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

Two new medical schools are planned at HBCUs (historically Black colleges and universities), one at Xavier University and the other at Morgan State University. The number of Black physicians as of 2021 was 48,248 and according to the Association of American Medical Colleges, an additional 21,000 Black physicians will be needed by 2034 to create a physician workforce that reflects the diversity of the United States. In this Commentary, the authors use prior work on projecting the number of Black medical school graduates from closed HBCUs to approximate the potential numbers of Black graduates from the two newly planned medical schools. Xavier and Morgan State will need to graduate 482 medical students per year for over 20 years to account for one HBCU medical school closed as a result of the 1910 Flexner Report. Projections from Xavier and Morgan State show 3,165 graduates by 2034.

Background: As an occupation, farmers are at high risk for depression and suicide and may exhibit distinctive depression symptom patterns.

Objective: To develop a new version of Patient Health Questionnaire-2 (PHQ-2) for rapid screening for Hawai'i farmers.

Methods: Cross-sectional survey collected Patient Health Questionnaire-9 (PHQ-9) data from 375 Hawai'i farmers. Network analysis included 144 participants with mild to severe depressive symptoms. Gaussian Graphical Models based on Spearman correlations were used to estimate depressive symptom networks, with bootstrapping employed to assess stability, and Receiver Operating Characteristic (ROC) analysis conducted to evaluate the sensitivity and specificity of the new PHQ-2.

Results: Three clusters emerged: Guilt-Mood-Anhedonia, Sleep-Fatigue-Appetite, and Suicide-Motor-Focus. Guilt and fatigue were central symptoms with high values across strength, closeness, betweenness, and expected influence. The new PHQ-2 (guilt and fatigue) demonstrated good validity (AUC = 0.883) and reliability (α =0.632).

Conclusions: The new PHQ-2 showed strong psychometric properties, providing a rapid screening tool for underserved populations of farmers. Findings have broader implications for addressing mental health needs in vulnerable communities globally.

The City of Boston established seven low- threshold shelters (LTS) between 2022- 2023 to address unsheltered homelessness, which disproportionately affects racially and ethnically marginalized groups. Guided by Housing First and harm reduction principles, these shelters provide immediate support for individuals experiencing homelessness and substance use disorder. Semi- structured qualitative interviews with 23 guests self- identified as belonging to racially and ethnically marginalized groups and focus groups with 35 LTS staff revealed barriers to housing stability rooted in structural racism, such as stigma, discrimination, and criminal- legal system involvement. Thematic framework analysis highlighted the critical role of LTS in fostering stability by addressing immediate needs. However, challenges in transitioning to permanent housing persisted, including difficulties obtaining identification and inadequate long- term support. Both guests and staff stressed the need for sustained financial, social, behavioral health, and medical support to ensure lasting stability. While LTS advanced short- term racial equity, overcoming systemic inequities requires additional efforts to sustain housing retention.

A diverse physician workforce is imperative to addressing health inequities, but few physicians identify as Black or Hispanic. Therefore, this study used the social constructionism framework to explore pediatric residents' perceptions of race in medical encounters. A qualitative study of 47 trainees at a tertiary care center revealed the following: (1) racism, not race, influences health; (2) trainee perceptions around race create feelings of discomfort during some racially discordant patient encounters, while they were a source of comfort for trainees of color during concordant encounters; and (3) trainee perceptions around race in racially discordant clinical encounters may result in a change in clinical practice. While participants expressed awareness that racism drives health disparities, they had limited understanding of how their interactions might further perpetuate disparate health outcomes for patients of color. This emphasizes the need to support anti-racism competencies in medical education and increase workforce diversity in health care.

