RESUMO
Cancer mortality rates have declined during the last 28 years, but that process is not equitably shared. Disparities in cancer outcomes by race, ethnicity, socioeconomic status, sexual orientation and gender identity, and geographic location persist across the cancer care continuum. Consequently, community outreach and engagement (COE) efforts within National Cancer Institute-Designated Cancer Center (NCI-DCC) catchment areas have intensified during the last 10 years as has the emphasis on COE and catchment areas in NCI's Cancer Center Support Grant applications. This review article attempts to provide a historic perspective of COE within NCI-DCCs. Improving COE has long been an important initiative for the NCI, but it was not until 2012 and 2016 that NCI-DCCs were required to define their catchment areas rigorously and to provide specific descriptions of COE interventions, respectively. NCI-DCCs had previously lacked adequate focus on the inclusion of historically marginalized patients in cancer innovation efforts. Integrating COE efforts throughout the research and operational aspects of the cancer centers, at both the patient and community levels, will expand the footprint of COE efforts within NCI-DCCs. Achieving this change requires sustained commitment by the centers to adjust their activities and improve access and outcomes for historically marginalized communities.
Assuntos
Institutos de Câncer , Relações Comunidade-Instituição , National Cancer Institute (U.S.) , Neoplasias , Humanos , Estados Unidos/epidemiologia , Neoplasias/terapia , Neoplasias/epidemiologia , Institutos de Câncer/organização & administração , Disparidades em Assistência à SaúdeRESUMO
As part of our commitment to amplifying the voices of underrepresented scientists, we are publishing the insights and experiences of a panel of underrepresented scientists. In this piece, they discuss strategies to recruit underrepresented minority students to universities and careers in science. These are the personal opinions of the authors and may not reflect the views of their institutions.
Assuntos
Pesquisa Biomédica/educação , Escolha da Profissão , Diversidade Cultural , Grupos Minoritários/educação , Seleção de Pessoal , Pesquisadores , Estudantes , Relações Comunidade-Instituição , Humanos , Mentores , Grupo AssociadoRESUMO
Social capital-the strength of an individual's social network and community-has been identified as a potential determinant of outcomes ranging from education to health1-8. However, efforts to understand what types of social capital matter for these outcomes have been hindered by a lack of social network data. Here, in the first of a pair of papers9, we use data on 21 billion friendships from Facebook to study social capital. We measure and analyse three types of social capital by ZIP (postal) code in the United States: (1) connectedness between different types of people, such as those with low versus high socioeconomic status (SES); (2) social cohesion, such as the extent of cliques in friendship networks; and (3) civic engagement, such as rates of volunteering. These measures vary substantially across areas, but are not highly correlated with each other. We demonstrate the importance of distinguishing these forms of social capital by analysing their associations with economic mobility across areas. The share of high-SES friends among individuals with low SES-which we term economic connectedness-is among the strongest predictors of upward income mobility identified to date10,11. Other social capital measures are not strongly associated with economic mobility. If children with low-SES parents were to grow up in counties with economic connectedness comparable to that of the average child with high-SES parents, their incomes in adulthood would increase by 20% on average. Differences in economic connectedness can explain well-known relationships between upward income mobility and racial segregation, poverty rates, and inequality12-14. To support further research and policy interventions, we publicly release privacy-protected statistics on social capital by ZIP code at https://www.socialcapital.org .
