but are much more likely to select every preventive service, particularly invasive services, once meeting with a racially concordant doctor. Our findings suggest black doctors could reduce the black-white male gap in cardiovascular mortality by 19 percent. (JEL I12, I14, C93)
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Earle, Craig C., Harold J. Burstein, Eric P. Winer, and Jane C. Weeks. "Quality of Non–Breast Cancer Health Maintenance Among Elderly Breast Cancer Survivors." Journal of Clinical Oncology 21, no. 8 (April 15, 2003): 1447–51. http://dx.doi.org/10.1200/jco.2003.03.060.
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Purpose: To assess the quality of preventive health care, the role of health care participation, and the patient and provider characteristics associated with high-quality care for breast cancer survivors. Methods: We analyzed the 1997 to 1998 Medicare data of elderly women who were diagnosed with nonmetastatic breast cancer in 1991 or 1992 while living in a Survival, Epidemiology, and End Results (SEER) tumor registry area and who survived to the end of 1998 without evidence of cancer recurrence. Controls were matched for age, race, and geographic location. Results: The 5,965 breast cancer survivors received more preventive services (influenza vaccination, lipid testing, cervical and colon screening, and bone densitometry) than matched controls. Among both groups, those who were younger, non–African-American, of higher socioeconomic status, living in urban areas, and receiving care in a teaching center were most likely to receive high-quality health maintenance. Those survivors who continued to see oncology specialists were more likely to receive appropriate follow-up mammography for their cancer, but those who were monitored by primary care physicians were more likely to receive all other non–cancer-related preventive services. Those who saw both types of practitioners received more of both types of services. When the control group was restricted only to women actively undergoing mammographic screening before the study period, receipt of preventive services was similar. Conclusion: Breast cancer survivors receive high-quality preventive services, but disparities on the basis of nonmedical factors still exist. Cancer follow-up may provide regular contact with the health system, maximizing the likelihood of receiving appropriate general medical care.
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Bedimo, Ariane Lisann, Steven D. Pinkerton, Deborah A. Cohen, Bradley Gray, and Thomas A. Farley. "Condom distribution: a cost–utility analysis." International Journal of STD & AIDS 13, no. 6 (June 1, 2002): 384–92. http://dx.doi.org/10.1258/095646202760029804.
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Objective: To explore the cost-effectiveness of a condom distribution programme. Methods: We conducted a cost-utility analysis of a social marketing campaign in which over 33 million condoms were made freely available throughout Louisiana. Surveys among 275,000 African Americans showed that condom use increased by 30%. Based on the estimated cost of the intervention and costs of HIV/AIDS-associated medical treatment, we estimated the quality-adjusted life years (QALYs) saved, and number of HIV infections averted by the programme. Results: The programme was estimated to prevent 170 HIV infections and save 1909 QALYs. Over $33 million in medical care costs were estimated to be averted, resulting in cost savings. Sensitivity analyses showed that these results were quite stable over a range of estimates for the main parameters. Condom increases as small as 2.7% were still cost-saving. Conclusion: Condom distribution is a community-level HIV prevention intervention that has the potential to reach large segments of the general population, thereby averting significant numbers of HIV infections and associated medical costs. The intervention is easy to scale up to large populations or down to small populations. The financial and health benefits of condom social marketing support making it a routine component of HIV prevention services nationally.
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Wagner, K., A. Szabo, C. Zheng, E. Okunseri, and C. Okunseri. "Billed and Paid Amounts for Preventive Procedures in Dental Medicaid." JDR Clinical & Translational Research 4, no. 4 (April 23, 2019): 371–77. http://dx.doi.org/10.1177/2380084419842533.
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Objective: To examine trends and variations in billed and paid amounts for preventive dental procedures by race/ethnicity, age, and sex in Wisconsin dental Medicaid. Methods: We analyzed data from the 2001 to 2013 Wisconsin Medicaid claims database for preventive dental procedures for children and adults. Billed and paid amounts for preventive dental procedures were aggregated over a visit and adjusted for inflation based on the Medical Care Consumer Price Index produced by the Bureau of Labor Statistics for 2013. Quantile regression was used to examine the trends over time and the effect of patient demographics. Result: At the 50th and 75th percentiles, the overall billed amounts for preventive dental procedures were $84.97 and $105.53, and the paid amounts were $35.80 and $41.66, respectively. At the 75th percentile, there was a $2.24 increase per year in the billed amount and a $26.88 overall increase from 2001 to 2013. In the paid amount, there was a $1.34 decrease per year for an overall $16.07 decrease from 2001 to 2013. Billed and paid claims for racial/ethnic minority enrollees were $1 to $3 higher per visit at the 75th percentile when compared with those of Whites. Regarding the billed:paid ratio, White, African American, and Hispanic enrollees had values of 50% to 52%, whereas American Indians had the lowest value at 47.7%. At the 75th percentile, children aged 10 to 19 y had significantly higher billed ($26.73) and paid ($9.92) amounts than did adults aged 20 to 69 y. Conclusion: The billed amount increased over time, and the paid amount decreased after adjustment for inflation. In addition, there was a wide gap between billed and paid amounts over time. Knowledge Transfer Statement: This study highlights clear differences between paid and billed amounts in Wisconsin dental Medicaid. The financial health of dental practices is dependent on appropriate reimbursement for dental services provided; thus, information of this nature could serve as a proxy performance measure for access to preventive dental care. Findings from this study could be used by policy makers and dental Medicaid program managers to develop outcome metrics to improve access to preventive dental services.
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Cuellar, Alison, Anthony T. LoSasso, Mona Shah, Alicia Atwood, and Tanya R. Lewis-Walls. "Wellness Programs With Financial Incentives Through Disparities Lens." American Journal of Health Promotion 32, no. 2 (December 4, 2017): 355–58. http://dx.doi.org/10.1177/0890117117743362.
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Purpose: To examine wellness programs with financial incentives and their effect on disparities in preventive care. Design: Financial incentives were introduced by 15 large employers, from 2010 to 2013. Setting: Fifteen private employers. Subjects: A total of 299 436 employees and adult dependents. Measures: Preventive services and participation in financial incentives. Analysis: Multivariate linear regression. Results: Disparities in preventive services widened after introduction of financial incentives. Asians were 3% more likely and African Americans were 3% less likely to receive wellness rewards than whites and non-Hispanics, controlling for other factors. Conclusion: Federal law limits targeting of wellness financial incentives by subgroups; thus, employers should consider outreach and culturally appropriate messaging.
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Crowe, Remle P., Roger Levine, Jennifer J. Eggerichs, and Melissa A. Bentley. "A Longitudinal Description of Emergency Medical Services Professionals by Race/Ethnicity." Prehospital and Disaster Medicine 31, S1 (November 28, 2016): S30—S69. http://dx.doi.org/10.1017/s1049023x16001072.
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AbstractObjectiveThe objective of this paper was to compare demographics, employment variables, satisfaction, and motivation for entering the field of Emergency Medical Services (EMS) between members of under-represented races/ethnicities and members of the majority group.MethodsA cohort of nationally certified EMS professionals was followed for 10 years through annual surveys; however, race/ethnicity was only available for 9 years (2000-2008). Descriptive statistics and 95% confidence intervals (CIs) were calculated and significance was determined by lack of CI overlap.ResultsFrom 2000 through 2008, the range of proportions of nationally certified EMS professionals by race/ethnicity was as follows: whites: 83.5%-86.0%, Hispanics: 4.2%-5.9%, and African-Americans: 2.5%-4.6%. There were no significant changes in the proportion of minority EMS professionals over the study period. Hispanics and African-Americans combined increased slightly from 6.7% of the population in 2000 to 9.9% in 2008. Likewise, the proportion of all under-represented races/ethnicities increased slightly from 2000 (14.0%) to 2008 (16.5%). Females were under-represented in all years. Nationally certified African-Americans were significantly more likely to be certified at the Emergency Medical Technician (EMT)-Basic level (compared with the EMT-Paramedic level) than whites in all but one survey year. The proportion of Hispanics registered at the EMT-Basic level was significantly higher than whites in three survey years. Accordingly, a larger proportion of whites were nationally registered at the EMT-Paramedic level than both African-Americans and Hispanics. A significantly larger proportion of African-Americans reported working in urban communities (population >25,000) compared with whites for nine of the 10 survey years. Similarly, a significantly larger proportion of Hispanics worked in urban communities compared with whites in 2002 and from 2005 to 2008. For satisfaction measures, there were no consistent differences between races/ethnicities. Among factors for entering EMS, the proportion of whites who reported having a friend or family member in the field was significantly higher than African-Americans in all years and significantly higher than Hispanics in four of the nine years.ConclusionThe ethnic/racial diversity of the population of nationally certified EMS professionals is not representative of the population served and has not improved over the 2000-2008 period. Similar to other health care professions, Hispanics and African-Americans are under-represented in EMS compared with the US population. This study serves as a baseline to examine under-represented populations in EMS.CroweRP, LevineR, EggerichsJJ, BentleyMA. A longitudinal description of Emergency Medical Services professionals by race/ethnicity. Prehosp Disaster Med. 2016;31(Suppl. 1):s30–s69.
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Stark, Azadeh, Bruce A. Jones, Deborah Chapman, Karen Well, Richard Krajenta, Frederick A. Meier, and Richard J. Zarbo. "Clinical Laboratory Specimen Rejection—Association With the Site of Patient Care and Patients' Characteristics: Findings From a Single Health Care Organization." Archives of Pathology & Laboratory Medicine 131, no. 4 (April 1, 2007): 588–92. http://dx.doi.org/10.5858/2007-131-588-clsrwt.
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Abstract Context.—Programs to track laboratory quality have reported aggregated specimen rejection rates ranging from 0.30% to 0.83%. Because the performance of the laboratory, rather than errors, has been the focus, reasons for specimen rejection or demographic characteristics of individuals at risk for specimens of poor quality may not be fully understood. Objective.—To calculate the proportions of rejected specimens stratified by point of collections and demographic information of patients. Design.—Retrospective cross-sectional study. Data were retrieved from the intrainstitutional electronic databases. Results.—The proportions of specimens that were rejected in the emergency department and inpatient services were 2-fold and more than 5-fold higher, respectively, than for the outpatient services. Assessment of data by patients' ethnic heritages yielded no significant differences among African Americans (0.38%), Caucasians (0.38%), or “Others” (0.35%) in the outpatient services (P = .07). In the emergency department, the proportions of rejected specimens for African Americans (2.24%) were almost twice that of Caucasians (1.39%) and 30% higher than for Others (1.70%). A similar finding was observed for the inpatient services. Conclusions.—The effect of ethnicity on the proportions of rejected specimens was significant for samples that were collected in the emergency department and inpatient services, even after adjusting for the total number of specimens. A constellation of factors, that is, disease severity and seriousness, practice of blood sample collection, and lesser proficiency of the nursing staff in phlebotomy may be reasons for this observation. However, the likelihood of differential care, although unlikely, cannot be refuted by the present data.
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Tucker, Carolyn M., Guillermo M. Wippold, Andrea D. Guastello, Tya M. Arthur, Frederic F. Desmond, Brian M. Rivers, Jenna L. Davis, Desiree Rivers, and B. Lee Green. "Predictors of Cancer Screening Among Culturally Diverse Men." American Journal of Men's Health 12, no. 4 (April 26, 2016): 837–43. http://dx.doi.org/10.1177/1557988316644398.
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Men have higher rates of all cancers and are more likely to die from cancer than women; however, men are less likely to utilize disease prevention services. African American/Black men and Hispanic men have lower cancer survival rates and are less likely to utilize health care services than non-Hispanic White men. The present study examined demographic variables (age, household income, education, marital status, race/ethnicity, health insurance status), motivators to engage in healthy eating, and motivators to engage in physical activity as predictors of culturally diverse, medically underserved men’s likelihood of getting a cancer screening (a) at the present time, (b) if no cancer symptoms are present, and (c) if a doctor discovers some cancer symptoms. Analyses were conducted using data from 243 men (47.3% non-Hispanic Black, 29.5% Hispanic, 16.5% non-Hispanic White, and 6.8% “other”) recruited at the Men’s Health Forum in Tampa, Florida. Age, having a medical or health condition that benefits from eating healthy, and having a commitment to physical activity were significant positive predictors of the likelihood of receiving a cancer screening. Motivation to engage in physical activity because of a personal priority was a significant negative predictor of the likelihood of getting a cancer screening. The findings from this study suggest that interventions to increase cancer screenings among culturally diverse, medically underserved men should be informed at least in part by an assessment of participating men’s motivators for engaging in health promoting lifestyle behaviors such as physical activity and healthy eating.
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Winston, Carole A., Paula Leshner, Jennifer Kramer, and Gillian Allen. "Overcoming Barriers to Access and Utilization of Hospice and Palliative Care Services in African-American Communities." OMEGA - Journal of Death and Dying 50, no. 2 (March 2005): 151–63. http://dx.doi.org/10.2190/qqkg-epfa-a2fn-ghvl.
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While there is ample evidence to support the need for hospice and palliative care services for African Americans, only 8% of patients who utilize those services are from African-American communities. The underutilization of end-of-life and palliative care can be attributed to several barriers to service access including incompatibility between hospice philosophy and African-American religious, spiritual, and cultural beliefs; health care disparities; distrust of the medical establishment; physician influence; financial disincentives, and hospice admission criteria. Suggestions for dismantling barriers to care access include developing culturally competent professionals in the health and human services, expanding the philosophy of hospice to include spiritual advisors from client communities, and funding national initiatives to promote improved access to health care at all stages in the life cycle of members of all underserved communities.
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Garza, Juan F., Michelle Janania Martinez, Prathibha Surapaneni, Tyler W. Snedden, Snegha Ananth, David J. Gregorio, Sushanth Kakarla, et al. "Does Insurance Status Interfere with Outcomes in Patients with Hodgkin and Non-Hodgkin Lymphoma?: The UT Health San Antonio Experience." Blood 134, Supplement_1 (November 13, 2019): 2141. http://dx.doi.org/10.1182/blood-2019-129085.