The medical-legal partnership (MLP) model is a multidisciplinary intervention with demonstrated success in addressing health-harming legal needs. We analyzed initial data from the Georgetown University Health Justice Alliance's Cancer Legal Assistance and Well-being Project (Cancer LAW), an MLP between Georgetown University and MedStar Health serving cancer patients receiving care at an urban, safety-net hospital in Washington, D.C. The sample included 81 patients, who had an average of two legal issues, most commonly in the areas of Social Security, estate planning, housing, and health insurance. Data collected during legal representation captured both financial and non-financial benefits to patients. Patients who responded to a post-legal services survey reported reduced stress, and nearly 75% of survey respondents reported that legal services helped them maintain their treatment regimen. Further research, including on the impact of legal services on health outcomes, may be helpful in efforts to incorporate legal services as an accepted best practice in cancer care.

The evidence of rising workplace violence in the health care sector is clear. Two recent surveys (of emergency physicians and nursing personnel) indicate that the rate of violence experienced by health care workers has increased, and the number of assaults is alarming. Workplace violence also a is a key compounder of staff attrition as well as patient safety. Absent federal protective legislation, OSHA (Occupational Safety and Health Administration) has developed a potential standard for the prevention of workplace violence in health care and social assistance.

Dr. Leslie Alan (Epstein) Falk was an American physician, medical historian, and social medicine expert committed to ensuring that the poor and underserved had equitable access to medical care. He fought tirelessly to bring awareness and change to health care barriers and was instrumental in developing health clinic systems to help the socioeconomically disadvantaged. The reach of his work extended but was not limited to assisting the people of war-torn Byelorussia after World War II, migrant farmers, coal miners in the U.S., and Black Americans. He was a hero committed to advancing social medicine and fighting for health care for all.

Background: In the United States, uninsured patients with kidney failure often rely on emergency (compassionate) hemodialysis in acute care settings to manage life-threatening complications, as scheduled hemodialysis is often unattainable due to cost. This reactive approach has higher mortality rates, health care utilization, and cost than scheduled hemodialysis. Quality of life (QoL) outcomes are underexplored. This study evaluates changes in QoL after transitioning uninsured patients from emergency to scheduled hemodialysis.

Methods: Kidney Dialysis Quality of Life (KDQOL) surveys were administered pre- and three-months post- transition at a federally qualified health center in Texas. A Wilcoxon signed-rank test analyzed score differences.

Results: Among 39 patients significant improvements were observed across all KDQOL domains, with the greatest improvements in the "burden of kidney disease" (54.7%), "physical composite (33.13%), and "symptoms" (22.32%).

Conclusion: Expanding access to scheduled hemodialysis may improve QoL, reduce symptom burden, and lower cost in underserved populations.

Prevalence of COVID-19 vaccination among women who use drugs is largely unknown. Using a community-based sample, we explored correlates of COVID-19 vaccination stratified by level of vaccine confidence, measured by the widely used Vaccine Hesitancy Scale. Level of vaccine confidence was found to be significantly associated with uptake of the COVID-19 vaccine as well as recent flu vaccination. Poisson regression with robust variance was used to identify correlates of vaccination within both groups. Among higher-confidence women, vaccine uptake was associated with education and experiencing pandemic-related health care barriers and food insecurity, and likelihood of vaccination was lower among those who did not believe the vaccine was FDA-approved than among those who did. Among lower-confidence women, likelihood of vaccination was greater among Black women, those in shared housing, and drug treatment, but lower among those recruited from high-vaccination neighborhoods and who believed newer vaccines carry greater risk.

This study aimed to investigate the physical health, mental health, health-related behaviors, life satisfaction, and health care utilization of Office municipal d'habitation de Trois-Rivières (OMHTR) public housing residents compared with those of residents of the Mauricie region in Quebec. We administered a reduced version of the Canadian Community Health Survey (CCHS) to 150 OMHTR residents between July and November 2019, and compared the data with aggregated data from the 2018 CCHS for the Mauricie region using multivariable logistic regression. Results revealed significant disparities in health outcomes and service utilization patterns. OMHTR residents had higher odds of poor physical, oral, and mental health, along with dissatisfaction across various life domains. They also showed increased likelihood of seeking health care for mental health issues and reported injuries within the past year. These findings highlight considerable disparities in health outcomes and access to health care between OMHTR residents and their regional counterparts.