Roedlocklear2737

Objectives There is limited data describing the role of health disparity factors and socioeconomic status (SES) on emergent versus nonemergent gastrointestinal (GI) procedures within pediatrics. learn more We aimed to characterize risk factors and determine the role of SES on emergent versus nonemergent GI care. We hypothesized that patients with lower SES incur higher risk of having emergent procedures performed. Methods Retrospective chart review was performed between 2012 and 2016, with 2556 patient records reviewed. Demographic data and SES categories were determined. The majority of emergent procedures were performed on an inpatient basis. Health disparity factors analyzed included age, gender, insurance type, race, language, and SES using census tracts. Logistic regression analyses and paired t-tests were utilized. Results Two hundred eighty-six (11.2%) patients had emergent GI procedures performed. Logistic regression (odds ratio [OR], confidence interval (95% CI)] showed patients from 6-11 to 12-17 years of age were less likely to seek emergent care than the youngest group [0.47, 0.33-0.66 and 0.61, 0.45-0.84]. Patients with Medicaid insurance [1.68, 1.27-2.26], African American or "other" race [2.07, 1.48-2.90 and 2.43, 1.77-3.36, respectively], as well as "other" language [2.1, 1.14-3.99] more often sought emergent care. Using geocoded data, we found that as SES increases by 1, emergent risk for procedures decreased by 2.9% (OR 0.97, p=0.045). Conclusions Children with lower SES, at extremes of age (18 years), non-English or Spanish speaking and with Medicaid insurance are at higher risk of undergoing emergent GI procedures. This study gives us an opportunity to plan targeted interventions to improve access and quality of care.Purpose Syrian refugees (SRs) in Lebanon are often relegated to informal camps with poor living conditions and substandard access to health care. This study examined the unique condition of urban camp-dwelling SRs in Lebanon. This population is rarely studied as they are marginalized and difficult to access. We sought to assess the prevalence of noncommunicable diseases (NCDs) and health care-seeking behaviors within this population. Methods A randomized group of urban camp-dwelling SR participants completed a survey on disease burden, health care-seeking patterns, and attitudes toward care. A second group completed interviews regarding health care experiences. We present descriptive population and epidemiologic measures to quantify NCD burden and health care-seeking behaviors. Results Of 101 participants, 39% reported arthritis, 25% skin infection, 24% high blood pressure, 16% chronic lung conditions, 16% eye disease, and 15% diabetes. Major themes from interviews with SRs included poor living conditions, high cost of health care services, and perceived discrimination by health care workers (HCWs). The major theme from interviews with HCWs was a perception that SRs received health care services similar to members of surrounding communities. Discussion In this population, we found a higher prevalence of NCDs at younger ages than in the general SR population. We described perceived barriers to accessing health care, including the noteworthy finding of perceived discrimination by HCWs in a linguistically and culturally related host community. We discussed social determinants of health within the camp and refugees' ability to access health care services.Purpose Safety net health services, such as federally funded health clinics, are interventions that aim to mitigate inequality in resource distribution, thus primarily clustered in poor areas with lack of access to health care. However, not all neighborhoods with the most needs benefit from safety net health services. In this article, we explore the distribution of a federally funded health service intervention designed to serve impoverished areas, the medically underserved areas (MUAs), and the relationship between MUA designation and neighborhood sociodemographic characteristics. Methods We explore the spatial distribution of MUAs. The 2010 U.S. census data including 868 census tracts in Chicago were used for the analysis. We then examined the likelihood of being designated as an MUA using census tract level neighborhood demographic variables. Results We found that the likelihood of obtaining MUA designation increases for neighborhoods with higher levels of poverty, the likelihood of being designated as an MUA begins to decline beyond the tipping point, whereas the proportion of black residents continues to increase. In census tracts that were eligible but not designated, there was a greater proportion of black residents compared with white residents (p less then 0.01). The census tracks also had higher mean disadvantage scores (p less then 0.01) and lower social capital (p less then 0.01). Furthermore, MUA eligible areas that were not designated as MUAs were predominantly black neighborhoods in poverty. Conclusion Studies have documented that receiving MUA designation substantially reduces disparities in access to health care, and yet, our study finding indicates that the most racially segregated poor neighborhoods are excluded from the benefits of having such federal health safety net program. Seemingly race-neutral safety net health services may still be distributed in a way that perpetuates racial inequality in health.Purpose To examine indebtedness for medical care among racial and ethnic minorities and people with serious psychological distress (SPD) using a nationally representative sample in the United States. Methods Using the 2014-2017 Medical Expenditure Panel Survey, we examine medical debt among individuals with SPD. We develop a logistic regression model to estimate the odds of medical debt by