Racism, Chronic Disease, and Mental Health: Time to Change Our Racialized System of Second-Class Care.

In this article, we describe how the "weathering hypothesis" and Adverse Childhood Experiences set the stage for higher rates of chronic disease, mental health disorders and maternal mortality seen in African American adults. We illustrate the toll that untreated and overtreated mental health disorders have on Black individuals, who have similar rates of mental health disorders as their white counterparts but have fewer outpatient mental health services and higher rates of hospitalizations. We discuss the history of Medicaid, which, while passed alongside Medicare during the Civil Rights era, was Congress's concession to Southern states unwilling to concede federal oversight and funds to the provision of equal healthcare for poor and Black people. Medicaid, which covers 33% of all Blacks in the US and suffers from chronic underfunding and state efforts to weaken it through demonstration waivers, is a second-class system of healthcare with eligibility criteria that vary by state and year. We propose the adoption of a national, single payer Medicare for All system to cover everyone equally, from conception to death. While this will not erase all structural racism, it will go a long way towards leveling the playing field and achieving greater equity in the US.

Recognizing and intervening in child sex trafficking.

Know the risk factors, choose from among 3 validated screening tools, and use a trauma-informed approach with those likely involved in trafficking.

Curriculum and evaluation results of a third-year medical student longitudinal pathway on underserved care.

BACKGROUND: There is a need to train compassionate and competent physicians to care for the growing underserved population in this country. DESCRIPTION: The authors developed the third-year Longitudinal Ambulatory Care Experience (LACE) Underserved Care pathway at Baylor College of Medicine in 2003 to help interested students prepare to be clinicians who care for the underserved. The pathway curriculum included seminar/journal clubs on relevant underserved care topics, clinical time with an underserved care preceptor, visits to community organizations, an assignment to help an uninsured patient obtain health care funding, and a group project. The authors report on the student evaluations of the first 4 years of the pathway, 2003 to 2007. The Institutional Review Board of Baylor College of Medicine granted this educational study exempt status. EVALUATION: Students highly rated each pathway component in enhancing their knowledge, skills and attitudes. For 2005 to 2007, students rated most knowledge, skills, and attitudes items more highly at the conclusion of the pathway compared to the beginning (p <.05). CONCLUSIONS: The pathway has been successful in enhancing knowledge, skills, and attitudes in underserved care for its participants. Further study is needed to evaluate long-term outcomes of participants in this pathway, including practice setting, knowledge, skills, attitudes, quality of care, and ability to help patients navigate through the health care system and overcome barriers.

Transportation characteristics associated with non-arrivals to paediatric clinic appointments: a retrospective analysis of 51 580 scheduled visits.

BACKGROUND: Prior work has not studied the effects of transportation accessibility and patient factors on clinic non-arrival. OBJECTIVES: Our objectives were: (1) to evaluate transportation characteristics and patient factors associated with clinic non-arrival, (2) to evaluate the comparability of bus and car drive time estimates, and (3) to evaluate the combined effects of transportation accessibility and income on scheduled appointment non-arrival. METHODS: We queried electronic administrative records at an urban general pediatrics clinic. We compared patient and transportation characteristics between arrivals and non-arrivals for scheduled appointments using multivariable modeling. RESULTS: There were 15 346 (29.8%) clinic non-arrivals. In separate car and bus multivariable models that controlled for patient and transit characteristics, we identified significant interactions between income and drive time, and clinic non-arrival. Patients in the lowest quartile of income who were also in the longest quartile of travel time by bus had an increased OR of clinic non-arrival compared with patients in the lowest quartile of income and shortest quartile of travel time by bus (1.55; P<0.01). Similarly, patients in the lowest quartile of income who were also in the longest quartile of travel time by car had an increased OR of clinic non-arrival compared with patients in the lowest quartile of income and shortest quartile of travel time by car (1.21, respectively; P<0.01). CONCLUSIONS: Clinic non-arrival is associated with the interaction of longer travel time and lower income.