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Introduction: Historically, a lack of health insurance has been reported to correlate with decreased access to medical care, a delay in cancer treatment and poorer outcomes overall. Furthermore, access to preventive services for cancer screening also decrease with lack of medical insurance (1, 2). Also, studies report that an increase in Medicaid expansion help reduce racial disparities previously seen between African American and Caucasian patients (3). The aim of this study was to present and analyze vitality data based on insurance coverage among Hispanic (HI) and non-Hispanic (NH) population at the only NCI designated cancer center of South Texas primarily serving Hispanics. Methods: This is a retrospective observational study of a cohort of patients seen with diagnosis of lymphoma by International Classification of Diseases (ICD) codes from 2008 to 2018 at UT Health San Antonio. Diffuse Large B Cell Lymphoma (DLBCL) cases were not included. Variables included age of diagnosis, lymphoma subtype, stage at diagnosis, comorbidities, treatment received, lines of therapy, B symptoms present, death, and cause of death and current vitality status. Continuously distributed outcomes were summarized with the mean and standard deviation and categorical outcomes were summarized with frequencies and percentages. The significance of variation in the mean with disease category was assessed with one-way ANOVA and the significance of associations between categorical outcomes was assessed with Pearson's Chi Square or Fisher's Exact test as appropriate. Multivariate logistic regression was used to model binary outcomes in terms of covariates and indicators of disease. All statistical testing was two-sided with a significance level of 5%. R1 was used throughout. Primary end point was to characterize insurance status. Secondary end points - overall 3 and 5-year survival based on insurance and demographics. Results: A total of 477 patients with lymphoma were identified. Hodgkin lymphoma (HL)( n = 116, 24%), non-Hodgkin lymphoma (NHL) (n = 308, 65%), T cell lymphoma (TCL) ( n = 53, 11%). Subtypes for all indolent lymphomas ( n = 217), of which included; Follicular lymphoma (FL) ( n = 123), Marginal Zone lymphoma (MZL) ( n = 53), Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) (n = 8), Small lymphocytic lymphoma (SLL) ( n = 28). Overall mean age of diagnosis for all lymphoma subtypes was 51, male patients (n = 244, 51%), female patients (n = 232, 49%), HI (n = 263, 56%) vs NH (n = 204, 44%), Mean BMI at diagnosis was 29 across all lymphoma groups. Most patients identified had Medicare (MC) (n = 115, 24%), or commercial insurance (CI) ( n = 222, 47%), others were approved for indigent care coverage (ICC) (n = 85, 18%), for Medicaid (MI) (n = 17, 4%), or unfunded (UF)( n = 35, 7%). Of those diagnosed with HL (n = 116); 60% (70) had MC or CI, 40% (46) had ICC, MI or were UF. Of those with Indolent Lymphomas (n = 217), 77% (166) had MC or CI and 23% (49) had ICC, MI or UF; and among patients with T cell lymphomas (n = 53), 63% (22) had MC or CI and 37% (13) ICC, MI or UF respectively. Overall number of HI patients alive at 3 years with MC or CI was 98 and 5 recorded deaths. Those with ICC or MI/UF were 52 and 11 respectively. Comparison of vitality data at 3 years follow up among both groups did not show a difference with a fisher p value of 0.056. Overall number of NH alive at 3 years with MC or CI was 90 and 11 recorded deaths. Those with ICC or MI/UF were 21 and 3 respectively. Comparison of vitality data at 3 years follow up among both groups did not show a difference with a fisher p value of 0.173. Overall number of HI alive at 5 years with MC or CI was 78 and 7 recorded deaths. Those with ICC or MI/UF were 36 and 11 respectively. Comparison of vitality data at 5 years follow up among both groups did not show a difference with a fisher p value of 0.064. Overall number of NH alive at 5 years with MC or CI was 70 and 14 recorded deaths and those with ICC or MI/UF were 16 and 4 respectively. Comparison of vitality data at 5 years follow up among both groups did not show a difference with a fisher p value of 0.169. Conclusion: Across all HI and NH, at the 3 and 5 year follow up mark, there was no significant vitality difference shown in our patient population between those with CI and or MC vs those with MI, ICC or UF. This study demonstrated that across all lymphoma subtypes, patients with access to healthcare had similar outcomes in vitality irrespective of demographics or insurance. Disclosures No relevant conflicts of interest to declare.
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Carroll, J. K., R. Epstein, K. Fiscella, E. Volpe, P. Jean-Pierre, and G. Morrow. "Health promotion and cancer screening services for African refugee women." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 6101. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.6101.
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6101 Background: Previous work has shown that refugee women do not receive adequate preventive healthcare services, especially cancer screening. To identify factors that could affect the provision of cancer screening services to African Somali refugee women living in Rochester, NY, we assessed beliefs these women have about health promotion, access to care and use of preventive healthcare services. Methods: Individual in-depth interviews were conducted on a community-based sample of 34 resettled Somali-born women who were older than 18 years. Interviews were audiotaped and transcribed verbatim. A professional interpreter listened to all audiotaped interviews to check accuracy of transcription and translation. Content was analyzed by a multidisciplinary team using a grounded theory approach. Results: Median age of the women was 27 years. Length of residence in US was two months to nine years. For these women, health maintenance for acute survival took precedence over long-term prevention of disease. All women were familiar with basic health promotion practices, immunizations and routine medical examinations, and participants used both US-based and traditional techniques to prevent illness. Most women (71%, n=24), recognized the importance of maintaining good hygiene (59%, n=20) understood the need to have an adequate source of safe food and water, (74%, n=25) saw the need for access to a regular source of healthcare and (65%, n=22) acknowledged the need to function well at home. Few women understood cancer prevention services. Only three (9%) women recognized that the purpose of the Papanicalaou test was to screen for cervical cancer. Only six women (18%) recognized mammography (either the term or the procedure) and all of them were English-speaking, had lived in the US five years or longer, and had worked in the healthcare field. Conclusions: While traditional beliefs about health promotion did not appear to impede delivery of most preventive services, and participants understood prevention of infectious disease, their familiarity with cancer and cancer screening services was poor. Future health promotion programs need to increase refugee women’s knowledge about these services while building on other positive health-promoting beliefs. Supported by AHRQ 5R03HS014105 and NCI 1R25CA102618 No significant financial relationships to disclose.
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Arevian, Armen C., Felica Jones, Elizabeth M. Moore, Nichole Goodsmith, Sergio Aguilar-Gaxiola, Toby Ewing, Hafifa Siddiq, et al. "Mental Health Community and Health System Issues in COVID-19: Lessons from Academic, Community, Provider and Policy Stakeholders." Ethnicity & Disease 30, no. 4 (September 24, 2020): 695–700. http://dx.doi.org/10.18865/ed.30.4.695.
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The coronavirus pandemic of 2019 (COVID-19) has created unprecedented changes to everyday life for millions of Americans due to job loss, school closures, stay-at-home orders and health and mortality consequences. In turn, physicians, academics, and policymakers have turned their attention to the public mental health toll of COVID-19.This commentary reporting from the field integrates perceptions of academic, community, health system, and policy leaders from state, county, and local levels in commenting on community mental health needs in the COVID-19 pandemic. Stakeholders noted the broad public health scope of mental health challenges while expressing concern about exacerbation of existing disparities in access and adverse social determinants, including for communities with high COVID-19 infection rates, such as African Americans and Latinos. They noted rapid changes toward telehealth and remote care, and the importance of understanding impacts of changes, including who may benefit or have limited access, with implications for future services delivery. Needs for expanded workforce and training in mental health were noted, as well as potential public health value of expanding digital resources tailored to local populations for enhancing resilience to stressors.The COVID-19 pandemic has led to changes in delivery of health care services across populations and systems. Concerns over the mental health impact of COVID-19 has enhanced interest in remote mental care delivery and preventive services, while being mindful of potential for enhanced disparities and needs to address social determinants of health. Ongoing quality improvement across systems can integrate lessons learned to enhance a public mental well-being.Ethn Dis. 2020;30(4):695-700; doi:10.18865/ed.30.4.695
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Estes, Carroll L., and Elizabeth A. Binney. "Toward a Transformation of Health and Aging Policy." International Journal of Health Services 18, no. 1 (January 1988): 69–82. http://dx.doi.org/10.2190/j493-y81w-juth-uary.
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Millions of Americans are plagued by serious problems of inadequate health care benefits, limiting their access to services and creating hardship. For those under 65 years of age, the problem is the lack of insurance for many working poor and others. For the elderly, the problem is one of underinsurance in terms of both cost and coverage, particularly for long-term care. Policies of cost containment and cost shifting to consumers have exacerbated these problems, and current health policy proposals offer little respite. Arguments are made for a program of public national health care. Health policy interventions are considered at four levels: incrementalism, modification, alteration, and transformation. A proposal is presented for universal health benefits that are organized and operated to eliminate for-profit medical care and to promote social and preventive care.
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Roberts, D. Allen, Seifu Abera, Guiomar Basualdo, Roxanne P. Kerani, Farah Mohamed, Rahel Schwartz, Beyene Gebreselassie, Ahmed Ali, and Rena Patel. "Barriers to accessing preventive health care among African-born individuals in King County, Washington: A qualitative study involving key informants." PLOS ONE 16, no. 5 (May 10, 2021): e0250800. http://dx.doi.org/10.1371/journal.pone.0250800.
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Studies of African immigrant health in the U.S. have traditionally focused on infectious diseases. However, the rising burden of non-communicable diseases (NCDs) indicates the increasing importance of general preventive health care. As part of a series of community health events designed for African-born individuals in King County, Washington, we administered key informant interviews (KIIs) with 16 health event participants, medical professionals, and community leaders to identify barriers and facilitators to use of preventive health care among African-born individuals. We used descriptive thematic analysis to organize barriers according to the socio-ecological model. Within the individual domain, KII participants identified lack of knowledge and awareness of preventive health benefits as barriers to engagement in care. Within the interpersonal domain, language and cultural differences frequently complicated relationships with health care providers. Within the societal and policy domains, healthcare costs, lack of insurance, and structural racism were also reported as major barriers. Participants identified community outreach with culturally competent and respectful providers as key elements of interventions to improve uptake. In conclusion, African immigrant communities face several barriers, ranging from individual to policy levels, to accessing health services, resulting in substantial unmet need for chronic disease prevention and treatment. Community-centered and -led care may help facilitate uptake and engagement in care.
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Fichtenbaum, Rudy, and Kwabena Gyimah-Brempong. "The Effects of Race on the Use of Physicians' Services." International Journal of Health Services 27, no. 1 (January 1997): 139–56. http://dx.doi.org/10.2190/gqhj-cuqt-n63h-cg0h.
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In recent years several studies have examined the role of race in determining both health care status and access to care. Most studies in this area have focused primarily on health care status, although the issue of access is often mentioned. While there are many reasons for differences in health status, access to resources may play an important role. Using a Poisson regression, a decomposition analysis, and data from the 1987 National Medical Expenditure Survey, the authors of this article show that significant differences remain in the number of physician office visits for whites and African-Americans. The proportion of the racial differences in the number of office visits not explained by differences in objective factors is relatively large. In fact, the results show that a considerable part of the racial differential can be explained by differential responses to these objective factors. This implies that, even if all the objective factors that affect the demand for visits are equalized across race, significant differences in the utilization of health care services will remain.
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Fouad, Mona N., Aras Acemgil, Sejong Bae, Andres Forero, Nedra Lisovicz, Michelle Y. Martin, Gabriela R. Oates, Edward E. Partridge, and Selwyn M. Vickers. "Patient Navigation As a Model to Increase Participation of African Americans in Cancer Clinical Trials." Journal of Oncology Practice 12, no. 6 (June 2016): 556–63. http://dx.doi.org/10.1200/jop.2015.008946.
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Purpose: Less than 10% of patients enrolled in clinical trials are minorities. The patient navigation model has been used to improve access to medical care but has not been evaluated as a tool to increase the participation of minorities in clinical trials. The Increasing Minority Participation in Clinical Trials project used patient navigators (PNs) to enhance the recruitment of African Americans for and their retention in therapeutic cancer clinical trials in a National Cancer Institute–designated comprehensive cancer center. Methods: Lay individuals were hired and trained to serve as PNs for clinical trials. African American patients potentially eligible for clinical trials were identified through chart review or referrals by clinic nurses, physicians, and social workers. PNs provided two levels of services: education about clinical trials and tailored support for patients who enrolled in clinical trials. Results: Between 2007 and 2014, 424 African American patients with cancer were referred to the Increasing Minority Participation in Clinical Trials project. Of those eligible for a clinical trial (N = 378), 304 (80.4%) enrolled in a trial and 272 (72%) consented to receive patient navigation support. Of those receiving patient navigation support, 74.5% completed the trial, compared with 37.5% of those not receiving patient navigation support. The difference in retention rates between the two groups was statistically significant (P < .001). Participation of African Americans in therapeutic cancer clinical trials increased from 9% to 16%. Conclusion: Patient navigation for clinical trials successfully retained African Americans in therapeutic trials compared with non–patient navigation trial participation. The model holds promise as a strategy to reduce disparities in cancer clinical trial participation. Future studies should evaluate it with racial/ethnic minorities across cancer centers.
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Bazargan, Mohsen, Cheryl Wisseh, Edward Adinkrah, Hoorolnesa Ameli, Delia Santana, Sharon Cobb, and Shervin Assari. "Influenza Vaccination among Underserved African-American Older Adults." BioMed Research International 2020 (November 5, 2020): 1–9. http://dx.doi.org/10.1155/2020/2160894.
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Background. Racial disparities in influenza vaccination among underserved minority older adults are a public health problem. Understanding the factors that impact influenza vaccination behaviors among underserved older African-Americans could lead to more effective communication and delivery strategies. Aims. We aimed to investigate rate and factors associated with seasonal influenza vaccination among underserved African-American older adults. We were particularly interested in the roles of demographic factors, socioeconomic status, and continuity and patient satisfaction with medical care, as well as physical and mental health status. Methods. This community-based cross-sectional study recruited 620 African-American older adults residing in South Los Angeles, one of the most under-resources areas within Los Angeles County, with a population of over one million. Bivariate and multiple regression analyses were performed to document independent correlates of influenza vaccination. Results. One out of three underserved African-American older adults aged 65 years and older residing in South Los Angeles had never been vaccinated against the influenza. Only 49% of participants reported being vaccinated within the 12 months prior to the interview. One out of five participants admitted that their health care provider recommended influenza vaccination. However, only 45% followed their provider’s recommendations. Multivariate logistic regression shows that old-old (≥75 years), participants who lived alone, those with a lower level of continuity of care and satisfaction with the accessibility, availability, and quality of care, and participants with a higher number of depression symptoms were less likely to be vaccinated. As expected, participants who indicated that their physician had advised them to obtain a flu vaccination were more likely to be vaccinated. Our data shows that only gender was associated with self-report of being advised to have a flu shot. Discussion. One of the most striking aspects of this study is that no association between influenza vaccination and being diagnosed with chronic obstructive pulmonary disease or other major chronic condition was detected. Our study confirmed that both continuity of care and satisfaction with access, availability, and quality of medical care are strongly associated with current influenza vaccinations. We documented that participants with a higher number of depression symptoms were less likely to be vaccinated. Conclusion. These findings highlight the role that culturally acceptable and accessible usual source of care van play as a gatekeeper to facilitate and implement flu vaccination among underserved minority older adults. Consistent disparities in influenza vaccine uptake among underserved African-American older adults, coupled with a disproportionate burden of chronic diseases, places them at high risk for undesired outcomes associated with influenza. As depression is more chronic/disabling and is less likely to be treated in African-Americans, there is a need to screen and treat depression as a strategy to enhance preventive care management such as vaccination of underserved African-American older adults. Quantification of associations between lower vaccine uptake and both depression symptoms as well as living alone should enable health professionals target underserved African-American older adults who are isolated and suffer from depression to reduce vaccine-related inequalities.
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Beito, David T., and Linda Royster Beito. "“Let Down Your Bucket Where You Are”." Social Science History 30, no. 4 (2006): 551–69. http://dx.doi.org/10.1017/s0145553200013584.