Assuntos
Status Econômico , Amigos , Renda , Capital Social , Mobilidade Social , Adulto , Criança , Relações Comunidade-Instituição , Conjuntos de Dados como Assunto , Status Econômico/estatística & dados numéricos , Mapeamento Geográfico , Humanos , Renda/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Racismo , Mídias Sociais/estatística & dados numéricos , Mobilidade Social/estatística & dados numéricos , Apoio Social , Estados Unidos , VoluntáriosRESUMO
We are a group of archaeologists, anthropologists, curators and geneticists representing diverse global communities and 31 countries. All of us met in a virtual workshop dedicated to ethics in ancient DNA research held in November 2020. There was widespread agreement that globally applicable ethical guidelines are needed, but that recent recommendations grounded in discussion about research on human remains from North America are not always generalizable worldwide. Here we propose the following globally applicable guidelines, taking into consideration diverse contexts. These hold that: (1) researchers must ensure that all regulations were followed in the places where they work and from which the human remains derived; (2) researchers must prepare a detailed plan prior to beginning any study; (3) researchers must minimize damage to human remains; (4) researchers must ensure that data are made available following publication to allow critical re-examination of scientific findings; and (5) researchers must engage with other stakeholders from the beginning of a study and ensure respect and sensitivity to stakeholder perspectives. We commit to adhering to these guidelines and expect they will promote a high ethical standard in DNA research on human remains going forward.
Assuntos
Cadáver , DNA Antigo/análise , Guias como Assunto , Genética Humana/ética , Internacionalidade , Biologia Molecular/ética , Indígena Americano ou Nativo do Alasca , Antropologia/ética , Arqueologia/ética , Relações Comunidade-Instituição , Humanos , Povos Indígenas , Participação dos Interessados , TraduçõesRESUMO
Identifying rates at which birders engage with different species can inform the impact and efficacy of conservation outreach and the scientific use of community-collected biodiversity data. Species that are thought to be "charismatic" are often prioritized in conservation, and previous researchers have used sociological experiments and digital records to estimate charisma indirectly. In this study, we take advantage of community science efforts as another record of human engagement with animals that can reveal observer biases directly, which are in part driven by observer preference. We apply a multistage analysis to ask whether opportunistic birders contributing to iNaturalist engage more with larger, more colorful, and rarer birds relative to a baseline approximated from eBird contributors. We find that body mass, color contrast, and range size all predict overrepresentation in the opportunistic dataset. We also find evidence that, across 472 modeled species, 52 species are significantly overreported and 158 are significantly underreported, indicating a wide variety of species-specific effects. Understanding which birds are highly engaging can aid conservationists in creating impactful outreach materials and engaging new naturalists. The quantified differences between two prominent community science efforts may also be of use for researchers leveraging the data from one or both of them to answer scientific questions of interest.
Assuntos
Aves , Participação da Comunidade , Relações Comunidade-Instituição , Conservação dos Recursos Naturais , Animais , Bases de Dados Factuais , Humanos , Fenótipo , Especificidade da EspécieRESUMO
PURPOSE: National Cancer Institute (NCI)-designated cancer centers are required to consider their impact on the catchment area they serve. These activities are facilitated by community outreach and engagement (COE) activities as specified in the Cancer Center Support Grant (CCSG) request for applications. While the critical importance of COE activities to NCI-designated cancer centers is well known, it is less clear what impact the COE component has on the overall CCSG merit descriptor and score. METHODS: We undertook an online survey of all 62 NCI-designated Comprehensive and Clinical centers who reported their COE merit descriptor and overall CCSG priority score as of Fall 2021. RESULTS: Of 48 (77%) of responding centers, we identified a strong correlation between the COE merit descriptor and the overall numerical CCSG score received by the center (Spearman's rank correlation coefficient r = 0.360, p = 0.0053). When stratifying this relationship by center type, we observed a very strong correlation between COE and CCSG ratings for comprehensive cancer centers (n = 40; r = 0.544; p = 0.0003) but not for non-comprehensive cancer centers (n = 8; r = 0.073; p = 0.864). CONCLUSION: COE component merit descriptors for comprehensive cancer center CCSG evaluations are strongly correlated with the overall cancer center review score.
