Children with appendicitis on the US-Mexico border have socioeconomic challenges and are best served by a freestanding children's hospital.

INTRODUCTION: The US-Mexico border is medically underserved. Recent political changes may render this population even more vulnerable. We hypothesized that children on the border present with high rates of perforated appendicitis due to socioeconomic barriers. METHODS: A prospective survey was administered to children presenting with appendicitis in El Paso, Texas. Primary outcomes were rate of perforation and reason for diagnostic delay. We evaluated the association between demographics, potential barriers to care, risk of perforation and risk of misdiagnosis using logistic regression. p < 0.05 was considered significant. RESULTS: 98 patients participated from October 2016 to February 2017. 96 patients (98%) were Hispanic and 81 (82%) had Medicaid or were uninsured. 11 patients (11%) resided in Mexico or Guatemala. Patients were less likely to receive a CT and more likely to receive an ultrasound if they presented to a freestanding children's hospital (p = 0.01). 37 patients (38%) presented with perforation, of which 19 (52%) were the result of practitioner misdiagnosis. Patients who presented to a freestanding children's hospital were less likely to be misdiagnosed than patients presenting to other facilities (p = 0.05). Children who underwent surgery in a freestanding children's hospital had the shortest length of stay after adjusting for perforation status and potential confounders (p < 0.01). CONCLUSION: Children with low socioeconomic status did not have difficulty accessing care on the USA-Mexico border, but they were commonly misdiagnosed. Children were less likely to receive a CT, more likely to be correctly diagnosed and length of stay was shorter when patients presented to a freestanding children's hospital.

Aging memory self-efficacy: elders share their thoughts and experience.

Twenty-six elders responded to an open-ended question as part of a study that examined the relationships among depression, health, memory self-efficacy, and metamemory. Participants rated their overall memory function as fair to average (M = 4.26, standard deviation [SD] = 1.29). The average memory efficacy scores were high (M = 51.35, SD = 23.56). The final question invited participants to share any additional information they thought might be important to this item. This article represents a content analysis of these comments. The mean age of responders was 68.78; all had high perceived health and no depression. No differences on memory self-efficacy arose among age groups. Themes included memory management, rationalization, reflection, information seeking, and correlation establishment. Therefore, it is important for clinicians to ask elders about memory function during routine health care encounters, as individuals are interested in memory assessment and management.