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Under the burden of Jim Crow, how did African Americans obtain health care? For nearly 40 years the Afro-American Hospital of Yazoo City, Mississippi, was a leading health care supplier for blacks in the Mississippi Delta. It was founded in 1928 by the Afro-American Sons and Daughters, a black fraternal society, and provided a wide range of medical services. The society, which eventually had 35,000 members, was led by Thomas J. Huddleston, a prosperous black entrepreneur and advocate of Booker T. Washington’s self-help philosophy. The hospital had a low death rate compared to other hospitals that served blacks in the South during the period. It ceased operation in 1966 as a fraternal entity after years of increasingly burdensome regulation, competitive pressure from government and third-party health care alternatives, and the migration of younger dues-paying blacks to the North.
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Qiao, Shan, Guangyu Zhou, and Xiaoming Li. "Disclosure of Same-Sex Behaviors to Health-care Providers and Uptake of HIV Testing for Men Who Have Sex With Men: A Systematic Review." American Journal of Men's Health 12, no. 5 (June 27, 2018): 1197–214. http://dx.doi.org/10.1177/1557988318784149.
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To promote HIV-testing and offer optimal care for men who have sex with men (MSM), health-care providers (HCPs) must first be aware of their patients’ sexual behaviors. Otherwise, HCPs may overlook MSM’s risks for HIV infection and their special health-care needs. For MSM, reporting their same-sex behaviors to HCPs (disclosure to HCPs) may promote their linkage to HIV prevention and treatment cascade and improve their health outcomes. No literature review has been conducted to examine the relationship between disclosure to HCPs and uptake of HIV-testing among MSM. The current study reviewed and synthesized findings from 29 empirical studies published in English by 2016. We summarized the rates of MSM’s disclosure to HCPs, investigated the association between disclosure and HIV-testing among MSM, identified potential facilitators and barriers for disclosure, and discussed the implications of our findings in research and clinical practices. The disclosure rates varied across subgroups and study settings, ranging from 16% to 90% with a median of 61%. Disclosure to HCPs was positively associated with uptake of HIV-testing. African American MSM were less likely to disclose to HCPs. MSM who lived in urban settings with higher education attainment and higher income were more likely to disclose. MSM tended to perceive younger or gay-friendly doctors as safer targets of disclosure. Clinics with LGBT-friendly signs were viewed as safer contexts for disclosure. Having previous communications about substance use, sex, and HIV with HCPs could also facilitate disclosure. The main reasons for nondisclosure included lack of probing from HCPs, concerns on confidentiality breach and stigma, and perceived irrelevance with services. Providing appropriate trainings for HCPs and creating gay-friendly clinical settings can be effective strategies to facilitate disclosures of same-sex behaviors among MSM and meet their specific medical needs. Interventions to promote disclosure should give priorities to MSM from the most marginalized subgroups (e.g., MSM in rural areas, MSM of ethnic minorities).
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Pingitore, David, Lonnie Snowden, Randy A. Sansone, and Michael Klinkman. "Persons with Depressive Symptoms and the Treatments They Receive: A Comparison of Primary Care Physicians and Psychiatrists." International Journal of Psychiatry in Medicine 31, no. 1 (March 2001): 41–60. http://dx.doi.org/10.2190/6bul-mwtq-0m18-30gl.
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Objective: To determine if demographic differences exist in patients with depressive symptoms as the principal reason for visits to primary care physicians (PCP) versus psychiatrists. To estimate the likelihood of these patients receiving a range of mental health services from each provider group. Methods: Review and analysis of all outpatient visits made by patients with depressive symptoms using the National Ambulatory Medical Care Surveys (NAMCS) conducted in 1995 and 1996. Results: A significantly greater proportion of visits by persons with depressive symptoms as the principal reason for visit were made to psychiatrists than to primary care physicians ( T = −3.56, p = .000). However, men, African-Americans, other Non-White persons, and persons aged 65 to 74 and 75 years and over were proportionately more likely to visit a PCP than a psychiatrist. Women, whites, and persons aged 45 to 64 were proportionately more likely to make a visit to a psychiatrist than to a PCP. The overall intensity of care delivered by PCPs for patients with depressive symptoms was significantly lower than that provided by psychiatrists ( t = −2.03, p = .02). Analysis of individual services also revealed significant differences in service provision. Conclusions: Demographic differences among the patient caseloads of these physician groups have implications for mental health service delivery because of known distinctions in prevalence rates, symptom presentation, and functionality among depressed patient subgroups.
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BLACK, B. S., P. V. RABINS, P. GERMAN, R. ROCA, M. McGUIRE, and L. J. BRANT. "Use of formal and informal sources of mental health care among older African-American public-housing residents." Psychological Medicine 28, no. 3 (May 1998): 519–30. http://dx.doi.org/10.1017/s0033291798006631.
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Background. Elderly residents of public housing have high rates of psychiatric disorders, but most of those in need of care do not use any mental health service. This study examines the use of formal and alternative informal sources of mental health care in a sample of elderly African-American public-housing residents.Method. Data from an epidemiological survey of six Baltimore public-housing developments for the elderly (weighted N=818) were analysed to examine the utilization of mental health services by older African-American residents. Logistic regression analyses were used to determine correlates of using formal and informal sources by those needing mental health care.Results. Thirty-five per cent of subjects needed mental health care. Less than half (47%) of those in need received any mental health care in the previous 6 months. Residents in need were more likely to use formal (38·5%) than informal sources (18·6%) for care. The strongest correlates of using formal providers were substance use disorder (OR=15·62), Medicare insurance (OR=10·31) and psychological distress (OR=10·27). The strongest correlates of using informal sources were perceiving little or no support from religious/spiritual beliefs (OR=21·65), cognitive disorder (OR=19·71) and having a confidant (OR=15·07).Conclusions. Contrary to elderly African-Americans in general, those in public housing rely more on formal than informal sources for mental health problems. Nevertheless, both sources fail to fill the gap between need and met need. Interventions to increase identification, referral and treatment of elderly public-housing residents in need should target general medical providers and clergy and include assertive outreach by mental health specialists.
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Cole, Allison M., Gina A. Keppel, Laura-Mae Baldwin, Ryan Gilles, John Holmes, Chardonnay Vance, Bill Kriesgman, et al. "Room for Improvement: Rates of Birth Cohort Hepatitis C Screening in Primary Care Practices—A WWAMI Region Practice and Research Network Study." Journal of Primary Care & Community Health 10 (January 2019): 215013271988429. http://dx.doi.org/10.1177/2150132719884298.
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Introduction: An estimated 2.4 million people in the United States live with hepatitis C. Though there are effective treatments for chronic hepatitis C, many infected individuals remain untreated because 40% to 50% of individuals with chronic hepatitis C are unaware of their hepatitis C status. In 2013, the United States Preventive Services Task Force (USPSTF) recommended that adults born between 1945 and 1965 should be offered one-time hepatitis C screening. The purpose of this study is to describe rates of birth cohort hepatitis C screening across primary care practices in the WWAMI region Practice and Research Network (WPRN). Methods: Cross-sectional observational study of adult patients born between 1945 and 1965 who also had a primary care visit at 1 of 9 participating health systems (22 primary care clinics) between July 31, 2013 and September 30, 2015. Data extracted from the electronic health record systems at each clinic were used to calculate the proportion of birth cohort eligible patients with evidence of hepatitis C screening as well as proportions of screened patients with positive hepatitis C screening test results. Results: Of the 32 139 eligible patients, only 10.9% had evidence of hepatitis C screening in the electronic health record data (range 1.2%-49.1% across organizations). Among the 4 WPRN sites that were able to report data by race and ethnicity, the rate of hepatitis C screening was higher among African Americans (39.9%) and American Indians/Alaska Natives (23.2%) compared with Caucasians (10.7%; P < .001). Discussion: Rates of birth cohort hepatitis C screening are low in primary care practices. Future research to develop and test interventions to increase rates of birth cohort hepatitis C screening in primary care settings are needed.
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Bantug, Elissa Thorner, Catherine Saiki, Jane Zorzi, Vered Stearns, and Antonio C. Wolff. "Piloting survivorship care planning with the metastatic breast cancer patient." Journal of Clinical Oncology 34, no. 26_suppl (October 9, 2016): 146. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.146.
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146 Background: Emotional distress and poor symptom management are highly prevalent among patients with metastatic breast cancer (MBC). A high disease burden can further negatively impact these patients’ quality of life. To address the evolving survivorship needs in their trajectory from initial diagnosis of advanced disease to end-of-life care, patients with MBC require prompt assessment, reevaluation, and specialized support services. Limited survivorship resources are devoted to this patient population and greater attention to their needs is warranted. Methods: To address the survivorship needs of patients with MBC Johns Hopkins, we developed a new initiative designated a “Living with Breast Cancer” appointment. During this dedicated clinic encounter, a palliative care nurse practitioner works with the patient and her caregiver to develop an individualized “survivorship care plan” that describes medical and psychosocial care, symptom management, nutrition counseling, goal setting, mind/body techniques, palliative care, legacy work, pain management, health screening recommendations, family support, community referrals, and care coordination with oncology providers, among others. Patients with stable MBC are referred to this service by our medical oncology team. Patients are then asked to complete an evaluation survey (either by email or over the phone) 4-6 weeks after the appointment. Results: Since the initiation of program in March 2016, we evaluated 8 patients (3 African-Americans; 3 Caucasian; 2 Asians); mean age is 54.1 years (range, 38-75). Most patients were approximately 1-year post diagnosis of MBC (range, 1-10 years). We are currently collecting and analyzing evaluation survey results. At the time of the meeting, further demographics and evaluation results through August 2016 will be reported. Conclusions: If successful, the Living with Breast Cancer initiative may allow for more patient-centered care of individuals with MBC and their families at Johns Hopkins. The creation of an infrastructure for care coordination, survivorship support services and education aims to promote individualized services within the metastatic setting and improve the quality of life for this population.
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Hamada, Yohhei, Haileyesus Getahun, Birkneh Tilahun Tadesse, and Nathan Ford. "HIV-associated tuberculosis." International Journal of STD & AIDS 32, no. 9 (February 20, 2021): 780–90. http://dx.doi.org/10.1177/0956462421992257.
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Tuberculosis (TB) remains a leading cause of morbidity and mortality among people living with HIV. HIV-associated TB disproportionally affects African countries, particularly vulnerable groups at risk for both TB and HIV. Currently available TB diagnostics perform poorly in people living with HIV; however, new diagnostics such as Xpert Ultra and lateral flow urine lipoarabinomannan assays can greatly facilitate diagnosis of TB in people living with HIV. TB preventive treatment has been underutilized despite its proven benefits independent of antiretroviral therapy (ART). Shorter regimens using rifapentine can support increased availability and scale-up. Mortality is high in people with HIV-associated TB, and timely initiation of ART is critical. Programs should provide decentralized and integrated TB and HIV care in settings with high burden of both diseases to improve access to services that diagnose TB and HIV as early as possible. The new prevention and diagnosis tools recently recommended by WHO offer an immense opportunity to advance our fight against HIV-associated TB. They should be made widely available and scaled up rapidly supported by adequate funding with robust monitoring of the uptake to advance global TB elimination.
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Nurutdinova, Diana, Shruti Ramachandran, Sukanya Kadam, Vince Mojica, Michael Mullen, and Matt Baney. "Linkage to HIV Outpatient Care Following an Inpatient Stay." Open Forum Infectious Diseases 4, suppl_1 (2017): S419. http://dx.doi.org/10.1093/ofid/ofx163.1050.
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Abstract Background Immediate linkage to outpatient HIV follow-up care after hospitalization is a crucial opportunity to review treatment plan and coordinate necessary and additional services. The purpose of this review is to evaluate potential gaps in transition from inpatient to outpatient care services in persons with HIV. Data from multiple electronic medical records and billing systems were used to assess the rate of follow-up care at HIV outpatient facilities within the Mount Sinai Health System (MSHS), among patients hospitalized in four of the largest hospitals within MSHS. Methods ICD-10 codes were utilized to capture all hospitalized patients in 2016 with a primary or secondary diagnosis of HIV and their discharge date, across various electronic systems used by MSHS hospitals. Additional visit data was pulled from the EMR used by the five HIV outpatient facilities in order to determine the linkage to care rate. Linkage to HIV care was defined as the proportion of patients who attended an appointment at one of five HIV outpatient clinics within MSHS, within 90 days of discharge. Results A total of 3,992 inpatient discharges were associated with the diagnosis of HIV at the Mount Sinai Health System in 2016. Among these, 2,760 (69%) were male and 1,970 (49%) were African Americans while 56% were in the range of 50–69 years. The average length of stay was 6.6 days (SE±0.6). Out of these discharges, 1020 (25%) were scheduled to be seen at the system’s HIV outpatient care facilities within the 90 day interval. Subsequently, 275 patients (27%) have kept their appointments. Conclusion The data suggests that a smaller proportion of the inpatient discharges is linked to care within the system in addition to low appointment compliance rate. Further efforts to optimize early linkage to care and retention may help to affect patient outcomes. Interventions focusing on chronic disease management may assist to further improve these rates. At the systems level, enhanced and increased discharge planning and coordination is required between inpatient units and outpatient clinics in addition to greater outreach by outpatient clinics immediately upon discharge. Disclosures All authors: No reported disclosures.
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Kershberg, Hilary B., Monica Alvarado, Jaime L. Natoli, Emily Parkhurst, Hui Zhou, and George E. Tiller. "Use of the electronic medical record (EMR) to identify women at increased risk for hereditary breast and ovarian cancer (HBOC)." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 236. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.236.
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236 Background: Diagnosis of breast cancer at a young age is an indication for genetic counseling and possible BRCA testing. However, not all women with this early diagnosis are referred for genetic counseling, especially if they do not have a family history of breast or ovarian cancer. Methods: The genetics department in Kaiser Permanente Southern California (KPSC) provides clinical genetic services in an integrated health care system serving over 3.6 million members. Using data from the KPSC tumor registry, the KPSC EMR system, and a departmental cancer test results database, we identified 454 women diagnosed with early breast cancer (<46 years) between September 2005 and September 2010 who had not received genetic counseling. We contacted these women with a letter and/or phone call offering a genetics consultation, and we offered BRCA testing to all those who came for counseling. Results: 142 women (31%) came in for genetic counseling, and 312 women (69%) declined, did not keep their appointment, or never responded. Hispanics were more likely to schedule and keep an appointment than Caucasians (OR=1.35, 95% CI, 0.79-2.31), although this was not statistically significant. Of those who came in for counseling, African Americans were significantly less likely to accept genetic testing than Caucasians (OR=0.31, 95% CI, 0.10-0.98).Of the 142 patients who were counseled, 122 (86%) accepted testing. We identified 6 patients (5%) who were positive for a deleterious BRCA mutation and 6 patients (5%) who had a variant of uncertain significance. Of the 6 women with deleterious mutations, only 1 had a first-degree relative with breast or ovarian cancer, and 4 had mutation probabilities <10%. Conclusions: This project demonstrates how an integrated care approach and EMR system provide an opportunity to identify and contact women who are at increased risk for inherited cancer susceptibility.
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Larkin, Gregory Luke, Cynthia A. Claassen, Andrea J. Pelletier, and Carlos A. Camargo. "National Study of Ambulance Transports to United States Emergency Departments: Importance of Mental Health Problems." Prehospital and Disaster Medicine 21, no. 2 (April 2006): 82–90. http://dx.doi.org/10.1017/s1049023x0000340x.
