Promoting Sustainability Practices in the Outpatient Pediatric Setting.

Healthcare systems intend to address health needs of a community, but unfortunately may also inadvertently exacerbate the climate crisis through increased greenhouse gas (GHG) emissions. Clinical medicine has not evolved to promote sustainability practices. New attention to the enormous impact of healthcare systems on GHG emissions and an escalating climate crisis has resulted in some institutions taking proactive measures to mitigate these negative effects. Some healthcare systems have made large-scale changes to conserve energy and materials, resulting in significant monetary savings. In this paper, we share our experience with developing an interdisciplinary work "green" team within our outpatient general pediatrics practice to implement changes, albeit small, to reduce our workplace carbon footprint. We share our experience with reducing paper usage by consolidating vaccine information sheets into a single use information sheet with quick response (QR) codes. We also share ideas for all workplaces to raise awareness of sustainability practices and to foster new ideas to address the climate crisis in both our professional and personal realms. These can help promote hope for the future and shift the collective mindset about climate action.

Contact by Collection Agencies for Medical Debt: Rural-Urban Differences Among Older and Younger Medicare Beneficiaries.

Geographic disparities in health and health care are increasingly well-documented, as are financial barriers to accessing care. Still, less is known about whether Medicare beneficiaries differ in their ability to pay for care by rurality. Using data from the 2016 Medicare Current Beneficiary Survey (n = 12,688 U.S. community-dwelling beneficiaries), we analyzed rural-urban differences in rates of collection agency contact for unpaid medical bills using chi-square tests and multivariable logistic regression for the full sample and by age (65+ and <65). Nearly 10% of Medicare beneficiaries had been contacted by a collection agency for medical debt in the previous year, with higher percentages among rural beneficiaries (8% for urban vs 10% for rural micropolitan and 11% for rural noncore, p < .05). This difference attenuated after adjusting for educational attainment and income, suggesting that attention to socio-economic status among rural Medicare beneficiaries would help to address financial barriers to care and decrease medical debt.

Impact of Evidence-Based Charge Nurse Education on Charge Nurse Skills and Nurse-Specific Metrics.

OBJECTIVE: This research study was designed to analyze the impact of an evidence-based charge nurse (CN) education program on novice and experienced CNs' self-confidence and satisfaction with the role, skill competencies, and nursing metrics. BACKGROUND: Charge nurses are critical to effective daily unit operations. However, executive nursing leadership found that unit performance varied by CN despite experience. METHODS: University faculty partnering with nurse leaders developed an evidence-based CN education program including a series of classes, coaching in skills and role responsibilities by nurse leaders, and evaluation of skills competencies before and after the CN education program. RESULTS: The CN program was associated with significant positive changes in CN performance, nurse-specific metrics, hospital-acquired events, and patient satisfaction. CONCLUSIONS: Interventions targeting frontline leaders positively impact CN performance.

Racial and Ethnic Differences in Self-Rated Health Among Rural Residents.

This study examines racial and ethnic differences in self-rated health among rural residents and whether these differences can be explained by socio-demographic characteristics. We used data from the 2011-2017 National Health Interview Survey to assess differences in self-rated health by race and ethnicity among rural residents (living in non-metropolitan counties; n = 46,883). We used logistic regression analyses to estimate the odds of reporting fair/poor health after adjusting for individual socio-demographic characteristics. Non-Hispanic Black and American Indian rural residents reported worse self-rated health than their non-Hispanic White counterparts (25.8% and 20.8% reporting fair/poor health, respectively, vs. 14.8%; p < 0.001). After adjusting for socio-demographic characteristics, disparities remained for non-Hispanic Black rural residents (Adjusted Odds Ratio = 1.55; 95% CI 1.36, 1.76). This study suggests more attention is required to address inequities among rural people and to develop policies to address structural racism and improve the health of all rural residents.

Differences by Rurality in Satisfaction with Care Among Medicare Beneficiaries.

PURPOSE: There are stark differences between rural and urban areas in demographic characteristics, health status, and health care, yet less is known about rural-urban differences in Medicare beneficiaries' satisfaction with care. We seek to identify rural-urban differences in satisfaction with care for Medicare beneficiaries and whether those differences are explained by differences in beneficiary characteristics. METHODS: We used data from the 2016 Medicare Current Beneficiary Survey (n = 10,625), in which beneficiaries indicated their level of satisfaction for 9 measures related to quality and access/affordability of care. We first assessed bivariate differences in satisfaction with care by rural-urban location (metropolitan, rural micropolitan, and rural noncore) across each measure. We then used logistic regression to assess whether differences remained after adjusting for sociodemographic and health characteristics. RESULTS: For nearly all measures, satisfaction with care decreased with increasing rurality. Differences in satisfaction persisted for satisfaction with ease of getting to the doctor from home (adjusted odds ratio [AOR] micropolitan: 0.63, P = .037; AOR noncore: 0.61, P = .023) and availability of care by specialists (AOR micropolitan: 0.51, P = .001; AOR noncore: 0.61, P < .001) after adjusting for sociodemographic and health characteristics. CONCLUSIONS: Rural Medicare beneficiaries reported lower satisfaction with care than their urban counterparts across a variety of measures, and some of these differences remained after adjustments were made for sociodemographic and health characteristics. These findings may have implications for access to and quality of care that rural Medicare beneficiaries receive and their subsequent health outcomes.

