Journal of the National Medical Association最新文献_第3页

COVID-19 vaccine uptake and intention of Black adults: A county-wide analysis of an online survey 黑人成年人的 COVID-19 疫苗接种率和意向：全县在线调查分析。

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2024.07.007

Krissy Moehling Geffel , Harika P. Dyer , Andrea D. Casas , Stephanie N. Christian-Afflu , Dara D. Méndez , Tiffany L. Gary-Webb

Background

There are demonstrated racial inequities in coronavirus 2019 (COVID-19) disease burden, and the initial vaccine rollout did not equitably address these disparities.

Methods

We conducted analyses of a national Facebook survey restricted to Black adult residents of Allegheny County, Pennsylvania for the period of May 2021 to January 2022. We assessed the associations between demographics, health status, social normative context, perceived racial discrimination, and beliefs about COVID-19 mitigation strategies on vaccine uptake and intention and compared reasons reported for vaccine hesitancy, and vaccine non-intention among the unvaccinated. Multivariable logistic regression was conducted on a subset of unvaccinated respondents to explore variables associated with vaccine intent.

Results

Over 85 % of 1,552 respondents were vaccinated against COVID-19 at the time of the survey. Compared to the unvaccinated, vaccinated respondents were older and more highly educated (P <0.001), more likely to have at least one chronic health condition (P =0.03) and had a stronger social normative context in support of vaccination (P <0.001). Vaccinated respondents also reported greater personal adherence to wearing face masks when out in public and were more likely to report positive perceptions of the effectiveness of mitigation strategies (e.g., face masks) towards preventing COVID-19 transmission (P <0.001).

Unvaccinated respondents were more likely to report intention to be vaccinated if they felt that face masks were very effective in the prevention of COVID-19 compared to those who felt this mitigation strategy was only moderately/slightly/not at all effective (OR: 4.52; 95 % CI: 1.23–16.59; P =0.02) and if they did not report mistrust in the government or COVID-19 vaccines compared to those reporting mistrust (OR: 7.72; 95 % CI: 1.34–44.64; P =0.02).

Conclusion

COVID-19 vaccination levels were high among Black adult residents of Allegheny County who responded to the survey. Future efforts should continue to strive towards addressing reasons for mistrust with focused attention from healthcare institutions and the government on increasing their trustworthiness, alongside employment of evidence-based strategies to increase vaccination rates. Additionally, efforts should continue to engage unvaccinated and vaccine hesitant persons’ perspectives to inform ongoing health equity interventions.

背景：在冠状病毒 2019（COVID-19）疾病负担方面存在明显的种族不平等：冠状病毒 2019（COVID-19）疾病负担中存在明显的种族不平等，而最初的疫苗推广并未公平地解决这些不平等问题：我们对 2021 年 5 月至 2022 年 1 月期间仅限于宾夕法尼亚州阿勒格尼县黑人成年居民的全国 Facebook 调查进行了分析。我们评估了人口统计学、健康状况、社会规范背景、感知到的种族歧视以及对 COVID-19 缓解策略的看法与疫苗接种率和接种意向之间的关联，并比较了未接种者报告的疫苗犹豫原因和不接种疫苗的意向。对未接种疫苗的受访者子集进行了多变量逻辑回归，以探讨与疫苗接种意向相关的变量：在 1,552 位受访者中，超过 85% 的人在调查时接种了 COVID-19 疫苗。与未接种者相比，接种者的年龄更大、受教育程度更高（P 结论：接种者的年龄和受教育程度均高于未接种者（P 结论：接种者的年龄和受教育程度均低于未接种者）：在阿勒格尼县回答调查的黑人成年居民中，COVID-19 疫苗接种率较高。未来的工作应继续努力解决不信任的原因，医疗保健机构和政府应重点关注提高其可信度，同时采用循证策略提高疫苗接种率。此外，还应继续努力从未接种疫苗者和疫苗接种犹豫者的角度出发，为正在进行的健康公平干预提供信息。

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引用次数: 0

Cardiovascular complications of sickle cell disease: A primer for the general clinician 镰状细胞病的心血管并发症：普通临床医生入门指南

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2023.11.010

Chibuzo Ilonze , Gift C. Echefu , Alexandria L. Broadnax , Adedoyin Johnson , Aniekeme Etuk , Onyedika J. Ilonze