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AbstractIntroduction:Understanding ambulance utilization patterns is essential to assessing prehospital system capacity and preparedness at the national level.Objective:To describe the characteristics of patients transported to US emergency departments (EDs) by ambulance and to determine predictors of ambulance utilization.Methods:Data were obtained from the National Hospital Ambulatory Medical Care Survey using mode of arrival, demographic and visit information, ICD-9-CM E and V-codes, and classified reasons for the visit.Results:The rates for ED visits of persons conveyed by ambulence were stable between 1997 and 2003, consisting of approximately one in every seven ED visits (14%). In 2003, there were 16.2 million ED visits for which an ambulance was used in the US. However, for patients with mental health visits, nearly one in three ED presentations (31%) arrived by ambulance. Significantly higher rates of ambulance use were associated with: (1) mental health visits; (2) older age; (3) African-Americans; (4) Medicare or self-pay insurance status; (5) urban ED location; (6) US regions outside of the South; (7) presentation between 12 midnight to 0800 hours; (8) injury-related visits; (9) urgent visit status; and/or (10) those resulting in hospital admission. Among mental health patients, older age, self-pay insurance status, urban ED location, regions outside the southern US, and urgent visit classification predicted ambulance use. Ambulance usage within the mental health group was highest for suicide and lowest for mood and anxiety disorder-related visits.Conclusion:Reliance on ambulance services varies by age, insurance status, geographic factors, time of day, urgency of visit, subsequent admission status, and type of mental health disorder. Even after controlling for many confounding factors, mental health problems remain an important predictor of ambulance use.
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Oladeru, Oluwadamilola Temilade, Sung Jun Ma, Joseph Miccio, Katy Wang, Kristopher Attwood, Anurag K. Singh, Daphne A. Haas-Kogan, and Paula M. Neira. "Breast and cervical cancer screening disparities among transgender patients." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 7024. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.7024.
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7024 Background: Over a million Americans identify themselves as transgender and this population is growing. Transgender status was a pre-existing condition prior to the Affordable Care Act (ACA), and transgender individuals faced unique disparities in gender-specific cancer screening in part due to discrimination in health insurance coverage. Modern literature for transgender adults’ adherence to cancer screening is limited. To fill this knowledge gap, we conducted a cross sectional study to investigate transgender individuals’ self-reported adherence to cancer screening and access to primary care compared to cisgender individuals. Methods: The Behavioral Risk Factor Surveillance System database was queried for transgender (either male-to-female [MTF] or female-to-male [FTM]) and cisgender adults from 2014-2016 and 2018. Primary endpoints were adherence to breast and cervical cancer screening guidelines and access to primary health care. Those with prior hysterectomy, breast and cervical cancer were excluded. Multivariable logistic regression was performed to evaluate the association of transgender status with cancer screening and healthcare access, after adjusting for demographic characteristics and survey weights. Results: A total of 219,665 and 206,446 participants were eligible for breast and cervical cancer screening, respectively. Of those, 614 (0.28%) and 587 (0.29%) transgender participants were eligible for each cancer screening type, respectively, representing a weighted estimate of nearly 200,000 transgender participants total. When compared to cisgender counterparts, transgender participants were less likely to adhere to breast cancer screening (FTM: OR 0.47, p < 0.001; MTF: OR 0.04, p < 0.001) and to have received any breast cancer screening (FTM: OR 0.32, p < 0.001; MTF: OR 0.02, p < 0.001). Similarly, FTM participants were less likely to adhere to cervical cancer screening (OR 0.42, p < 0.001) and to have received any cervical cancer screening (OR 0.26, p < 0.001). In addition, transgender participants were more likely to have no primary care physician (FTM: OR 0.79, p < 0.001; MTF: OR 0.58, p < 0.001) and to be unable to see a physician when needed within the past year due to medical cost (FTM: OR 1.44, p < 0.001; MTF: OR 1.36, p < 0.001). Conclusions: Despite the implementation of the ACA, limited primary care access and poor adherence to breast and cervical cancer screening are evident for transgender populations. Further research efforts to improve the utilization of preventive cancer services are needed for this underserved population.
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Alcendor, Donald J. "Racial Disparities-Associated COVID-19 Mortality among Minority Populations in the US." Journal of Clinical Medicine 9, no. 8 (July 30, 2020): 2442. http://dx.doi.org/10.3390/jcm9082442.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a betacoronavirus that causes the novel coronavirus disease 2019 (COVID-19), is highly transmissible and pathogenic for humans and may cause life-threatening disease and mortality, especially in individuals with underlying comorbidities. First identified in an outbreak in Wuhan, China, COVID-19 is affecting more than 185 countries and territories around the world, with more than 15,754,651 confirmed cases and more than 640,029 deaths. Since December 2019, SARS-CoV-2 transmission has become a global threat, which includes confirmed cases in all 50 states within the United States (US). As of 25 July 2020, the Johns Hopkins Whiting School of Engineering Center for Systems Science and Engineering reports more than 4,112,651 cases and 145,546 deaths. To date, health disparities are associated with COVID-19 mortality among underserved populations. Here, the author explores potential underlying reasons for reported disproportionate, increased risks of mortality among African Americans and Hispanics/Latinos with COVID-19 compared with non-Hispanic Whites. The author examines the underlying clinical implications that may predispose minority populations and the adverse clinical outcomes that may contribute to increased risk of mortality. Government and community-based strategies to safeguard minority populations at risk for increased morbidity and mortality are essential. Underserved populations living in poverty with limited access to social services across the US are more likely to have underlying medical conditions and are among the most vulnerable. Societal and cultural barriers for ethnic minorities to achieve health equity are systemic issues that may be addressed only through shifts in governmental policies, producing long-overdue, substantive changes to end health care inequities.
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Muralidhar, Kiranmayee, Willy Marcos Valencia, Fei Tang, and Stuti Dang. "Social Determinants and Frailty in High-Need, High-Risk Veterans." Innovation in Aging 4, Supplement_1 (December 1, 2020): 179. http://dx.doi.org/10.1093/geroni/igaa057.578.
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Abstract The VA Geriatrics and Extended Care Data Analysis Center uses national predictive modelling to identify High-Need High-Risk (HNHR) Veterans, to provide targeted services and reduce hospitalization and institutionalization risk. To learn the needs of Miami VA HNHR Veterans, we mailed a needs-assessment survey to 2124 Veterans, of whom 634 responded (29.8% response rate). The average respondent age was 70.5±9.2. Among them, 127(20%) were <65 years old, 326(51.4%) were 65-74, and 179(28.2%) were ≥75; 389(61.4%) White, 225(35.5%) Black/African Americans; 515(81.2%) were Non-Hispanic, 111(17.5%) Hispanic/Latino; 173(27.3%) were high school graduates, 350(55.2%) had at least some college credit, 39(6.2%) had a master’s degree or more and 536(84.5%) were health literate. As per Morley’s FRAIL scale, 266(42%) were frail, 242(38.2%) were pre-frail and 87(13.7%) were robust. Social risk factors possibly associated with frailty were analyzed using ordinal logistic regression. Univariate analysis showed significant association with poor health literacy, having a caregiver, social isolation, transportation trouble, delayed or missed doctors’ appointments due to transportation, a negative perception of aging, likelihood of depression, being homebound, inability to use the internet, lack of technology for video conferencing and lack of email use (p≤0.01). Through multivariate ordinal logistic regression analysis, adjusting for patients’ age and Jen Frailty Index, we found that the same social risk factors other than internet use showed significant association with frailty (p≤0.01). HNHR Veterans have complex social needs with a limited ability to manage their chronic conditions, necessitating interventions that address not only their medical issues but also their access barriers and social support.
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Abu Rous, Fawzi, Sunny R. K. Singh, Pin Li, Mohamed Elgamal, Hussna Abunafeesa, Rebecca Chacko, Sowjanya Vuyyala, Yaser Alkhatib, and Philip Kuriakose. "Satisfaction of hem/onc patients with video visits during the COVID-19 pandemic at a tertiary care center in Michigan." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 185. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.185.
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185 Background: In early 2020, the WHO declared the COVID-19 pandemic a public health emergency. Consequently, medical institutions minimized health care services to facilitate social distancing and telemedicine became the forefront of patient-provider interaction. Herein, we present the results of our study that explored patient satisfaction with video visits during the pandemic at a tertiary care center. Methods: A 12-question survey (table) was emailed following a video visit with a Hem/Onc provider carried out between February and December 2020, questions were answered anonymously. The survey also collected patient demographics. The survey evaluated 5 aspects of telemedicine using a five-point graded scale. Results: A total of 1107 patients responded. Median age was 65 years (25-97) with 51.5% over 65, 64% were females and 36% males. Based on zip codes of primary residence and 2015-2019 US Census data, a significant proportion lived in inner-city Detroit, 77.3% were Caucasians, and 15.2% African Americans. Median household income was 66.8K (Michigan’s median is 57K). Regarding access: ease of scheduling appointments, ease of contacting the office and ability to schedule desired appointments, were respectively given positive responses (good, very good, or fair) by 97.61%, 97.32%, and 98.4%. Regarding CP: ability to explain problem, show concern for worries, include patients in decisions, and discussion of treatment plan, were respectively given positive responses by 99.09%, 99.26%, 98.9%, 99.35%. Regarding telemedicine technology: ease of talking to CP, quality of video, and audio connections, were respectively given positive responses by 94.27%, 90.77%, and 91.42%. For the overall visit assessment, 98.58% gave a positive response for the video staff performance. Regarding their comfort level to return to clinic: 78.75% were comfortable and 10.14% were not. Conclusions: Patients reported an overall high level of satisfaction with telemedicine. One area of improvement is the technological aspect. More than 50% were older than 65 years and a significant proportion lived in underserved areas which indicates that telemedicine is easily accessible. Moreover, around 80% were comfortable to return to clinic while 10% were not which highlights the importance of offering both telemedicine and in-person care.[Table: see text]
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Breault, Kaley N., Brittney H. Arakaki, Peminda K. Cabandugama, and Jordan M. Rowe. "Does a Supplement Cocktail a Day Keep the Doctor Away? An Unusual Case of Alcohol Induced Diabetes Mellitus: A Case Report and Review of Literature." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A379—A380. http://dx.doi.org/10.1210/jendso/bvab048.773.
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Abstract Background: Currently there are no evidence-based medical recommendations to support the use of supplements in type 1 diabetes mellitus (DM), although there is some data that supports glucose lowering in type 2 DM with supplements such as cinnamon. Additionally, there is no evidence regarding the use of supplements in insulin-dependent DM secondary to pancreatic dysfunction from alcohol use disorder. Despite lack of clear evidence, it is estimated that more than 65% of Americans with DM use at least one dietary supplement for perceived health benefits. (1)Clinical Case: A 58-year old male presented with insulin-dependent DM secondary to pancreatic dysfunction from alcohol use disorder. Initial labs were significant for a low C-peptide of 0.13 ng/mL (0.80–3.85 ng/mL), A1c -9.4%, and blood glucoses ranging from 160–300 mg/dL. Patient’s DM regimen consisted of glargine 40 units nightly and aspart 12 units three times a day with meals. On a subsequent visit two months later, the patient stated that he had begun taking numerous supplements in hopes that these would improve his overall medical status. Supplements included Blood Boost Formula, Ultra K2 with MK-7, Chromium Picolinate, Male Enhancement, Super C Immune Complex, Nugenix Total-T, Niacinamide, Omega Q Plus Max, Cortisol Hormone Balancer, and Vitamin D3. Simultaneously, the patient self-discontinued all his maintenance medications except for his aforementioned insulin regimen due to the fear of negatively impacting his pancreas. Unexpectedly, his blood glucoses improved to a range of 90–150 mg/dL after being on these supplements without increasing his insulin dose. Upon literature review, three ingredients showed the most evidence for the possible explanation for his improvement in glucose control: L-arginine, nettle extract, and biotin with chromium. Conclusion: Literature review of in vivo and randomized, placebo-controlled studies demonstrated mechanisms of action for L-arginine, nettle extract, and biotin with chromium that indicate their potential role in lowering blood glucoses and increasing C-peptide levels in insulin-dependent DM secondary to pancreatic dysfunction from alcohol use disorder. Further investigations include exploring long-term impact on pancreatic function, glucose control, and insulin resistance. Reference: (1) Garrow, D., Egede, L. Association Between Complementary and Alternative Medicine Use, Preventive Care Practices, and Use of Conventional Medical Services Among Adults with Diabetes. Diabetes Care 2006 Jan; 29(1): 15–19.
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Master, Samip, Connie Arnold, Terry Davis, and Richard Preston Mansour. "Education, Employment, Social Support and Insurance Coverage in Adult Patients with Sickle Cell Disease." Blood 128, no. 22 (December 2, 2016): 4864. http://dx.doi.org/10.1182/blood.v128.22.4864.4864.
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Abstract Introduction: The average life expectancy of patients with sickle cell disease (SCD) has increased from early 20s well over 50 now. With improving pediatric healthcare, nearly all SCD patients become chronically ill adults, however little is known about these adult patients. This pilot study assessed adult SCD patients' age, education, literacy, employment, marital status, social support, and insurance status. Methods: A convenience sample of 100 sickle cell patients 18 and older cared for at academic medical system hematology clinic were enrolled in the study. A research assistant administered a structured interview which included demographic questions (insurance, education, employment, social support, marital status and persons taking care of them at home). PROMIS (Patient-Reported outcomes measurement information system) surveys assessed depression, anxiety and pain.Literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM-SF) and cognitive ability, using the Callahan 6-Item Screener. Results: Patients ranged in age from 19 to 66 years (mean age - 33), 100% were African Americans, 52% females. Education was varied - over one third ( 37%) did not graduate from high school, 26% were high school graduates, 14% had some college, and 12% were college graduates. Literacy was extremely low. No patient read at or above a 9th grade level, 99% < 6th grade level and 1% 7th- 8th grade. Only 16% were employed; 45% were married; 31% lived alone and 63% live with family. Almost all patients (98%) had insurance - 61% had Medicaid, 25% Medicare and 12% private insurance. Mean score of 5.77 on Callahan cognitive screener indicating patients did not need to be screened further for cognitive ability. Conclusion: Adult SCD patients in our study had very low education, literacy and employment levels. Many patients had inadequate social support. Our findings indicate that despite the fact that almost all patients were insured and theoretically had access to care, they still needed literacy and culturally appropriate information and on- going support to be able to understand and use health information and services to make appropriate health decisions and properly care for themselves. Disclosures No relevant conflicts of interest to declare.
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Alvarez, Ofelia A., Sandra Echenique, Hector Rodriguez-Cortes, Thomas J. Harrington, E. Leila Jerome Clay, Vandy Black, Mary Murph, Christopher Wells, and Ifeyinwa (ify) Osunkwo. "Patient Perception on Health Care Delivery for Sickle Cell Disease and Opportunities for Quality Improvement." Blood 134, Supplement_1 (November 13, 2019): 5862. http://dx.doi.org/10.1182/blood-2019-123215.