SPD status. We stratify the odds of medical debt for those with SPD by insurance type. Results The results indicate that after controlling for predisposing, enabling, and physical needs factors, those experiencing SPD have double the odds of having medical debt compared with those without SPD. Non-Hispanic blacks had higher odds of medical debt compared with non-Hispanic whites. We find that individuals with SPD covered under private health insurance have double the odds of having medical debts; and those who are uninsured have triple the odds of having medical debt compared with their counterparts without SPD. Conclusion The findings suggest that odds of medical debt are higher among people with SPD, even when insured. Additional health policy initiatives to address medical debt among those with SPD may be warranted.Purpose This study sought to examine the association between lifetime trauma (i.e., childhood, adulthood, and cumulative) and body mass index (BMI) and if this association was mediated by psychosocial factors (i.e., depressive symptoms and stress) in a sample of African American women. Methods We examined lifetime trauma among African American women in the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure Study (InterGEN) study. We conducted mediation analyses with bootstrapping to assess the direct and indirect effects of increasing forms of trauma across the lifespan on BMI. Depressive symptoms and stress were examined as mediators of these associations. Results The analytic sample included 138 women with a mean age of 31.9 years. Approximately half of women reported any childhood trauma (47.8%) and more than half (73.2%) reported any adulthood trauma. The direct effects of all forms of trauma were associated with greater depressive symptoms. Only lifetime trauma was associated with higher stress overload (B=2.40, standard error [SE]=1.12, p less then 0.05). Higher depressive symptoms were associated with higher BMI in all models. The indirect effects of adulthood trauma (B=0.60, SE=0.20, p less then 0.01) and lifetime trauma (B=0.53, SE=0.20, p less then 0.01) on BMI were partially mediated by depressive symptoms. Conclusion These findings indicate that depressive symptoms mediate the associations between adulthood and lifetime trauma with BMI. Interventions aimed at reducing elevated BMI in African American women should account for the influence of depressive symptoms. Future research should replicate these analyses in other samples of African American women.Purpose African Americans with life-limiting illnesses experience significant health inequities. Lay health workers (LHWs) may help overcome existing challenges of communicating with African Americans about advance care planning (ACP) and end-of-life decision-making. Church-based LHWs have some advantages over other LHWs but no curriculum exists to fully prepare them. This article describes the development, content, format, and implementation of a curriculum designed to meet this need. Methods We created a church-based curriculum to train African American, LHWs as communications-facilitators who can support persons with life-limiting illnesses, not only with ACP but also with issues that arise as illnesses progress. Learners are church members whom we call comfort care supporters. The curriculum organizes the LHW interactions with clients by the mnemonic LIGHT Listening, Identifying, Guiding, Helping, and Translating. Results The final curriculum consists of three parts (1) a 26-h classroom component delivered in nine modules organized around eight themes meaning and prognosis of a life-limiting illness, spirituality and the meaning of death, understanding the dying process, major decisions and choices, goals of care, end-of-life services, and resources, intrafamily communication, and role and activities of the LHW; (2) a visit component; and (3) experiential, case-based discussions during monthly meetings. Conclusions LHWs may improve quality of care and thus reduce health inequities at the end-of-life. Preparing LHWs for conversations about ACP is necessary but insufficient. This curriculum also prepares LHWs to attend to the spiritual needs of clients and to support clients with their other needs as their illness progresses.Purpose To examine the burden of uncontrolled hyperglycemia in patients with diabetes mellitus (DM) and their characteristics in a large urban city. Methods A randomized sample of 4993 patients with DM ≥18 years old who received routine health care in a large university teaching hospital in the city of Philadelphia was analyzed. Uncontrolled hyperglycemia was classified as blood hemoglobin A1c >8%. The associations of uncontrolled hyperglycemia with sociodemographic and cardiovascular factors were analyzed using univariate and multivariate analysis methods. Results The results show that patients 18-54 years had the highest prevalence of uncontrolled hyperglycemia (36.0%), followed by those at age 55-64 (30.9%), 65-74 (22.9%), and ≥75 (20.6%) years (p less then 0.0001). Unadjusted hyperglycemia was significantly associated with patients with increased total cholesterol to high-density lipoprotein ratio (odds ratio [OR]=1.59, 95% confidence interval [CI] 1.33-1.90, p less then 0.001), and with prevalent coronary heart disease (OR=1.39, 95% CI 1.16-1.67, p=0.001). Patients living in neighborhoods with lower socioeconomic status (SES) had significantly higher uncontrolled hyperglycemia rates across the city (r=0.52, R 2=0.27, p=0.03). Conclusions Findings of this study is one of the first studies to address that younger adults had higher rates of uncontrolled hyperglycemia. Further attention should be paid to the challenges of controlling DM in younger adults and patients who live in neighborhoods with lower SES.