Sickle cell disease (SCD) is the most common hereditary hemoglobinopathy and mainly affects individuals of African ancestry. As survival has improved especially in high-income countries, increased rates of cardiopulmonary complications such as pulmonary hypertension, heart failure with diastolic dysfunction, and sudden death are encountered in clinical practice. These complications are the leading causes of morbidity and mortality as these individuals survive into adulthood. Understanding the need for, early identification, timely intervention, and implementation of preventive strategies are critical in reversing this trend and improving quality of life and survival rates. This manuscript aims to provide a comprehensive review of the pathogenesis of cardiovascular complications associated with sickle cell disease and equip the clinician with tools to facilitate the early diagnosis and management of patients with SCD as increasing numbers survive into adulthood.

镰状细胞病（SCD）是最常见的遗传性血红蛋白病，主要影响非洲血统的患者。随着存活率的提高，尤其是在高收入国家，临床上肺动脉高压、舒张功能障碍性心力衰竭和猝死等心肺并发症的发病率也在增加。这些并发症是这些患者成年后发病和死亡的主要原因。了解需求、早期识别、及时干预和实施预防策略对于扭转这一趋势、提高生活质量和存活率至关重要。本手稿旨在全面回顾与镰状细胞病相关的心血管并发症的发病机制，并为临床医生提供一些工具，以便随着越来越多的 SCD 患者长大成人，对他们进行早期诊断和管理。

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引用次数: 0

Protecting black lives: Reducing disparities in cardiovascular morbidity and mortality 保护黑人生命:减少心血管发病率和死亡率的差异

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2023.11.011

Onyedika J. Ilonze , Hakeem Ayinde , Keith C. Ferdinand

引用次数: 0

Trends in fatal opioid overdoses and opioid-related emergency department visits among the black population in California, 2011–2022 2011-2022 年加利福尼亚州黑人中阿片类药物过量致死和阿片类药物相关急诊就诊的趋势。

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2024.10.002

Sabrina L. Smiley, Heesung Shin

引用次数: 0

Knowledge, attitudes, and practices of sickle cell hemoglobinopathies: A case-control study from the sickle cell belt of Odisha, India 镰状细胞血红蛋白病的知识、态度和实践：印度奥迪沙镰状细胞带病例对照研究。

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2024.10.003

Basanta Kumar Bindhani , Kallur Nava Saraswathy , Jayanta Kumar Nayak , Naorem Kiranmala Devi

Despite the high prevalence of sickle cell haemoglobin (HbS) in Odisha, awareness and understanding of sickle cell trait (SCT) and sickle cell disease (SCD) remain low in affected communities. This cross-sectional study assesses the knowledge, attitude, and practice (KAP) regarding sickle cell hemoglobinopathies among 182 sickle cell carriers and 200 age-sex-community matched controls. The overall knowledge of sickle cell hemoglobinopathies was very low among both case and control groups (score 2.8/10). Although most respondents had heard about SCD (85.71% vs. 82%), few were aware of SCT (34.07% vs. 27%). Notably, none of the participants knew their haemoglobin genotype or carrier status. Only a very small proportion were aware of symptoms, causes, and preventive measures. The overall attitude score was marginally higher in the control group (4.75/11) than in the case group (4.55/11), with an average score of 42.25%. While most recognized the need for regular treatment and screening of children (82.4% carriers, 90.5% controls), many were undecided about the necessity of premarital screening. The overall practice score was very low in both groups (0.4/5), but the mean practice score was significantly higher in cases than controls (11.01% vs. 7.55%). Most participants did not undergo regular health check-ups or engage in preventive measures (97.25%). Traditional health practices were commonly relied upon for treatment. Participants reported a lack of awareness about SCT and fear of discrimination, social isolation, and marriage refusal as major barriers to screening participation.