Full textAbstract:
The Health Resources and Services (HRSA)-sponsored Sickle Cell Disease (SCD)Treatment Demonstration Regional Collaborative Program, EMBRACE SCD Florida has three aims: 1. To educate providers about SCD, 2. To assess patients' perception on health care and barriers encountered, and 3. To increase hydroxyurea (HU) treatment as disease-modifying therapy. We report the patients' perception on health care delivery as assessed by surveys of 65 patients at two SCD centers in South Florida. All participants signed the IRB-approved informed consent/assent and completed a 46-question survey. Surveys addressed patient demographics, HU use, pain experienced, facility utilization and confidence in SCD doctors and primary care providers (PCPs). Parents represented 62 % of the sample respondents. There were 37 female and 28 male patients, with a mean age of 14.8 years, median 12 years (range 1-45). Patients were self-identified as SS (N=42, 65%), SC (N=8), sickle-β+ thalassemia (N=5), sickle-β0 thalassemia (N=2), other (N=1), and 7 (11%) did not know their genotype. Most (55%) were African-Americans; 26% Haitians, 12% Black non-African-American or other, and 6% were White. Nine percent were Hispanic. Insurance coverage was identified as Medicaid (75%), Managed Care Organization (7%), Medicare (13%), and private insurance (5%). Of the 44 patients with SS and Sβ0, 84% (N=37) received medical advice to take HU from SCD provider. In addition, 12 patients (4 unknown type, 5 Sβ+ and 3 SC) were advised to take HU for a total of 49 or 75% of all patients surveyed. Seventy-eight percent (N=38) of those agreed to be treated, and 22% (N=11) declined HU. Eighty-four percent of those who agreed to be treated (N=32) reported taking HU as prescribed. Those patients who have received HU identified many barriers: lack of money to pay (N=5), nausea (N=5), hair loss (N=1), do not like the taste (N=8), do not like to take medications so they either do not take it frequently (N=7) or force themselves to take it (N=12), lack of effectiveness for their pain (N=10), and forgetting to take HU (N=18). Eighteen of 49 (37%) said they had no problems taking HU. We asked all patients about their pain experience. Of the 63 who responded, 30 (47.6%) said pain was managed well all the time, whereas the rest perceived difficulties in pain management: 20 (31.7%), 12 (19%), and one (1.6%) perceived their pain was managed well 75% of time, 50% of the time, and 25% or less of the time, respectively. The frequency of taking pain medications was variable among patients. The most common frequency of taking pain medications was several times a month (24 of 63 or 38%), but ranged from taking pain medication daily (N=9, 14%) to never or almost never (N=10, 16%). The emergency room (ER) was the first place they would go to when they get sick. One patient reported he prefers staying home. Patients reported a median of two ER visits (range 0-45) and two hospitalizations (range 0-30) in the previous 12 months. Almost all (92%) patients reported having a PCP. Sixty-seven percent visited the PCP 1-3 times per year, whereas 88% visited the SCD doctor 4-12 times per year. Whereas 68.3% patients trusted their PCP to manage their SCD, their level of trust with the SCD doctor was 95.2% (p <0.01). Similarly, 68% patients agreed that both the PCP and the SCD doctor should share responsibilities in their care. The table shows what participants considered most important for their PCP and their SCD doctor to know or learn about SCD. The most common single thing participants would change about the health care system was insurance/health care coverage (N=7), improved communication with providers (N=4), better care (N=2), or to have a cure for SCD (N=2). Six would not change anything. Eighty-four percent of patients did not know how to contact Sickle Cell Disease of America (SCDAA). Nine patients or parents (14%) felt discriminated against by health providers (N=3, doctors, nurses, pharmacy) and others (N=6, employers, classmates, others) as a result of their SCD. We identified five opportunities for quality improvement: 1. Improve pain control as 52.4% patients viewed their pain was sub-optimally managed, 2. Further examine and decrease barriers for HU treatment, 3. PCP education, as 31.7% of patients lacked trust in their competence, 4. Educate and encourage patient interaction with community-based organizations like SCDAA, and 5. Explore policy change in health care insurance coverage. Table Disclosures Alvarez: Forma Therapeutics: Consultancy; Novartis: Consultancy. Clay:Novartis: Speakers Bureau. Black:NHLBI: Research Funding; Micelle BioPharma: Research Funding; Pfizer: Research Funding; Sancilio and Company: Research Funding; Sanofi: Consultancy; Prolong Pharmaceuticals: Consultancy; Novartis: Research Funding; HRSA: Research Funding. Osunkwo:Novartis: Consultancy, Speakers Bureau; Pfizer: Consultancy; Terumo: Speakers Bureau; Micella Biopharma: Other: DSMB member.
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Beuran, M. "TRAUMA CARE: HIGHLY DEMANDING, TREMENDOUS BENEFITS." Journal of Surgical Sciences 2, no. 3 (July 1, 2015): 111–14. http://dx.doi.org/10.33695/jss.v2i3.117.
Full textAbstract:
From its beginning, mankind suffered injuries through falling, fire, drowning and human aggression [1]. Although the frequency and the kinetics modifiy over millennia, trauma continues to represent an important cause of morbidity and mortality even in the modern society [1]. Significant progresses in the trauma surgery were due to military conflicts, which next to social sufferance came with important steps in injuries’ management, further applied in civilian hospitals. The foundation of modern trauma systems was started by Dominique Jean Larrey (1766-1842) during the Napoleonic Rin military campaign from 1792. The wounded who remained on the battlefield till the end of the battle to receive medical care, usually more than 24 hours, from that moment were transported during the conflict with flying ambulances to mobile hospitals. Starting with the First World War, through the usage of antiseptics, blood transfusions, and fracture management, the mortality decreased from 39% in the Crimean War (1853–1856) to 10%. One of the most preeminent figures of the Second World War was Michael DeBakey, who created the Mobile Army Surgical Hospitals (MASH), concept very similar to the Larrey’s unit. In 1941, in England, Birmingham Accident Hospital was opened, specially designed for injured people, this being the first trauma center worldwide. During the Golf War (1990–1991) the MASH were used for the last time, being replaced by Forward Surgical Teams, very mobile units satisfying the necessities of the nowadays infantry [1].
Nowadays, trauma meets the pandemic criteria, everyday 16,000 people worldwide are dying, injuries representing one of the first five causes of mortality for all the age groups below 60 [2]. A recent 12-month analysis of trauma pattern in the Emergency Hospital of Bucharest revealed 141 patients, 72.3% males, with a mean age of 43.52 ± 19 years, and a mean New Injury Severity Score (NISS) of 27.58 ± 11.32 [3]. The etiology was traffic related in 101 (71.6%), falls in 28 (19.9%) and crushing in 7 (5%) cases. The overall mortality was as high as 30%, for patients with a mean NISS of 37.63 [3].
At the scene, early recognition of severe injuries and a high index of suspicion according to trauma kinetics may allow a correct triage of patients [4]. A functional trauma system should continuously evaluate the rate of over- and under-triage [5]. The over-triage represents the transfer to a very severe patient to a center without necessary resources, while under-triage means a low injured patient referred to a highly specialized center. If under-triage generates preventable deaths, the over-triage comes with a high financial and personal burden for the already overloaded tertiary centers [5]. To maximize the chance for survival, the major trauma patients should be transported as rapid as possible to a trauma center [6]. The initial resuscitation of trauma patients was divided into two time intervals: ten platinum minutes and golden hour [6]. During the ten platinum minutes the airways should be managed, the exsanguinating bleeding should be stopped, and the critical patients should be transported from the scene. During the golden hour all the life-threatening lesions should be addressed, but unfortunately many patients spend this time in the prehospital setting [6]. These time intervals came from Trunkey’s concept of trimodal distribution of mortality secondary to trauma, proposed in 1983 [7]. This trimodal distribution of mortality remains a milestone in the trauma education and research, and is still actual for development but inconsistent for efficient trauma systems [8].
The concept of patients’ management in the prehospital setting covered a continuous interval, with two extremities: stay and play/treat then transfer or scoop and run/ load and go. Stay and play, usually used in Europe, implies airways securing and endotracheal intubation, pleurostomy tube insertion, and intravenous lines with volemic replacement therapy. During scoop and run, used in the Unites States, the patient is immediately transported to a trauma center, addressing the immediate life-threating injuries during transportation.
In the emergency department of the corresponding trauma center, the resuscitation of the injured patients should be done by a trauma team, after an orchestrated protocol based on Advanced Trauma Life Support (ATLS). The modern trauma teams include five to ten specialists: general surgeons trained in trauma care, emergency medicine physicians, intensive care physicians, orthopedic surgeons, neurosurgeons, radiologists, interventional radiologists, and nurses. In the specially designed trauma centers, the leader of the trauma team should be the general surgeon, while in the lower level centers this role may be taken over by the emergency physicians.
The implementation of a trauma system is a very difficult task, and should be tailored to the needs of the local population. For example, in Europe the majority of injuries are by blunt trauma, while in the United States or South Africa they are secondary to penetrating injuries. In an effort to analyse at a national level the performance of trauma care, we have proposed a national registry of major trauma patients [9]. For this registry we have defined major trauma as a New Injury Severity Score higher than 15. The maintenance of such registry requires significant human and financial resources, while only a permanent audit may decrease the rate of preventable deaths in the Romanian trauma care (Figure 1) [10].
Figure 1 - The website of Romanian Major Trauma Registry (http://www.registrutraume.ro).
USA - In the United States of America there are 203 level I centers, 265 level II centers, 205 level III or II centers and only 32 level I or II pediatric centers, according to the 2014 report of National Trauma Databank [11]. USA were the first which recognized trauma as a public health problem, and proceeded to a national strategy for injury prevention, emergency medical care and trauma research. In 1966, the US National Academy of Sciences and the National Research Council noted that ‘’public apathy to the mounting toll from accidents must be transformed into an action program under strong leadership’’ [12]. Considerable national efforts were made in 1970s, when standards of trauma care were released and in 1990s when ‘’The model trauma care system plan’’[13] was generated. The American College of Surgeons introduced the concept of a national trauma registry in 1989. The National Trauma Databank became functional seven years later, in 2006 being registered over 1 million patients from 600 trauma centers [14].
Mortality from unintentional injury in the United States decreased from 55 to 37.7 per 100,000 population, in 1965 and 2004, respectively [15]. Due to this national efforts, 84.1% of all Americans have access within one hour from injury to a dedicated trauma care [16].
Canada - A survey from 2010 revealed that 32 trauma centers across Canada, 16 Level I and 16 Level II, provide definitive trauma care [18]. All these centers have provincial designation, and funding to serve as definitive or referral hospital. Only 18 (56%) centers were accredited by an external agency, such as the Trauma Association of Canada. The three busiest centers in Canada had between 798–1103 admissions with an Injury Severity Score over 12 in 2008 [18].
Australia - Australia is an island continent, the fifth largest country in the world, with over 23 million people distributed on this large area, a little less than the United States. With the majority of these citizens concentrated in large urban areas, access to the medical care for the minority of inhabitants distributed through the territory is quite difficult. The widespread citizens cannot be reached by helicopter, restricted to near-urban regions, but with the fixed wing aircraft of the Royal Flying Doctor Service, within two hours [13]. In urban centers, the trauma care is similar to the most developed countries, while for people sparse on large territories the trauma care is far from being managed in the ‘’golden hour’’, often extending to the ‘’Golden day’’ [19].
Germany - One of the most efficient European trauma system is in Germany. Created in 1975 on the basis of the Austrian trauma care, this system allowed an over 50% decreasing of mortality, despite the increased number of injuries. According to the 2014 annual report of the Trauma Register of German Trauma Society (DGU), there are 614 hospitals submitting data, with 34.878 patients registered in 2013 [20]. The total number of cases documented in the Trauma Register DGU is now 159.449, of which 93% were collected since 2002. In the 2014 report, from 26.444 patients with a mean age of 49.5% and a mean ISS of 16.9, the observed mortality was 10% [20].
The United Kingdom - In 1988, a report of the Royal College of Surgeons of England, analyzing major injuries concluded that one third of deaths were preventable [21]. In 2000, a joint report from the Royal College of Surgeons of England and of the British Orthopedic Association was very suggestive entitled "Better Care for the Severely Injured" [22]. Nowadays the Trauma Audit Research network (TARN) is an independent monitor of trauma care in England and Wales [23]. TARN collects data from hospitals for all major trauma patients, defined as those with a hospital stay longer than 72 hours, those who require intensive care, or in-hospital death. A recent analysis of TARN data, looking at the cost of major trauma patients revealed that the total cost of initial hospital inpatient care was £19.770 per patient, of which 62% was attributable to ventilation, intensive care and wards stays, 16% to surgery, and 12% to blood transfusions [24].
Global health care models
Countries where is applied
Functioning concept
Total healthcare costs from GDP
Bismarck model
Germany
Privatized insurance companies (approx. 180 nonprofit sickness funds). Half of the national trauma beds are publicly funded trauma centers; the remaining are non-profit and for-profit private centers.
11.1%
Beveridge model
United Kingdom
Insurance companies are non-existent. All hospitals are nationalized.
9.3%
National health insurance
Canada, Australia, Taiwan
Fusion of Bismarck and Beveridge models. Hospitals are privatized, but the insurance program is single and government-run.
11.2% for Canada
The out-of-pocket model
India, Pakistan, Cambodia
The poorest countries, with undeveloped health care payment systems. Patients are paying for more than 75% of medical costs.
3.9% for India
GDP – gross domestic product
Table 1 - Global health care models with major consequences on trauma care [17].
Traumas continue to be a major healthcare problem, and no less important than cancer and cardiovascular diseases, and access to dedicated and timely intervention maximizes the patients’ chance for survival and minimizes the long-term morbidities. We should remember that one size does not fit in all trauma care. The Romanian National Trauma Program should tailor its resources to the matched demands of the specific Romanian urban and rural areas.
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Ongtengco, Ana, Kevin Roy, Liang Zhang, and Jessie Chin. "An Explorative Longitudinal Study on the Five-Year Patient Portal Use among an Underserved Patient Population." Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 8, no. 1 (September 2019): 146. http://dx.doi.org/10.1177/2327857919081035.
Full textAbstract:
The purpose of the study was to identify and assess multiple aspects of patient portal usage behavior in an underserved urban patient population. Given the rise of patient-centered care, patients are required to take active roles to gather health information, make informed health decisions and manage their own healthcare, which behavior were associated with health outcome (Barry & Edgman-Levitan, 2012; Oates, Weston & Jordan, 2000). Patient portals serve as a mean to coordinate patient-centered care by delivering health information to patients (e.g. medical test results), exchanging information with healthcare providers (e.g., messaging providers), and facilitating the delivery of health care services (e.g., scheduling appointments). However, studies often showed that patients in underserved communities did not take full advantages of the patient portals (e.g,. Cazaja et al., 2015, Wallace et al., 2016). These disparities in patient portal usages were associated with many factors, including the complexities of the American healthcare system, lack of internet access, lack of support to navigate through the health systems, and the lack of health literacy among an underserved adult population. To better understand the current use of patient portal of an underserved patient population, we conducted an explorative analysis of portal usage at the University of Illinois Hospitals and Health Sciences System (UIHealth). UIHealth serves throughout the city of Chicago, including areas with high racial segregation (minority population higher than 75%), where patients’ household income is lower than the median of Chicago residents. The majority of patient populations in UIHealth are African Americans (61%) followed by Hispanic/Latino (17%) and White (17%). The study was conducted using a retrospective analysis of Google Analytics portal data from March 2015 to March 2019. User behavior data were extracted to show aspects of usage, including most popular portal functions, language used, time spent on each page, and returning user visits, etc. We used weekly summary data as individual data points (208 data points in total) in the analysis. We found that, over four years, both retuning and new users increased by more than 50%. Regarding the number of users per week, there were local drops in the overall growth which drops were associated with fewer visits to UIHealth during holidays or cold weather. Hence, portal visits were associated with clinic visits. With regards to the most popular functions, writing messages to healthcare providers and viewing medical test results were the most used functions over the years. Results suggested that patients would utilize portal to gather information about their health status (for later discussion with physicians or making informed decisions) and communicate with healthcare providers. Interestingly, we found the dominant devices used to access the portal have shifted from desktop computers (2015-2017) to mobile phones (2017-2019), suggesting the increasing need to present health information in bitable size in smaller screens; and the increasing smartphone adoptions of underserved adults as an alternative solution to get internet access. Overall, improving the accessibility of patient portals remains to be a major issue for empowering patients in contemporary value-based healthcare systems. The explorative study has shed lights on the longitudinal trends of portal usage among an underserved population, which creates practical implications on the design of a more efficient interface between patients and their healthcare providers with the ultimate goal to improve health equity.