Rural Counties With Majority Black Or Indigenous Populations Suffer The Highest Rates Of Premature Death In The US.

Despite well-documented health disparities by rurality and race/ethnicity, research investigating racial/ethnic health differences among US rural residents is limited. We used county-level data to measure and compare premature death rates in rural counties by each county's majority racial/ethnic group. Premature death rates were significantly higher in rural counties with a majority of non-Hispanic black or American Indian/Alaska Native (AI/AN) residents than in rural counties with a majority of non-Hispanic white residents. After we adjusted for community-level covariates, differences in premature death remained significant in counties with a majority of AI/AN residents but not those with a majority of non-Hispanic black residents. This study highlights the particular vulnerability of non-Hispanic black and AI/AN rural communities to high rates of premature mortality. Policies to improve rural health should focus on these racially diverse communities, addressing economic vitality and current and historical political context to mitigate health inequities and the harmful health effects of neglecting social determinants of health.

Youth Engaged Participatory Air Monitoring: A 'Day in the Life' in Urban Environmental Justice Communities.

Air pollution in Southern California does not impact all communities equally; communities of color are disproportionately burdened by poor air quality and more likely to live near industrial facilities and freeways. Government regulatory monitors do not have the spatial resolution to provide air quality information at the neighborhood or personal scale. We describe the A Day in the Life program, an approach to participatory air monitoring that engages youth in collecting data that they can then analyze and use to take action. Academics partnered with Los Angeles-based youth environmental justice organizations to combine personal air monitoring, participatory science, and digital storytelling to build capacity to address local air quality issues. Eighteen youth participants from four different neighborhoods wore portable personal PM2.5 (fine particles <2.5 µm in diameter) monitors for a day in each of their respective communities, documenting and mapping their exposure to PM2.5 during their daily routine. Air monitoring was coupled with photography and videos to document what they experienced over the course of their day. The PM2.5 exposure during the day for participants averaged 10.7 µg/m3, although the range stretched from <1 to 180 µg/m3. One-third of all measurements were taken <300 m from a freeway. Overall, we demonstrate a method to increase local youth-centered understanding of personal exposures, pollution sources, and vulnerability to air quality.

The Association Between PM2.5 and Ozone and the Prevalence of Diabetes Mellitus in the United States, 2002 to 2008.

OBJECTIVE: To examine the association between air pollution and diabetes prevalence in the United States, 2002 to 2008. METHODS: Annual average particulate matter (PM2.5) and ozone concentrations were calculated using daily county-level data from the CDC's Tracking Network. Individual-level outcome and covariate data were obtained from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System for 862,519 individuals. We used Poisson regression analyses to examine associations between each air pollutant (per 10-unit increase) with diabetes, including regional sub-analyses. Analyses were adjusted for year, age, sex, race, ethnicity, education, income, smoking status, body mass index, exercise, and asthma. RESULTS: Positive associations between each pollutant and diabetes were found (PM2.5: prevalence ratio [PR] = 1.10; 95% confidence interval [CI] = 1.03, 1.17; ozone: PR = 1.06; 95% CI = 1.03, 1.09). There was limited evidence of effect modification by region. CONCLUSIONS: Interventions to reduce ambient air pollution may help alleviate the diabetes burden in the US.

Tissue hypoxia during ischemic stroke: adaptive clues from hypoxia-tolerant animal models.

The treatment and prevention of hypoxic/ischemic brain injury in stroke patients remain a severe and global medical issue. Numerous clinical studies have resulted in a failure to develop chemical neuroprotection for acute, ischemic stroke. Over 150 estimated clinical trials of ischemic stroke treatments have been done, and more than 200 drugs and combinations of drugs for ischemic and hemorrhagic strokes have been developed. Billions of dollars have been invested for new scientific breakthroughs with only limited success. The revascularization of occluded cerebral arteries such as anti-clot treatments of thrombolysis has proven effective, but it can only be used in a 3-4.5h time frame after the onset of a stroke, and not for every patient. This review is about novel insights on how to resist tissue hypoxia from unconventional animal models. Ability to resist tissue hypoxia is an extraordinary ability that is not common in many laboratory animals such as rat and mouse models. For example, we can learn from a naked mole-rat, Chrysemys picta, how to actively regulate brain metabolic activity to defend the brain against fluctuating oxygen tension and acute bouts of oxidative stress following the onset of a stroke. Additionally, a euthermic arctic ground squirrel can teach us how the brain of a stroke patient can remain well oxygenated during tissue hypoxia with no evidence of cellular stress. In this review, we discuss how these animals provide us with a system to gain insight into the possible mechanisms of tissue hypoxia/ischemia. This issue is of clinical significance to stroke patients. We describe specific physiological and molecular adaptations employed by different animals' models of hypoxia tolerance in aquatic and terrestrial environments. We highlight how these adaptations might provide potential clues on strategies to adapt for the clinical management of tissue hypoxia during conditions such as stroke where oxygen demand fails to match the supply.