尽管镰状细胞血红蛋白（HbS）在奥里萨邦的发病率很高，但受影响社区对镰状细胞性状（SCT）和镰状细胞病（SCD）的认识和了解仍然很低。这项横断面研究评估了 182 名镰状细胞携带者和 200 名年龄性别与社区匹配的对照者对镰状细胞血红蛋白病的认识、态度和实践（KAP）。病例组和对照组对镰状细胞血红蛋白病的总体了解程度都很低（2.8/10 分）。虽然大多数受访者听说过 SCD（85.71% 对 82%），但很少有人知道 SCT（34.07% 对 27%）。值得注意的是，没有一位参与者知道自己的血红蛋白基因型或携带者状态。只有极少数人了解症状、病因和预防措施。对照组的总体态度得分（4.75/11）略高于病例组（4.55/11），平均得分率为 42.25%。虽然大多数人都认识到定期治疗和儿童筛查的必要性（82.4% 的携带者，90.5% 的对照组），但许多人对婚前筛查的必要性并不确定。两组参与者的总体实践得分都很低（0.4/5），但病例的平均实践得分明显高于对照组（11.01% 对 7.55%）。大多数参与者没有定期进行健康检查或采取预防措施（97.25%）。他们通常依靠传统的保健方法进行治疗。参与者表示，缺乏对小儿麻痹症的认识以及害怕歧视、社会孤立和拒绝婚姻是参加筛查的主要障碍。

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引用次数: 0

Primary care physician density and mortality in the United States 美国初级保健医生的密度与死亡率。

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2024.10.001

Ali Bin Abdul Jabbar , Khawaja M Talha , Vijay Nambi , Dmitry Abramov , Abdul Mannan Khan Minhas

Background

Geographic physician availability differences are associated with healthcare outcomes. However, the association between primary care physician (PCP) density and mortality outcomes is less well-established.

Methods

The study analyzed 2019 county-level nonfederal PCP data from the Health Resources and Services Administration Area Health Resource File and mortality data using the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research). All-cause and cardiovascular disease (CVD)- related age-adjusted mortality rates (AAMR) per 100,000 population stratified by the number of PCPs per 100,000 quartiles were extracted. Using AAMRs as continuous variables, linear regression was performed to determine the association of AAMRs with PCPs per 100,000 (reference, first quartile), adjusting for the social vulnerability index (SVI).

Results

A total of 3142 counties were included in the analysis. Among counties stratified by PCPs per 100,000 quartiles, all-cause AAMRs were 828 (95% CI, 824–832) in the first quartile, 798 (95% CI, 796–801) in the second quartile, 737 (95% CI, 735–739) in the third quartile, and 679 (95% CI, 678–680) in the fourth quartile. Similar trends were seen in CVD-related AAMRs, which were 446 (95% CI, 443–449), 439 (95% CI, 437–441), 403 (95% CI, 402–404), and 365 (95% CI, 364–366), respectively. Counties without PCP (221, included in first quartile) had all-cause and CVD-related AAMR of 797 (95%CI, 783–812) and 430 (95%CI, 419–440), respectively. Compared with the first quartile, SVI-adjusted analyses showed β-coefficient (95%CI) of all-cause mortality for the second, third, and fourth quartiles of −4.11 (95% CI, −18.31, 10.08), −35.37 (95% CI, −49.57, −21.17) and −85.79 (95% CI, −100.10, −71.48). Similar results were observed for CVD-related AAMR.

Conclusion

Higher PCP per 100,000 is generally associated with better all-cause and CVD-associated mortality outcomes, however complex factors likely play a role in determining these outcomes in counties with lower PCP per 100,000, which warrant further investigation.

背景：地理上的医生可用性差异与医疗保健结果有关。然而，初级保健医生（PCP）密度与死亡率结果之间的关联却不那么明确：该研究分析了卫生资源与服务管理局地区卫生资源档案中的 2019 年县级非联邦初级保健医生数据，以及使用疾病预防控制中心 WONDER（用于流行病学研究的广泛在线数据）的死亡率数据。根据每十万人中初级保健医生数量的四分位数，提取了每十万人中与全因和心血管疾病（CVD）相关的年龄调整死亡率（AAMR）。将年龄调整死亡率作为连续变量，进行线性回归，以确定年龄调整死亡率与每十万人初级保健医生数（参考值，第一四分位数）之间的关系，并对社会脆弱性指数（SVI）进行调整：共有 3142 个县被纳入分析。在按每 10 万名初级保健医生四分位数分层的县中，全因急性心肌梗死死亡率在第一四分位数为 828（95% CI，824-832），第二四分位数为 798（95% CI，796-801），第三四分位数为 737（95% CI，735-739），第四四分位数为 679（95% CI，678-680）。与心血管疾病相关的 AAMRs 也呈现类似趋势，分别为 446（95% CI，443-449）、439（95% CI，437-441）、403（95% CI，402-404）和 365（95% CI，364-366）。没有五氯苯酚的县（221 个，包括在第一四分位数中）的全因和心血管疾病相关 AAMR 分别为 797（95%CI，783-812）和 430（95%CI，419-440）。与第一四分位数相比，SVI 调整分析显示，第二、第三和第四四分位数的全因死亡率 β 系数（95%CI）分别为-4.11（95% CI，-18.31，10.08）、-35.37（95% CI，-49.57，-21.17）和-85.79（95% CI，-100.10，-71.48）。心血管疾病相关的 AAMR 也观察到类似的结果：每 10 万人中较高的 PCP 一般与较好的全因死亡率和心血管疾病相关死亡率结果相关，但在每 10 万人中较低 PCP 的县中，决定这些结果的因素可能很复杂，值得进一步研究。