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Allgulander, Christer, Orlando Alonso Betancourt, David Blackbeard, Helen Clark, Franco Colin, Sarah Cooper, Robin Emsley, et al. "16th National Congress of the South African Society of Psychiatrists (SASOP)." South African Journal of Psychiatry 16, no. 3 (October 1, 2010): 29. http://dx.doi.org/10.4102/sajpsychiatry.v16i3.273.
Full textAbstract:
<p><strong>List of abstracts and authors:</strong></p><p><strong>1. Antipsychotics in anxiety disorders</strong></p><p>Christer Allgulander</p><p><strong>2. Anxiety in somatic disorders</strong></p><p>Christer Allgulander</p><p><strong>3. Community rehabilitation of the schizophrenic patient</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera</p><p><strong>4. Dual diagnosis: A theory-driven multidisciplinary approach for integrative care</strong></p><p>David Blackbeard</p><p><strong>5. The emotional language of the gut - when 'psyche' meets 'soma'</strong></p><p>Helen Clark</p><p><strong>6. The Psychotherapy of bipolar disorder</strong></p><p>Franco Colin</p><p><strong>7. The Psychotherapy of bipolar disorder</strong></p><p>Franco Colin</p><p><strong>8. Developing and adopting mental health policies and plans in Africa: Lessons from South Africa, Uganda and Zambia</strong></p><p>Sara Cooper, Sharon Kleintjes, Cynthia Isaacs, Fred Kigozi, Sheila Ndyanabangi, Augustus Kapungwe, John Mayeya, Michelle Funk, Natalie Drew, Crick Lund</p><p><strong>9. The importance of relapse prevention in schizophrenia</strong></p><p>Robin Emsley</p><p><strong>10. Mental Health care act: Fact or fiction?</strong></p><p>Helmut Erlacher, M Nagdee</p><p><strong>11. Does a dedicated 72-hour observation facility in a district hospital reduce the need for involuntary admissions to a psychiatric hospital?</strong></p><p>Lennart Eriksson</p><p><strong>12. The incidence and risk factors for dementia in the Ibadan study of ageing</strong></p><p>Oye Gureje, Lola Kola, Adesola Ogunniyi, Taiwo Abiona</p><p><strong>13. Is depression a disease of inflammation?</strong></p><p><strong></strong>Angelos Halaris</p><p><strong>14. Paediatric bipolar disorder: More heat than light?</strong></p><p>Sue Hawkridge</p><p><strong>15. EBM: Anova Conundrum</strong></p><p>Elizabeth L (Hoepie) Howell</p><p><strong>16. Tracking the legal status of a cohort of inpatients on discharge from a 72-hour assessment unit</strong></p><p>Bernard Janse van Rensburg</p><p><strong>17. Dual diagnosis units in psychiatric facilities: Opportunities and challenges</strong></p><p>Yasmien Jeenah</p><p><strong>18. Alcohol-induced psychotic disorder: A comparative study on the clinical characteristics of patients with alcohol dependence and schizophrenia</strong></p><p>Gerhard Jordaan, D G Nel, R Hewlett, R Emsley</p><p><strong>19. Anxiety disorders: the first evidence for a role in preventive psychiatry</strong></p><p>Andre F Joubert</p><p><strong>20. The end of risk assessment and the beginning of start</strong></p><p>Sean Kaliski</p><p><strong>21. Psychiatric disorders abd psychosocial correlates of high HIV risk sexual behaviour in war-effected Eatern Uganda</strong></p><p>E Kinyada, H A Weiss, M Mungherera, P Onyango Mangen, E Ngabirano, R Kajungu, J Kagugube, W Muhwezi, J Muron, V Patel</p><p><strong>22. One year of Forensic Psychiatric assessment in the Northern Cape: A comparison with an established assessment service in the Eastern Cape</strong></p><p>N K Kirimi, C Visser</p><p><strong>23. Mental Health service user priorities for service delivery in South Africa</strong></p><p>Sharon Kleintjes, Crick Lund, Leslie Swartz, Alan Flisher and MHaPP Research Programme Consortium</p><p><strong>24. The nature and extent of over-the-counter and prescription drug abuse in cape town</strong></p><p>Liezl Kramer</p><p><strong>25. Physical health issues in long-term psychiatric inpatients: An audit of nursing statistics and clinical files at Weskoppies Hospital</strong></p><p>Christa Kruger</p><p><strong>26. Suicide risk in Schizophrenia - 20 Years later, a cohort study</strong></p><p>Gian Lippi, Ean Smit, Joyce Jordaan, Louw Roos</p><p><strong>27.Developing mental health information systems in South Africa: Lessons from pilot projects in Northern Cape and KwaZulu-Natal</strong></p><p>Crick Lund, S Skeen, N Mapena, C Isaacs, T Mirozev and the Mental Health and Poverty Research Programme Consortium Institution</p><p><strong>28. Mental health aspects of South African emigration</strong></p><p>Maria Marchetti-Mercer</p><p><strong>29. What services SADAG can offer your patients</strong></p><p>Elizabeth Matare</p><p><strong>30. Culture and language in psychiatry</strong></p><p>Dan Mkize</p><p><strong>31. Latest psychotic episode</strong></p><p>Povl Munk-Jorgensen</p><p><strong>32. The Forensic profile of female offenders</strong></p><p>Mo Nagdee, Helmut Fletcher</p><p><strong>33. The intra-personal emotional impact of practising psychiatry</strong></p><p>Margaret Nair</p><p><strong>34. Highly sensitive persons (HSPs) and implications for treatment</strong></p><p>Margaret Nair</p><p><strong>35. Task shifting in mental health - The Kenyan experience</strong></p><p>David M Ndetei</p><p><strong>36. Bridging the gap between traditional healers and mental health in todya's modern psychiatry</strong></p><p>David M Ndetei</p><p><strong>37. Integrating to achieve modern psychiatry</strong></p><p>David M Ndetei</p><p><strong>38. Non-medical prescribing: Outcomes from a pharmacist-led post-traumatic stress disorder clinic</strong></p><p>A Parkinson</p><p><strong>39. Is there a causal relationship between alcohol and HIV? Implications for policy, practice and future research</strong></p><p>Charles Parry</p><p><strong>40. Global mental health - A new global health discipline comes of age</strong></p><p>Vikram Patel</p><p><strong>41. Integrating mental health into primary health care: Lessons from pilot District demonstration sites in Uganda and South Africa</strong></p><p>Inge Petersen, Arvin Bhana, K Baillie and MhaPP Research Programme Consortium</p><p><strong>42. Personality disorders -The orphan child in axis I - Axis II Dichotomy</strong></p><p><strong></strong>Willie Pienaar</p><p><strong>43. Case Studies in Psychiatric Ethics</strong></p><p>Willie Pienaar</p><p><strong>44. Coronary artery disease and depression: Insights into pathogenesis and clinical implications</strong></p><p>Janus Pretorius</p><p><strong>45. Impact of the Mental Health Care Act No. 17 of 2002 on designated hospitals in KwaZulu-Natal: Triumphs and trials</strong></p><p>Suvira Ramlall, Jennifer Chipps</p><p><strong>46. Biological basis of addication</strong></p><p>Solomon Rataemane</p><p><strong>47. Genetics of Schizophrenia</strong></p><p>Louw Roos</p><p><strong>48. Management of delirium - Recent advances</strong></p><p>Shaquir Salduker</p><p><strong>49. Social neuroscience: Brain research on social issues</strong></p><p>Manfred Spitzer</p><p><strong>50. Experiments on the unconscious</strong></p><p>Manfred Spitzer</p><p><strong>51. The Psychology and neuroscience of music</strong></p><p>Manfred Spitzer</p><p><strong>52. Mental disorders in DSM-V</strong></p><p>Dan Stein</p><p><strong>53. Personality, trauma exposure, PTSD and depression in a cohort of SA Metro policemen: A longitudinal study</strong></p><p>Ugashvaree Subramaney</p><p><strong>54. Eating disorders: An African perspective</strong></p><p>Christopher Szabo</p><p><strong>55. An evaluation of the WHO African Regional strategy for mental health 2001-2010</strong></p><p>Thandi van Heyningen, M Majavu, C Lund</p><p><strong>56. A unitary model for the motor origin of bipolar mood disorders and schizophrenia</strong></p><p>Jacques J M van Hoof</p><p><strong>57. The origin of mentalisation and the treatment of personality disorders</strong></p><p>Jacques J M Hoof</p><p><strong>58. How to account practically for 'The Cause' in psychiatric diagnostic classification</strong></p><p>C W (Werdie) van Staden</p><p><strong>POSTER PRESENTATIONS</strong></p><p><strong>59. Problem drinking and physical and sexual abuse at WSU Faculty of Health Sciences, Mthatha, 2009</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera, E, N Kwizera, J L Bernal Munoz</p><p><strong>60. Prevalence of alcohol drinking problems and other substances at WSU Faculty of Health Sciences, Mthatha, 2009</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera, E, N Kwizera, J L Bernal Munoz</p><p><strong>61. Lessons learnt from a modified assertive community-based treatment programme in a developing country</strong></p><p>Ulla Botha, Liezl Koen, John Joska, Linda Hering, Piet Ooosthuizen</p><p><strong>62. Perceptions of psychologists regarding the use of religion and spirituality in therapy</strong></p><p>Ottilia Brown, Diane Elkonin</p><p><strong>63. Resilience in families where a member is living with schizophreni</strong></p><p>Ottilia Brown, Jason Haddad, Greg Howcroft</p><p><strong>64. Fusion and grandiosity - The mastersonian approach to the narcissistic disorder of the self</strong></p><p>William Griffiths, D Macklin, Loray Daws</p><p><strong>65. Not being allowed to exist - The mastersonian approach to the Schizoid disorder of the self</strong></p><p>William Griffiths, D Macklin, Loray Daws</p><p><strong>66. Risky drug-injecting behaviours in Cape Town and the need for a needle exchange programme</strong></p><p>Volker Hitzeroth</p><p><strong>67. Neuroleptic malignant syndrome in adolescents in the Western Cape: A case series</strong></p><p>Terri Henderson</p><p><strong>68. Experience and view of local academic psychiatrists on the role of spirituality in South African specialist psychiatry, compared with a qualitative analysis of the medical literature</strong></p><p>Bernard Janse van Rensburg</p><p><strong>69. The role of defined spirituality in local specialist psychiatric practice and training: A model and operational guidelines for South African clinical care scenarios</strong></p><p>Bernard Janse van Rensburg</p><p><strong>70. Handedness in schizophrenia and schizoaffective disorder in an Afrikaner founder population</strong></p><p>Marinda Joubert, J L Roos, J Jordaan</p><p><strong>71. A role for structural equation modelling in subtyping schizophrenia in an African population</strong></p><p>Liezl Koen, Dana Niehaus, Esme Jordaan, Robin Emsley</p><p><strong>72. Caregivers of disabled elderly persons in Nigeria</strong></p><p>Lola Kola, Oye Gureje, Adesola Ogunniyi, Dapo Olley</p><p><strong>73. HIV Seropositivity in recently admitted and long-term psychiatric inpatients: Prevalence and diagnostic profile</strong></p><p>Christina Kruger, M P Henning, L Fletcher</p><p><strong>74. Syphilis seropisitivity in recently admitted longterm psychiatry inpatients: Prevalence and diagnostic profile</strong></p><p>Christina Kruger, M P Henning, L Fletcher</p><p><strong>75. 'The Great Suppression'</strong></p><p>Sarah Lamont, Joel Shapiro, Thandi Groves, Lindsey Bowes</p><p><strong>76. Not being allowed to grow up - The Mastersonian approach to the borderline personality</strong></p><p>Daleen Macklin, W Griffiths</p><p><strong>77. Exploring the internal confirguration of the cycloid personality: A Rorschach comprehensive system study</strong></p><p>Daleen Macklin, Loray Daws, M Aronstam</p><p><strong>78. A survey to determine the level of HIV related knowledge among adult psychiatric patients admitted to Weskoppies Hospital</strong></p><p><strong></strong> T G Magagula, M M Mamabolo, C Kruger, L Fletcher</p><p><strong>79. A survey of risk behaviour for contracting HIV among adult psychiatric patients admitted to Weskoppies Hospital</strong></p><p>M M Mamabolo, T G Magagula, C Kruger, L Fletcher</p><p><strong>80. A retrospective review of state sector outpatients (Tara Hospital) prescribed Olanzapine: Adherence to metabolic and cardiovascular screening and monitoring guidelines</strong></p><p>Carina Marsay, C P Szabo</p><p><strong>81. Reported rapes at a hospital rape centre: Demographic and clinical profiles</strong></p><p>Lindi Martin, Kees Lammers, Donavan Andrews, Soraya Seedat</p><p><strong>82. Exit examination in Final-Year medical students: Measurement validity of oral examinations in psychiatry</strong></p><p>Mpogisheng Mashile, D J H Niehaus, L Koen, E Jordaan</p><p><strong>83. Trends of suicide in the Transkei region of South Africa</strong></p><p>Banwari Meel</p><p><strong>84. Functional neuro-imaging in survivors of torture</strong></p><p>Thriya Ramasar, U Subramaney, M D T H W Vangu, N S Perumal</p><p><strong>85. Newly diagnosed HIV+ in South Africa: Do men and women enroll in care?</strong></p><p>Dinesh Singh, S Hoffman, E A Kelvin, K Blanchard, N Lince, J E Mantell, G Ramjee, T M Exner</p><p><strong>86. Diagnostic utitlity of the International HIC Dementia scale for Asymptomatic HIV-Associated neurocognitive impairment and HIV-Associated neurocognitive disorder in South Africa</strong></p><p>Dinesh Singh, K Goodkin, D J Hardy, E Lopez, G Morales</p><p><strong>87. The Psychological sequelae of first trimester termination of pregnancy (TOP): The impact of resilience</strong></p><p>Ugashvaree Subramaney</p><p><strong>88. Drugs and other therapies under investigation for PTSD: An international database</strong></p><p>Sharain Suliman, Soraya Seedat</p><p><strong>89. Frequency and correlates of HIV Testing in patients with severe mental illness</strong></p><p>Hendrik Temmingh, Leanne Parasram, John Joska, Tania Timmermans, Pete Milligan, Helen van der Plas, Henk Temmingh</p><p><strong>90. A proposed mental health service and personnel organogram for the Elizabeth Donkin psychiatric Hospital</strong></p><p>Stephan van Wyk, Zukiswa Zingela</p><p><strong>91. A brief report on the current state of mental health care services in the Eastern Cape</strong></p><p>Stephan van Wyk, Zukiswa Zingela, Kiran Sukeri, Heloise Uys, Mo Nagdee, Maricela Morales, Helmut Erlacher, Orlando Alonso</p><p><strong>92. An integrated mental health care service model for the Nelson Mandela Bay Metro</strong></p><p>Stephan van Wyk, Zukiswa Zingela, Kiran Sukeri</p><p><strong>93. Traditional and alternative healers: Prevalence of use in psychiatric patients</strong></p><p>Zukiswa Zingela, S van Wyk, W Esterhuysen, E Carr, L Gaauche</p>
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Singh, Rahul, Ryan Jordan, and Charin Hanlon. "Economic Impact of Sickle Cell Hospitalization." Blood 124, no. 21 (December 6, 2014): 5971. http://dx.doi.org/10.1182/blood.v124.21.5971.5971.
