Journal of Health Care for the Poor and Underserved最新文献

Little is known about clinical documentation for youth exposed to parental justiceinvolvement (e.g., parole, probation, jail, prison). We reviewed the electronic health records of 100 youth with at least one mention of parental incarceration between 2011-2019 from a large Midwestern pediatric hospital-based institution to describe clinical documentation and health characteristics. Within the sample, youth more commonly experienced incarceration of a father-identified figure (68%) as opposed to a mother-identified figure (32%). Seventeen percent (17%) of the youth were between zero and four years of age when clinicians documented exposure to a parent's incarceration. Nearly one-third of youth charts had no documentation regarding service referrals or follow-up from providers upon disclosure of parental incarceration. Few clinician documentation details were present related to the context of parental justice involvement (timing, type, and duration). Future research is needed to better understand the intersection of parental justice involvement and child health and service connection.

The decline in cervical cancer incidence in the United States has not been uniform and has been influenced by access to care. Hence, we must explore cervical cancer screening routes that do not require a provider visit. This commentary is a call to action that highlights alternatives to cervical cancer screening, specifically the use of self-collected vaginal samples for testing and urine human papillomavirus (HPV) testing. We further must standardize protocols and provide resources to make these alternatives successful.

Introduction: Diabetes self-management education and support (DSMES) is effective for reducing health complications among people with type 2 diabetes (PWD). However, standard DSMES interventions have not been effective for Marshallese Pacific Islanders.

Methods: A culturally adapted Family-DSMES intervention for Marshallese PWD was implemented in churches in Hawaii and Washington state and delivered by Marshal-lese community health workers. We assessed changes in hemoglobin A1c (HbA1c), body mass index (BMI), and blood pressure from pre-to post-intervention (12 weeks).

Results: One hundred eighty-five (185) participants-99 PWD and 86 family members-completed classes and had valid pre-and post-intervention HbA1c data. For PWD, there were significant decreases in HbA1c (-0.69%; p=.0000) and BMI (-0.38; p=.008).

Discussion: The clinically and statistically significant reduction in HbA1c among PWD adds evidence for the effectiveness of family models of DSMES. Results will be used to inform future interventions and research studies with Marshallese and other Pacific Islander communities.

The postpartum period provides an opportunity to improve maternal and infant health, including identifying risks and completing immunization series. Research on completion of varicella and measles, mumps, and rubella (MMR) vaccine series among postpartum mothers is limited. This study examined data from mothers with public health insurance who received prenatal and postpartum care at the Mount Sinai Health System between January 1, 2021, and June 27, 2022. Two hundred and fifty-four (254; 11.9%) lacked immunity to at least one of these viruses: 104 to measles, 53 to rubella, and 137 to varicella. Forty-four percent (44.5%) and 52.7% initiated varicella and MMR series, respectively, during their immediate postpartum care. However, only 19% and 3.8% completed varicella and MMR series during their six-week postpartum visit, respectively. These findings underscore low rates of complete vaccination for measles, rubella, and varicella among serologically non-immune postpartum mothers with public health insurance.

Objectives: Surgeons' awareness of ethno-racial disparities in orthopedic care is critical to the implementation and success of efforts to reduce them. We examine the association between surgeons' self-reported intentions to enhance their ability to work with orthopedic patients from diverse cultures and their awareness of disparities.

Methods: Seventy U.S. members of the Science of Variation Group, an international partnership of surgeons who treat orthopedic conditions, completed a survey. We used path analytical structural equation modeling analysis framework.

Results: Surgeons' intention to improve their ability to work with patients from different cultures was associated with their awareness of disparities at the individual, interpersonal, and system levels, after controlling for gender, race, social desirability, and prior training in working with patients from different cultures.

Conclusions: Education and training programs should target surgeons' motivation for cultural competence and foster supportive attitudes through outcome-related incentives to help increase surgeon awareness of ethno-racial care disparities.

Objective: To understand attitudes towards telemedicine and to further elucidate benefits, disadvantages, and visit preferences in a largely minority, urban safety-net setting.

Methods: Between 2020 and 2021, pregnant people, and parents of children younger than two years old were recruited from outpatient clinics. Interviews were conducted via phone, recorded, transcribed, and translated. Data were analyzed using content analysis.

Results: Seventy-four (74) individuals participated including 42 pregnant people and 32 parents. Most participants cited advantages to telemedicine including safety, convenience, improved access, and less disruption of work schedules, and wished to continue to have the telemedicine option available after the pandemic.

Conclusions: Patients seeking care in safety-net settings, many of whom are working parents, noted that telemedicine improves access to care by providing an efficient and accessible option that overcomes barriers related to transportation and work schedules. Their experiences highlight the importance of continuing to offer telemedicine services.

The Department of Veterans Affairs provides a shallow subsidy (i.e., subsidizing 50% of an individual's rent for two years) to Veterans experiencing housing instability. We sought to describe the characteristics of Veterans who received these subsidies. Methods. We conducted a retrospective cohort study of Veterans between 10/2019-9/2021. We identified Veteran-level characteristics associated with receiving a shallow subsidy using a multivariable two-part regression model. We also conducted qualitative interviews to identify how shallow subsidies are allocated. Results Black race, higher income, more education, and older age were positively associated with receiving a shallow subsidy; previous homelessness, prior VA outpatient cost, and participating in permanent supportive housing were negatively associated with receiving a shallow subsidy. Interviews revealed that income was the most influential determinant of whether to give shallow subsidies. Discussion Our mixed methods findings were consistent, indicating that socioeconomic stability is an important driver of shallow subsidy allocation decisions.

Homelessness is associated with poor health outcomes and early development of cardiovascular disease. This study investigated the correlates of incident stroke and its association with mortality among Veterans experiencing housing instability. Using a national sample of Veterans (n=565,608) with incident housing instability between 2014-2018, we compared characteristics of Veterans who did and did not experience incident stroke and conducted logistic regressions to assess two outcomes: incident stroke and mortality. Almost four percent experienced a first stroke and were more frequently male, older than 55 years, Black, and non-Hispanic. A higher rate of mortality was observed among those with a first stroke compared with those with no stroke (17.6% vs. 10.8%), although the difference was not statistically significant. Incident stroke was associated with triple the odds of death among unstably-housed Veterans compared with those who did not have an incident stroke. Implications include the need to screen and monitor for stroke risk among Veterans with experience of housing instability, particularly for those who are older.

At the height of the COVID-19 pandemic, racial/ethnic minority residents of Prince George's County were disproportionately affected by the virus. This report from the field details an intervention that trained community health workers recruited from racial/ethnic minority communities to promote COVID-19 vaccination and health literacy among racially/ethnically diverse communities.

Providing equitable, patient-centered oral health care requires the dental community to address the cultural and linguistic needs and preferences of patients and their communities. This report describes our three-part demonstration project, providing an innovative framework and interprofessional approach to enhance language access in oral health care.