{"title":"Primary care physician density and mortality in the United States","authors":"Ali Bin Abdul Jabbar , Khawaja M Talha , Vijay Nambi , Dmitry Abramov , Abdul Mannan Khan Minhas","doi":"10.1016/j.jnma.2024.10.001","DOIUrl":"10.1016/j.jnma.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Geographic physician availability differences are associated with healthcare outcomes. However, the association between primary care physician (PCP) density and mortality outcomes is less well-established.</div></div><div><h3>Methods</h3><div>The study analyzed 2019 county-level nonfederal PCP data from the Health Resources and Services Administration Area Health Resource File and mortality data using the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research). All-cause and cardiovascular disease (CVD)- related age-adjusted mortality rates (AAMR) per 100,000 population stratified by the number of PCPs per 100,000 quartiles were extracted. Using AAMRs as continuous variables, linear regression was performed to determine the association of AAMRs with PCPs per 100,000 (reference, first quartile), adjusting for the social vulnerability index (SVI).</div></div><div><h3>Results</h3><div>A total of 3142 counties were included in the analysis. Among counties stratified by PCPs per 100,000 quartiles, all-cause AAMRs were 828 (95% CI, 824–832) in the first quartile, 798 (95% CI, 796–801) in the second quartile, 737 (95% CI, 735–739) in the third quartile, and 679 (95% CI, 678–680) in the fourth quartile. Similar trends were seen in CVD-related AAMRs, which were 446 (95% CI, 443–449), 439 (95% CI, 437–441), 403 (95% CI, 402–404), and 365 (95% CI, 364–366), respectively. Counties without PCP (221, included in first quartile) had all-cause and CVD-related AAMR of 797 (95%CI, 783–812) and 430 (95%CI, 419–440), respectively. Compared with the first quartile, SVI-adjusted analyses showed β-coefficient (95%CI) of all-cause mortality for the second, third, and fourth quartiles of −4.11 (95% CI, −18.31, 10.08), −35.37 (95% CI, −49.57, −21.17) and −85.79 (95% CI, −100.10, −71.48). Similar results were observed for CVD-related AAMR.</div></div><div><h3>Conclusion</h3><div>Higher PCP per 100,000 is generally associated with better all-cause and CVD-associated mortality outcomes, however complex factors likely play a role in determining these outcomes in counties with lower PCP per 100,000, which warrant further investigation.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 600-606"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Validating the factor structure and reliability of the sleep quality scale in a community-based study in Ibadan, Nigeria 在尼日利亚伊巴丹的一项社区研究中验证睡眠质量量表的因子结构和可靠性。

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2024.09.001

Osahon Jeffery Asowata , Aderonke Busayo Sakpere , Anthony Ike Wegbom , Charles Emaikwu , David Kadan Danladi , Innocent Okoro , Sunday Oladiran , Tobi Elisha Adekolurejo , Akinkunmi Paul Okekunle , Onoja Matthew Akpa

Background

The sleep quality scale (SQS) is a comprehensive multidimensional sleep assessment scale used to evaluate sleep quality (SQ) among adults in the general population. However, the scale is yet to be validated among indigenous African populations such as in Nigeria. This study validated the factor structure and evaluated the reliability of a previously developed SQS among community-based adults in Ibadan, Nigeria.