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Abstract Introduction: Sickle Cell Disease (SCD), which afflicts 100,000 Americans, is the most common inherited blood disorder in the US. In 2004, there were about 113,000 hospitalizations for sickle cell related illnesses in the United States, 75% occurring in adults. Estimated annual cost of hospitalization that year was $488 million. Many large academic health care centers have organized sickle management clinics, a service often not available to community hospitals. We describe the economic impact of sickle cell inpatient management in a large community hospital. Methods: With IRB approval, a retrospective study of the cost of sickle cell crisis readmissions at New Hanover Regional Medical Center in Wilmington, NC was conducted, a 628 bed community hospital in Southeast North Carolina. Individuals identified were patients who had a diagnosis of sickle cell disease and had at least one disease related inpatient admission during a five year study time frame. Data collected pertained to patient demographics, economic impact as well as admission characteristics. Summary statistics were calculated and reported in means, standard deviations, counts and frequencies. The data was analyzed using SAS 9.1. Results: Within the study time frame, 88 patients, including 433 admissions were analyzed. Only 37 patients (168 admissions) had admissions related to their sickle cell disease. Patients were shown to be 97.3% African American, 56.8% female, 40.5% having Medicaid, and 54.1% with Medicare. Seventeen patients (45.9%) accounted for 131 readmissions (78.0% of total admissions). On average, each admission lasted 5.1 days [SD 3.7] and cost per (patient or per admission) patient was $7,637.95 [SD 5334.26]. In five years, patients spent 863 days in the hospital with a total cost of $1,283,176.83. Discussion: As healthcare costs continue to be scrutinized, a more conscious effort will need to be placed on delivering high quality cost-effective care to our sickle cell population. From this analysis, there is a clear economic burden of sickle cell related hospitalizations to community hospitals. It is also clear that there is a small subset of patients who consume a large percentage of the resources. This may lend itself well to focused collaborative care management services of these high consumers of healthcare resources. The inpatient management of sickle cell vaso-occlusive crisis is well known, but the goal of treatment extends beyond that of just inpatient management. Patients with SCD need effective management in the outpatient setting in hopes to prevent readmissions, reduce hospital length of stays, and ultimately decrease the economic burden to our healthcare system. Given the significant economic burden to the community hospital, we plan to initiate a focused ambulatory quality improvement project. We plan to track the economic cost of providing intensive outpatient management, balanced against this historical cost information. We will systematically study the ability of a community hospital to impact the natural history of this devastating disease. Disclosures No relevant conflicts of interest to declare.
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Guddati, Achuta Kumar, and Takefumi Komiya. "Analysis of outcomes and disposition in hospitalized patients with head and neck cancer over 15 years." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18021-e18021. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18021.
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e18021 Background: The care of hospitalized head and neck cancer patients often involves a multidisciplinary approach. The trends, outcomes and disposition in hospitalized patients with head and neck cancer in United States for the past two decades has not been well characterized. This retrospective study involves analysis of the demographics, outcomes and disposition of these patients and their trend over 15 years. The presence of medical comorbidities and the relationship to inpatient mortality was also studied. Methods: Hospitalization data from the National Inpatient Sample database was analyzed for the years: 2000 to 2014. Patients with head and neck cancer were identified using ICD-9 codes. Demographic features such as age, gender, race, geographical location, hospital size, hospital location, insurance etc. were analyzed. The trend of mortality was analyzed for the study period of 15 years. A sub-analysis of associated comorbidities was also performed in patients who have died during hospitalization. Univariate analysis was initially performed followed by multivariate analysis and logistic regression to identify risk factors associated with mortality. Results: An estimated 145,262 hospitalizations involving patients with head and neck cancer from 2000 to 2014 were studied and it showed a gradual yearly increment in hospitalization. 41% of the hospitalizations were in the 50-64 years age group. There was a 2:1 male preponderance. Caucasians constituted 60% followed by African Americans at 10%. A majority of the hospitalizations occurred in large sized hospitals and urban teaching hospitals. The mean length of stay was 6.4 days but 38% of the hospitalizations involving 2-5 days of stay. The inpatient mortality rate was 4.6% and it down trended over the past 15 years with statistical significance (p < 0.05). Inpatient mortality was highest in the > 80 years age group. Of note, inpatient mortality was equal between both the genders. Mortality was highest in the groups with a length of stay below 2 days and above 11 days. 58% of the discharges did not need any special services while 21% of the discharges involved home health care. The most common comorbidities were smoking and hypertension while < 1% of morbid obesity was observed. Multivariate analysis showed malnutrition, ESRD, cirrhosis, stroke and CHF were significant risk factors (ORs: 1.6, 1.94, 2.18, 2.2 and 1.78 respectively). Conclusions: Mortality in hospitalized patients with head and neck cancer has improved over the past 15 years. Inpatient mortality was high in the very elderly and in female patients (compared to the male preponderance upon admission). Malnutrition, cardiac/liver/renal dysfunction and stroke were significant risk factors for inpatient mortality. Strategies to mitigate inpatient mortality in these patients need to factor the above risk factors during their in-hospital management.
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Li, Yuanying, Hiroshi Yatsuya, Yoshihisa Hirakawa, Atsuhiko Ota, Masaaki Matsunaga, Hilawe Esayas Haregot, Chifa Chiang, et al. "Abstract P060: A Point-based Prediction Model for Predicting 10-year Risk of Developing Type 2 Diabetes Mellitus in Japanese Men: Aichi Workers’ Cohort Study." Circulation 135, suppl_1 (March 7, 2017). http://dx.doi.org/10.1161/circ.135.suppl_1.p060.
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Objective: Preventive services including screening for diabetes and its potential risk factorsare available to more Americans under Obamacare Preventive Care. Stratifying individuals by the predicted risk of developing type 2 diabetes mellitus (T2DM) would be useful for improving public health with efficient interventions. Although a number of T2DM prediction models have been reported, there is little evidence in East Asians, especially that from long-term follow-up studies. They are reported to have lower ability of innate insulin secretion and develop diabetes at much lower body mass index (BMI) than Caucasians and African Americans. Thus, this study aims to develop a point-based prediction model for 10-year risk of developing T2DM incidence in middle-aged Japanese men. Method: We followed 3,540 males in a worksite in Japan who were aged 35-64 years and free of diabetes in 2002 until March 31, 2015. Relationships of baseline age (continuous), BMI (<23, 23- <25 [reference category (Ref)], 25- <27.5, ≥27.5 kg/m 2 ), current smoking status (yes, no [Ref]), alcohol consumption(0 [Ref], <23, 23- <46, ≥46 g/day), regular exercise of a moderate or higher intensity, an interval of ≥3 days per week, and a duration of ≥30 minutes per time (yes [Ref], no), medication use for dyslipidemia (yes, no [Ref]), family history of diabetes (having the first degree’s relatives with diabetes, not having [Ref]), serum triglycerides (<150 [Ref], ≥150 mg/dl), high density lipoprotein cholesterol(≥40 [Ref], <40 mg/dl), and fasting blood glucose (<100 [Ref], 100- <110, 110- <126 mg/dl) with incidence of T2DM were examined by Cox proportional hazard model. Variables significantly associated with T2DM (p<0.10) in the univariate models were simultaneously entered into a multivariate model, and backward variable selection procedure was done to determine the final multivariate model. Points were assigned for each predictor according to the method used in the Framingham Study. Result: During the median follow-up of 12.2 years, 342 males developed T2DM. The point-based model employing BMI, current smoking status, family history of diabetes, and blood levels of triglycerides and fasting blood glucose showed reasonable discrimination (c-statistics: 0.73) and goodness of fit (Hosmer-Lemeshow p=0.22). Conclusion: Our point-based prediction model showed applicability in terms of identifying middle-aged Japanese men at high risk of developing T2DM. The present findings warrants further investigations to determine whether using the point-based prediction models is effective to reduce T2DM incidence.
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Dismuke-Greer, CE, SM Fakhry, MD Horner, TK Pogoda, MJ Pugh, M. Gebregziabher, CL Hall, D. Taber, and DA Spain. "Ethnicity/race and service-connected disability disparities in civilian traumatic brain injury mechanism of injury and VHA health services costs in military veterans: Evidence from a Level 1 Trauma Center and VA Medical Center." Trauma, April 6, 2020, 146040862091443. http://dx.doi.org/10.1177/1460408620914436.
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Introduction The objective of this study was to examine the association of military veteran socio-demographics and service-connected disability with civilian mechanism of traumatic brain injury and long-term Veterans Health Administration (VHA) costs. Methods We conducted a 17-year retrospective longitudinal cohort study of veterans with a civilian-related traumatic brain injury from a Level 1 Trauma Center between 1999 and 2013, with VHA follow-up through 2016. We merged trauma center VHA data, and used logit to model mechanism of injury, and generalized linear model to model VHA costs. Results African American race or Hispanic ethnicity veterans had a higher unadjusted rate of civilian assault/gun as mechanism of injury (15.38%) relative to non-Hispanic White (7.19%). African American race or Hispanic veterans who were discharged from the trauma center with traumatic brain injury and followed in VHA had more than twice the odds of assault/gun (OR 2.47; 95% CI 1.16:5.26), after adjusting for sex, age, and military service-connected disability. Veterans with service-connected disability ≥50% had more than twice the odds of assault/gun (OR 2.48; 95% CI 0.97:6.31). Assault/gun was associated with significantly higher annual VHA costs post-discharge ($16,807; 95% CI 672:32,941) among non-Hispanic White veterans. Military service-connected disability ≥50% was associated with higher VHA costs among both non-Hispanic White ($44,987; 95% CI $17,159:$72,816) and African American race or Hispanic ($37,901; 95% CI $4,543:$71,258) veterans. Conclusions We found that African American race or Hispanic veterans had higher adjusted likelihood of assault/gun mechanism of traumatic brain injury, and non-Hispanic White veterans had higher adjusted annual VHA resource costs associated with assault/gun, post trauma center discharge. Veterans with higher than 50% service-connected disability had higher likelihood of assault/gun and higher adjusted annual VHA resource costs. Assault/gun prevention efforts may be indicated within the VHA, especially in minority and service-connected disability veterans. More data from Level 1 Trauma Centers are needed to assess the generalizability of these findings.
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Yanushevsky, Rafael. "What is Behind the High Dental Costs in the U.S." Open Access Journal of Dental Sciences 6, no. 3 (2021). http://dx.doi.org/10.23880/oajds-16000306.
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Healthcare is among the most important issues for Americans since the U.S. health care system is the most expensive in the world. Analyzing the U.S. rising cost of health care in the 21 century it is impossible not to see that the increase of dental prices exceeds significantly the growth of prices for many other medical services. Regular preventive dental care is essential for good oral health, but many persons don’t get the care they need. More people are unable to afford dental care than other types of health care. Such situation with dental health is inadmissible.
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Vant Hof, Jeremy R., Jeffrey Misialek, Niki C. Oldenburg, Russell V. Luepker, Milton Eder, and Sue Duval. "Abstract 17306: Primary Prevention Aspirin Use Trends and Associations With Health Beliefs Among African Americans, 2015-2019." Circulation 142, Suppl_3 (November 17, 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.17306.
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Introduction: Cardiovascular disease (CVD) disproportionately affects African Americans. Aspirin has long been recommended as an option to reduce cardiovascular events. However, recent clinical trials involving primary prevention aspirin have prompted changes in national guidelines restricting the aspirin recommended population. Hypothesis: Primary prevention aspirin use will decline over the 5 year period 2015-2019. Methods: Using 3 cross-sectional surveys, data were collected from self-identified African Americans in 2015, 2017 and 2019, querying information on CVD risk factors, health behaviors and beliefs, and aspirin use. Poisson regression modeling was used to estimate age- and risk-factor adjusted aspirin prevalence, trends and associations. Results: A total of 1,491 African Americans adults, ages 45-79, 61% women and no prior CVD completed surveys and were included in this analysis. There was no change in age- and risk factor-adjusted aspirin use over the 3 surveys for women (37%, 34% and 35% respectively) or men (27%, 25%, 30% respectively). However, fewer participants believed aspirin was helpful in 2019--75% vs 84% in 2015 (p<0.05). In the total sample (n=1,491) aspirin discussions with a health care practitioner were highly associated with aspirin use (aRR 2.97, 95% CI 2.49-3.54), as were several health beliefs and social norms that affirm preventive behaviors and aspirin use (Figure). Conclusion: Despite major changes in national guidelines and negative perceptions of aspirin effectiveness in the media, overall primary prevention aspirin use did not significantly change in this African American sample from 2015 to 2019.
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Forsetlund, Louise, Morten Christoph Eike, and Gunn E. Vist. "Effect of interventions to improve health care services for ethnic minority populations." Norsk Epidemiologi 20, no. 1 (March 7, 2011). http://dx.doi.org/10.5324/nje.v20i1.1294.
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Objectives: Since the early 1990s there has been an increasing awareness of social and ethnic inequity in health and for the last few years there has also been an increasing focus on disparities in the quality of health services to ethnic minority groups. The aim of this review was to collect and summarise in a systematic and transparent manner the effect of interventions to improve health care services for ethnic minorities.<br />Methods: We searched several medical databases for systematic reviews and randomised controlled trials. Two researchers independently screened for and selected studies, assessed risk of bias, extracted data and graded the quality of the evidence for each outcome in the included studies. The analysis was done qualitatively by describing studies and presenting them in tables.<br />Results: We included 19 primary studies. The interventions were targeted at reducing clinical, structural and organisational barriers against good quality health care services. Eight studies examined the effect of educational interventions in improving outcomes within cross-cultural communication, smoking cessation, asthma care, cancer screening and mental health care. In six comparisons the effect of reminders for improving health care services and patient outcomes within cancer screening and diabetes care was examined. Two studies compared professional remote interpretation services to traditional interpretation services, two studies compared ethnic matching of client and therapist and two studies examined the effect of providing additional support in the form of more personnel in the treatment of diabetes and kidney transplant patients. Most patients were African-Americans and Latin-Americans and all ages were represented.<br />Conclusions: Educational interventions and electronic reminders to physicians may in some contexts improve health care and health outcomes for minority patients. The quality of the evidence varied from low to very low. The quality of available evidence for the other interventions was too low to draw reliable conclusions. We found no studies that only included young patients, but we suggest that interventions targeted at health personnel or health organisations may be applicable regardless of the age of the patient population. This review reveals that the evidence for interventions to improve health care for minorities is sparse and generally of low quality.