Methods

Data on SQ was extracted from 3,635 adult (≥18 years) from the Community-based Investigation of the Risk Factors for Cardiovascular Disease (COMBAT-CVDs) study. Cronbach-alpha (

α

) was used to evaluate the internal consistency or reliability of the SQS (>50 % cut-off), while the original 6-factor model of the SQS was explored using exploratory (≥0.5 cut-offs) and confirmatory factor analyses. The chi-square goodness of fit test and multiple fit indices were used to assess model fit at a two-sided P < 0.05.

Results

Overall, the participant's mean age was 35.33±15.20 years, and 54.60 % were male. The overall reliability estimate for the SQS was 86.00 %, while the restoration after sleep subscale reliability was 93.00 %. The exploratory and confirmatory factor analysis showed that the original 6-factor model of the SQS is a more plausible model for this sample of community-based adults: comparative fit index >0.92, Tucker-Lewis index > 0.91, root mean square error of approximation ≤ 0.05.

Conclusion

Our findings revealed that the SQS is promising for population-based assessment of SQ and may also assist in identifying sleep-related disorders and monitoring the efficacy of sleep treatment among indigenous Africans.

背景：睡眠质量量表（SQS睡眠质量量表（SQS）是一种全面的多维睡眠评估量表，用于评估普通成年人的睡眠质量（SQ）。然而，该量表尚未在尼日利亚等非洲本土人群中进行验证。本研究在尼日利亚伊巴丹的社区成年人中验证了之前开发的 SQS 的因子结构并评估了其可靠性：从心血管疾病风险因素社区调查（COMBAT-CVDs）研究中提取了 3,635 名成人（≥18 岁）的 SQ 数据。Cronbach-alpha (α) 用于评估 SQS 的内部一致性或可靠性（>50% 临界值），同时使用探索性（≥0.5 临界值）和确认性因素分析探索 SQS 的原始 6 因子模型。在双侧 P < 0.05 的条件下，采用卡方拟合优度检验和多重拟合指数来评估模型的拟合程度：总体而言，参与者的平均年龄为（35.33±15.20）岁，54.60%为男性。SQS 的总体可靠性估计值为 86.00%，而睡眠后恢复子量表的可靠性为 93.00%。探索性和确认性因素分析表明，SQS 的原始 6 因子模型对这一社区成人样本来说更为合理：比较拟合指数大于 0.92，Tucker-Lewis 指数大于 0.91，近似均方根误差小于 0.05：我们的研究结果表明，SQS 有望用于基于人群的 SQ 评估，还有助于识别与睡眠相关的疾病，并监测非洲原住民的睡眠治疗效果。

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引用次数: 0

Try not to think about food: An association between fasting, binge eating and food cravings 尽量不去想食物禁食、暴饮暴食和食物渴望之间的关联。

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2024.09.005

Jônatas de Oliveira , João Ferro , Victor Hugo Dantas Guimarães , Felipe Quinto da Luz

Background

When individuals follow a diet or limit their food intake, they activate cognitive restraint, which is defined as a mental effort to restrict dietary behavior with the goal of losing weight. As an example, fasting has also been associated with the recruitment of cognitive restraint, but further research is needed to fully understand its underlying mechanisms.

Aims

The aim of this study was to examine the relationship between the duration of fasting and disordered eating, such as food cravings, binge eating, and potential changes in eating habits.

Methods

An online survey was conducted among 853 first-semester university students to investigate their fasting practices and frequency over a three-month period prior to data collection. Participants who were on diets were excluded (n=214). After controlling the sample for biases, a comparison was made between 89 fasters and 369 non-fasters. The study compared levels of cognitive restraint, binge eating, food cravings, and consumption of ‘forbidden’ foods. A Poisson model was used to examine the association between hours of fasting and disordered eating traits. In the context of this study, the rate ratio was used to examine the relationship between fasting hours and disordered eating characteristics, such as binge eating and food cravings.

Results

The study found that fasters experienced an increase in food cravings and binge eating. However, fasters consumed fewer bread slices than non-fasters. The rate ratio of fasting hours practiced is 115% higher among binge eaters (RR 2.15; CI95% 1.70-2.73) compared to those who did not binge. The rate ratio of fasting hours is 29% higher in participants with moderate binge eating (RR 1.29; CI95% 1.05-1.59), increasing to 140% (RR 2.40; CI95% 1.86-3.11) in people with severe binge eating. As for food cravings (state), the rate ratio was 2% higher (RR 1.02; CI 95% 1.01-1.03) for each increase in the unit of the scale.

Conclusions

Our study has indicated that fasting is positively associated with increased levels of binge eating and food cravings.

背景：当人们节食或限制食物摄入量时，他们会启动认知克制，认知克制被定义为以减肥为目标而限制饮食行为的一种心理努力。目的：本研究旨在探讨禁食持续时间与食物渴望、暴饮暴食等饮食紊乱以及饮食习惯潜在变化之间的关系：方法：我们对 853 名大学一年级学生进行了在线调查，以了解他们在数据收集前三个月内的禁食习惯和频率。正在节食的参与者被排除在外（n=214）。在控制样本偏差后，对 89 名禁食者和 369 名非禁食者进行了比较。研究比较了认知克制、暴饮暴食、食物渴望和食用 "禁忌 "食物的水平。研究采用泊松模型来检验禁食时间与饮食失调特征之间的关联。在本研究中，比率比被用来研究禁食时间与暴食和食物渴望等饮食失调特征之间的关系：研究发现，禁食者对食物的渴望和暴饮暴食的情况有所增加。然而，禁食者比不禁食者吃的面包片要少。与不暴饮暴食者相比，暴饮暴食者的禁食时数比率高出115%（RR为2.15；CI95%为1.70-2.73）。中度暴食者的禁食时间比率高出29%（RR 1.29；CI95% 1.05-1.59），而重度暴食者的禁食时间比率则增加到140%（RR 2.40；CI95% 1.86-3.11）。至于对食物的渴望（状态），量表单位每增加一个，比率比就增加2%（RR 1.02；CI 95% 1.01-1.03）：我们的研究表明，禁食与暴食和食物渴望程度的增加呈正相关。

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引用次数: 0

Racial and socioeconomic disparities in the treatment of unruptured intracranial aneurysms: A county hospital experience 治疗未破裂颅内动脉瘤的种族和社会经济差异：一家县级医院的经验。

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.008

Taylor Smith , Kelley Wormmeester , John Attia , Mesha Martinez , Nicolas Useche , Juan Tejada

Background

With increasing prevalence of unruptured intracranial aneurysms (UIAs), there is a need to provide appropriate management. Several studies have suggested that minorities in the United States have limited access to non-invasive imaging leading to increased presentation of aneurysmal subarachnoid hemorrhages (aSAHs). Given our medical institution's commitment to ensuring racial equality within our health care system, we chose to analyze our practice to assess the utilization of care provided by our neuroendovascular team. We hypothesized that given our diverse neuroendovascular care team along with our dedication to equity in healthcare, that we would find no difference in care provided to minority patients versus white patients who presented with UIAs.

Methods

We conducted a retrospective electronic medical record-based review of all patients with UIAs (n = 140) between September 2010 and June 2022 treated at a county hospital. Data regarding age at the time of treatment, gender, race, insurance type and aneurysm location were obtained.

Results

Of the 140 patients that underwent treatment, 54 % of patients were from the Black/Hispanic group and 46 % were from the white/non-Hispanic group. Commercial/private insurance was more common among White/NonHispanic patients (57.7 % vs 51.4 %) whereas Medicaid or uninsured status was more common among Black/Hispanic patients (25.7 % vs 15.4 %), although these differences were not statistically significant.

Conclusion

Building a diverse neuroendovascular physician team with intentionality to equity in healthcare, and providing appropriate funding and resources to facilities used by marginalized populations, such as safety-net institutions, can mitigate minority patients’ limited access to intracranial aneurysmal care.