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"Physical Activity Promotion in Health Care Settings: the “Exercise is Medicine” Global Health Initiative Perspective." Swiss Sports & Exercise Medicine 62, no. 2 (2014). http://dx.doi.org/10.34045/ssem/2014/16.
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Physical inactivity constitutes the fourth leading cause of death globally. Health systems are being called to respond to the epidemic of non-communicable diseases (NCDs) and help deliver on the promise of prevention approaches. Substantial evidence exists in support of multi-prong physical activity counseling, prescription and referral strategies, in particular those linking clinical and community-based resources, to help increase physical activity (PA) levels. In late 2007, the “Exercise is Medicine” (EIM) initiative was established by the American College of Sports Medicine to institutionalize PA promotion into the US healthcare system. Within two years, representatives from scientific, public health and medical associations of several countries suggested to begin a multinational collaboration to make EIM a global health initiative (EIM-GHI). As such EIM-GHI’s mission expanded to building a global awareness and infrastructure to drive the implementation of evidence-based strategies for PA promotion in healthcare settings. Between 2010 and 2013, EIM has developed a presence in 39 countries and seven EIM regional centers (RC) have been established in North America, Latin America, Europe, Africa, Southeast Asia, China, and Australasia, with each RC responsible for co- ordinating EIM-related activities in its region. The EIM-GHI has taken a multisectorial approach to establishing EIM National Task Forces (NTF) in each country, to coordinate activities in 5 EIM focus areas: education & training, policy & surveillance, clinical & community integration, sustain- ability & outreach, and research & evaluation. Each NTF is composed of representatives from a variety of stakeholders from health care and public health, with close collaboration with media and industry partners encouraged. Broad implementation of PA prescription and referral systems as a global standard of care, integrating health care and community PA services, has the potential to improve PA at the population level and to contribute to achieving global targets for the reduction of inactivity and NCD morbidity and mortality.
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Azeem, Amir, Solomon K. Musani, Walter L. Beard, Thomas H. Mosley, Kenneth R. Butler, and Ervin R. Fox. "Abstract MP32: Long Term Prediction of Incident Heart Failure in African Americans - The Atherosclerosis Risk in Communities Study." Circulation 133, suppl_1 (March 2016). http://dx.doi.org/10.1161/circ.133.suppl_1.mp32.
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Background: Heart failure (HF) affects a large number of Americans with an estimated lifetime risk of over 20% among individuals over the age of 40 years. Heart failure is associated with significant morbidity, mortality and health care cost. Epidemiological data suggests that HF disproportionately affects African Americans. Existing risk prediction models may not accurately predict the risk of incident HF in this population limiting the implementation of screening and preventive strategies. We sought to examine the predictors of incident heart failure in a community-based African American cohort. Methods: The study population consisted of 2244 African American participants from the Jackson cohort of the Atherosclerosis Risk in Communities (ARIC) study. Participants with prevalent HF and missing data at the baseline were excluded. Cox proportional regression with backward elimination was used to assess the association of risk markers with first clinical HF event as follows: Model 1 - standard cardiovascular risk factors (age, gender, body mass index [BMI], systolic blood pressure, use of anti-hypertensive medication, diabetes status, current smoking, total cholesterol-HDL ratio [TC:HDL], logarithmically transformed-triglyceride); Model 2 - significant standard risk factors and biomarkers (logarithmically transformed-brain natriuretic peptide [BNP], logarithmically transformed-troponin, logarithmically transformed-albumin-creatinine ratio); Model 3 - significant standard risk factors and subclinical disease markers (estimated glomerular filtration rate [eGFR], ankle-brachial index, forced expiratory volume in one second [FEV1], forced vital capacity, left ventricular ejection fraction < 50%, left ventricular mass indexed to height2.7); Model 4 - significant standard risk factors, significant biomarkers, and significant subclinical disease markers. Results: The mean age and BMI were 58 years and 30 kg/m2 respectively. During a median follow-up of 18.1 years (maximum 19.8), there were 268 incident HF events. Triglyceride from Model 1, Troponin and Albumin-Creatinine ratio from Model 2, and eGFR from Model 3 were eliminated. In the final model, diabetes status (Hazard Ratio [95% Confidence Interval]: 1.76 [1.07, 2.89]), use of anti-hypertensive medication (2.38 [1.40, 4.06]), TC:HDL (1.34 [1.18, 1.52]) and BNP (1.28 [1.14, 1.44]) were significant predictors of incident HF. Higher FEV1 was associated with reduced risk of HF in this study (0.29 [0.11, 0.76]). Conclusion: In this community-dwelling African American population, diabetes status, use of anti-hypertensive medication, TC:HDL ratio, BNP and FEV1 were independent predictors of incident HF. This information may be useful to identify and target high risk individuals for aggressive preventive interventions.
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Pu, Jia, Dave Vanness, David Kreling, and Betty Chewning. "Abstract P156: Health Literacy and Health Behaviors Associated with Racial Disparities in Blood Pressure." Circulation 129, suppl_1 (March 25, 2014). http://dx.doi.org/10.1161/circ.129.suppl_1.p156.
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Introduction: Racial disparity in cardiovascular disease has prompted efforts to improve cardiovascular outcomes through patient education and health behavior promotion. However, little is known about the long-term effects of health literacy and health behaviors on cardiovascular disease outcomes. Hypothesis: This study aims to explore whether racial differences in long-term blood pressure outcomes are associated with baseline levels of health literacy, mediated through longitudinal patterns of health behaviors. Methods: This study used a prospective cohort from the Coronary Artery Risk Development in Young Adults (CARDIA) project, funded by NHLBI. Blood pressure was measured by trained CARDIA researchers at seven examinations between 1985 and 2005. Self-reported health behaviors (including smoking, binge drinking, overweight and sedentary lifestyle) were obtained at each examination. Cardiovascular health literacy was assessed as part of the 1990 observation. We used growth curve modeling to explore racial disparities in blood pressure and to examine if blood pressure outcomes could be explained by participants’ health literacy and their health behavior change. This study included 3,546 CARDIA study participants who remained in the most recent examination at year 2005, with 47% African Americans and 43% males. Results: Racial disparities were observed in participants’ initial blood pressure, blood pressure progression rate, health literacy and health behaviors. African Americans had higher blood pressure at baseline (systolic: 109 vs. 105; diastolic: 70 vs. 67 P<0.0001) and greater increases over time. Caucasians had a higher health literacy score (4 vs. 3.5 P<0.0001) and reported fewer risk behaviors on average. There was a positive relationship between health literacy, education attainment, parents’ education attainment, family income, having health insurance and having fewer risk behaviors. Participants with fewer risk behaviors had lower blood pressure. Blood pressure improved in years with fewer risk behaviors. Higher baseline health literacy was associated with having fewer risk behaviors in the following fifteen years. Overall, the results indicated that blood pressure outcomes were indirectly influenced by baseline health literacy through longitudinal patterns of risk behaviors. This relationship was stronger in Caucasians. Conclusions: This study suggests that racial differences in blood pressure are associated with both health literacy and health behaviors. In response to these findings, important gaps in hypertension preventive care and health behavior promotion should be identified and addressed through efforts to improve cardiovascular health literacy. For minority and high risk populations, multifaceted approaches in addition to patient education may be needed to initiate behavior change.
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Aberese-Ako, Matilda, Pascal Magnussen, Margaret Gyapong, Gifty D. Ampofo, and Harry Tagbor. "Managing intermittent preventive treatment of malaria in pregnancy challenges: an ethnographic study of two Ghanaian administrative regions." Malaria Journal 19, no. 1 (September 25, 2020). http://dx.doi.org/10.1186/s12936-020-03422-2.
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Abstract Background Malaria in pregnancy (MiP) is an important public health problem across sub-Saharan Africa. The package of measures for its control in Ghana in the last 20 years include regular use of long-lasting insecticide-treated bed nets (LLINs), directly-observed administration (DOT) of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) and prompt and effective case management of MiP. Unfortunately, Ghana like other sub-Saharan African countries did not achieve the reset Abuja targets of 100% of pregnant women having access to IPTp and 100% using LLINs by 2015. Methods This ethnographic study explored how healthcare managers dealt with existing MiP policy implementation challenges and the consequences on IPTp-SP uptake and access to maternal healthcare. The study collected date using non-participant observations, conversations, in-depth interviews and case studies in eight health facilities and 12 communities for 12 months in two Administrative regions in Ghana. Results Healthcare managers addressed frequent stock-outs of malaria programme drugs and supplies from the National Malaria Control Programme and delayed reimbursement from the NHIS, by instituting co-payment, rationing and prescribing drugs for women to buy from private pharmacies. This ensured that facilities had funds to pay creditors, purchase drugs and supplies for health service delivery. However, it affected their ability to enforce DOT and to monitor adherence to treatment. Women who could afford maternal healthcare and MiP services and those who had previously benefitted from such services were happy to access uninterrupted services. Women who could not maternal healthcare services resorted to visiting other sources of health care, delaying ANC and skipping scheduled ANC visits. Consequently, some clients did not receive the recommended 5 + doses of SP, others did not obtain LLINs early and some did not obtain treatment for MiP. Healthcare providers felt frustrated whenever they could not provide comprehensive care to women who could not afford comprehensive maternal and MiP care. Conclusion For Ghana to achieve her goal of controlling MiP, the Ministry of Health and other supporting institutions need to ensure prompt reimbursement of funds, regular supply of programme drugs and medical supplies to public, faith-based and private health facilities.
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Van’t Hof, Jeremy R., Jeffrey Misialek, Niki Oldenburg, Sue Duval, Alan T. Hirsch, and Russell V. Luepker. "Abstract P334: Primary Prevention Aspirin Use in an African American Population: The Impact of Health Beliefs and Social Norms." Circulation 135, suppl_1 (March 7, 2017). http://dx.doi.org/10.1161/circ.135.suppl_1.p334.
Full textAbstract:
Background: Cardiovascular disease (CVD) is a leading cause of death that disproportionately impacts African Americans. Aspirin (ASA) is a simple, low-cost medication that lowers the risk of a first heart attack or stroke by 12-22%. This study investigates the prevalence of primary prevention ASA use among a metropolitan, predominantly African American population. It examines the association between primary prevention ASA use and measures of health beliefs, social norms, and perceptions of CVD risk hypothesized to influence ASA use. Methods: Between April and August 2015, trained community health workers administered 10 minute, in-person surveys to a convenience sample of adults ages 45-79 years within the Minneapolis-St. Paul metro area. The survey defined demographics, CVD history, atherosclerosis risk factors and ASA use. CVD risk perceptions and ASA-related health beliefs and social norms were evaluated using a 4 point Likert scale. Logistic regression with adjustment for age and number of risk factors was used to examine the association of demographics and health beliefs with ASA use. Results: Of the 797 survey participants, 590 had no CVD history. Of these, 460 (78%) were between the ages of 50-69, the range recently defined in the 2016 United States Preventive Services Task Force (USPSTF) recommendation. Overall primary prevention ASA use was 38% and increased as the number of CVD risk factors (RF) increased, from 21% (0 RF) to 62% (≥ 3 RF). After adjusting for age and risk factors, ASA use was associated with diabetes (OR 2.6, 95% CI: 1.6-4.2) and current smoking (OR 0.4, 95% CI: 0.2-0.6). If a participant discussed ASA use with a doctor, they were much more likely to use ASA (OR 5.5, 95% CI: 3.7-8.1). Participants who believed ASA could prevent a heart attack or stroke were also more likely to use it (OR 4.6, 95% CI: 1.9-11.4). ASA use was higher among participants who perceived that their peers were using ASA (OR 3.7, 95% CI: 2.0-6.6), and among participants who believed those close to them thought they should use ASA (OR 6.6, 95% CI: 4.1-10.5). Perceived safety and ease of use were also positively associated with ASA use, (OR 9.8, 95% CI: 5.0-19.3 and OR 23.2, 95% CI: 8.2-65.5 respectively). Conclusion: Increased primary prevention aspirin use was associated with positive beliefs regarding the expectations and behaviors of participants’ social network, and about perceived effectiveness, safety and convenience of the medication. Novel interventions to increase primary prevention ASA use could focus on promoting conversations with physicians about appropriate ASA use, and normalizing ASA for at-risk individuals within communities.
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Allen, Norrina B., Mercedes Carnethon, Penny Gordon-Larsen, Catarina Kiefe, Ana Diez-Roux, David C. Goff, Michael Steffes, and Martha Daviglus. "Abstract P252: Health Professional Shortage Areas and Their Association With Cardiovascular Risk Factor Prevalence, Awareness, and Control: Findings From the Coronary Artery Risk Development in Young Adults (CARDIA) Study." Circulation: Cardiovascular Quality and Outcomes 4, suppl_1 (November 2011). http://dx.doi.org/10.1161/circoutcomes.4.suppl_1.ap252.
Full textAbstract:
Background: Over 65 million Americans live in Primary Care Health Professional Shortage Areas (HPSAs) which are associated with less preventive care, poorer general health and an increased risk for hospitalizations. However, little is known about how living in a HPSA impacts primary prevention for CVD. Methods: We used data from CARDIA, a multi-center cohort study of black and white men and women. Participants who had risk factor data and geocoded addresses available at year 20 (2005) were included in this analysis (n=3479). Primary care HPSAs were defined using data from US HRSA. Diabetes, hypertension and hyperlipidemia prevalence and control were defined according to ADA Guidelines 2000, JNC VI, and ATP III, respectively. Individuals who reported being diagnosed or reported use of medications were considered aware of the risk factor. The prevalence of smoking and obesity was also examined. Neighborhood (census block) characteristics were derived from Census 2000 and ACCRA. Multivariable Poisson models were used to examine the independent association of HPSA residence with each outcome. Results: Over 11% of CARDIA participants live in a HPSA. Residents of HPSAs were more likely to be female (64% vs 56%), African American (81% vs 43%), have low education, and low income. HPSA residents had more difficulty paying for food/basics and medical care, had poorer access to medical care and lived in areas with a higher cost of healthcare and low neighborhood SES. HPSA residents had a higher prevalence of hypertension (PR 1.39, 95% CI 1.18-1.65), obesity (1.30, 1.16-1.45) and smoking (1.72, 1.46-2.03) and were less likely to have their hypertension (0.79, 0.66-0.95) or hyperlipidemia (0.66, 0.44-0.99) controlled as compared to non-residents. The association between HPSA and risk factors prevalence was explained by race and neighborhood SES. The cost of medical care and having a usual source of care were the largest mediators of the association between HPSA residence and risk factor control. Conclusion: The increased prevalence and poorer control of CVD risk factors in HPSAs, can be explained by the demographic and neighborhood characteristics of their residents. Future interventions should be targeted to these high-risk populations found within HPSAs.