背景：随着未破裂颅内动脉瘤（UIAs）发病率的增加，有必要提供适当的治疗。有几项研究表明，美国少数族裔获得非侵入性成像的机会有限，导致动脉瘤性蛛网膜下腔出血（aSAHs）的发病率增加。鉴于我们的医疗机构致力于确保医疗系统中的种族平等，我们选择对我们的实践进行分析，以评估我们的神经内血管团队所提供的医疗服务的利用率。我们假设，鉴于我们的神经内血管治疗团队是多元化的，而且我们致力于实现医疗保健的公平性，我们会发现在为患有 UIAs 的少数族裔患者和白人患者提供的治疗服务方面没有差异：我们对 2010 年 9 月至 2022 年 6 月期间在一家县级医院接受治疗的所有 UIA 患者（n = 140）进行了基于电子病历的回顾性分析。我们获得了有关治疗时的年龄、性别、种族、保险类型和动脉瘤位置的数据：在接受治疗的 140 名患者中，黑人/西班牙裔患者占 54%，白人/非西班牙裔患者占 46%。商业/私人保险在白人/非西班牙裔患者中更为常见（57.7% 对 51.4%），而医疗补助或无保险状态在黑人/西班牙裔患者中更为常见（25.7% 对 15.4%），尽管这些差异在统计学上并不显著：结论：建立一支多元化的神经血管内科医生团队，致力于实现医疗保健的公平性，并为边缘化人群使用的机构（如安全网机构）提供适当的资金和资源，可以减少少数族裔患者获得颅内动脉瘤治疗的机会。

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引用次数: 0

Disparities in Advanced Care Planning: Exploring Factors, Outcomes, and Equity 晚期护理规划中的差异：探索因素、结果和公平性

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.050

Toni-Ann J'nelle Lewis Degrees MD, MPH, Fatiah Joseph MD, Michael E. Kaiser MD, MPH, Gabriella J. Phillip MD, Joshua Green DPM, Francin Alexis MD, Louis Mudannayake MD, Anna Goehring MD, Kwesi Blackman MD, MBA, David Conner MD, MPH, William M. Briggs PhD

Purpose

ACP is pivotal in patient care. It emphasizes respecting an individual's values, preferences, and goals in decision-making. Although ACP is beneficial to patients and families, disparities persist, particularly among marginalized groups. We undertook this study to assess these disparities between ACP among patients of various groups and evaluate the relationship between these factors on shared-decision making.

Methods

A retrospective cohort analysis collected data from a single facility spanning March to September 2023, focusing on palliative care encounters. Data were categorized by demographics (race, age, gender) and factors affecting patient and family decisions, including religion, marital status, diagnosis, and ultimate choices (DNR/DNI, comfort-measures, hospice). We examined these variables through logistic regression models, chi-square tests, and F-tests (p < 0.05) to uncover potential correlations with advanced care planning.

Results

End-stage dementia patients showed a significant association with the likelihood and probability of undergoing ACP. Patients opting for comfort-directed care, DNR/DNI, and hospice care correlated significantly with ACP. Interestingly, there was no statistically significant association (p-value >0.05) between race, gender, marital status, religion, or age and the likelihood of undergoing ACP.

Conclusion

Our results diverge from past trends, showing diminished rates of ACP completion among specific ethnic and religious demographics. One potential rationale is the integration of social workers within our facility, actively engaging in ACP with patients. This approach facilitates early interventions and ensures comprehensive patient services across both outpatient and inpatient settings. Overcoming obstacles to ACP conversations and embracing diverse perspectives is essential to achieving equitable and compassionate end-of-life care.

目的 ACP 在病人护理中举足轻重。它强调在决策过程中尊重个人的价值观、偏好和目标。虽然 ACP 对患者和家属有益，但差距依然存在，尤其是在边缘化群体中。我们开展了这项研究，以评估不同群体患者之间的 ACP 差异，并评估这些因素与共同决策之间的关系。方法回顾性队列分析收集了 2023 年 3 月至 9 月期间一家医疗机构的数据，重点关注姑息治疗。数据按人口统计学（种族、年龄、性别）和影响患者及家属决策的因素进行分类，包括宗教信仰、婚姻状况、诊断和最终选择（DNR/DNI、舒适措施、临终关怀）。我们通过逻辑回归模型、卡方检验和 F 检验（p < 0.05）对这些变量进行了研究，以发现它们与晚期护理规划之间的潜在关联。选择舒适护理、DNR/DNI 和临终关怀的患者与 ACP 显著相关。有趣的是，种族、性别、婚姻状况、宗教信仰或年龄与接受 ACP 的可能性之间没有统计学意义（p 值为 0.05）。其中一个可能的原因是我们的医疗机构整合了社会工作者，他们积极地与病人一起参与 ACP。这种方法有利于早期干预，并确保在门诊和住院环境中为患者提供全面的服务。克服 ACP 对话的障碍并接受不同的观点对于实现公平和富有同情心的临终关怀至关重要。

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