Assuntos
Relações Comunidade-Instituição , Neoplasias , Estados Unidos , Humanos , National Cancer Institute (U.S.) , Inquéritos e Questionários , Neoplasias/terapiaRESUMO
PURPOSE: Community engagement has benefits for cancer centers' work and for its researchers. This study examined the experiences and perceptions of community engagement by members of the Case Comprehensive Cancer Center (Case CCC) to create and implement a framework to meet the needs of the entire cancer center. METHODS: This study included three phases: 1) Semi-structured interviews with 12 researchers from a basic science program to identify needs and suggestions for the support of community engagement; 2) Preliminary interview results informed the development of a survey of 86 cancer center members' about their awareness of and readiness to integrate community outreach and engagement into their research; and 3) The Case CCC Office of Community Outreach and Engagement reviewed the results from phases 1 and 2 to develop and then utilize a framework of engagement opportunities. RESULTS: In the interviews and surveys, cancer center members recognized the importance of community engagement and expressed an interest in participating in COE-organized opportunities for bidirectional engagement. While participation barriers include communication issues, limited awareness of opportunities, and competing priorities, members were open to learning new skills, changing approaches, and utilizing services to facilitate engagement. The framework outlines engagement opportunities ranging from high touch, low reach to low touch, and high reach and was used to develop specific services. CONCLUSION: This study identified varying needs around community engagement using an approach aimed at understanding the perspectives of a community of scientists. Implementing the framework enables reaching scientists in different ways and facilitates scientists' recognition of and engagement with opportunities.
Assuntos
Institutos de Câncer , Humanos , Institutos de Câncer/organização & administração , Neoplasias/psicologia , Neoplasias/terapia , Participação da Comunidade/métodos , Inquéritos e Questionários , Fortalecimento Institucional , Relações Comunidade-InstituiçãoRESUMO
An implementation and effectiveness evaluation of the Community Scholars Program was conducted at the University of Pennsylvania to enhance community capacity to collaborate with academics in mutually beneficial, equitable, and transformative research. Mixed methods were employed using administrative data, surveys, and key informant interviews. Participants expressed high satisfaction, valued interactive learning, and identified areas for improvement. The program increased knowledge and self-confidence in research-related skills and trust in the research process. The program serves as an institutional model to create long-term, mutually beneficial community-academic partnerships. (Am J Public Health. 2024;114(3):284-288. https://doi.org/10.2105/AJPH.2023.307549).
Assuntos
Pesquisa Participativa Baseada na Comunidade , Relações Comunidade-Instituição , Humanos , Avaliação de Programas e Projetos de Saúde , Pesquisa Participativa Baseada na Comunidade/métodos , Currículo , ConfiançaRESUMO
In June 2022, Alabama legalized fentanyl test strips (FTS). In response to this new opportunity to prevent overdoses, Project Linkage, Education, and Prevention (LEAP)-an academic-community partnership providing substance use prevention services-quickly purchased FTS and started distributing them in the Birmingham area. We describe how the Addiction Prevention Coalition, a substance use education and harm reduction provider, distributed 7300 FTS in the first year of legalization via Project LEAP and discuss its efforts to decrease substance use among young people. (Am J Public Health. 2024;114(8):785-788. https://doi.org/10.2105/AJPH.2024.307681).
Assuntos
Fentanila , Humanos , Alabama , Overdose de Drogas/prevenção & controle , Analgésicos Opioides , Relações Comunidade-Instituição , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Redução do DanoRESUMO
This article describes a community-academic partnership designed and implemented to address disparities in accessing COVID-19 testing in Arizona, from November 2020 through March 2023. An equitable community-academic partnership, the involvement of local leaders, and the engagement of community health workers were critical for the success of the intervention. More than 5000 previously underserved patients were tested and received COVID-19 related services. A profile comparison with a matched group documents the success of the program in reaching the targeted population. (Am J Public Health. 2024;114(S5):S388-S391. https://doi.org/10.2105/AJPH.2024.307684).
Assuntos
COVID-19 , Área Carente de Assistência Médica , Populações Vulneráveis , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Arizona , Feminino , Masculino , Adulto , SARS-CoV-2 , Relações Comunidade-Instituição , Pessoa de Meia-Idade , Agentes Comunitários de Saúde/organização & administração , Disparidades em Assistência à Saúde , Idoso , Teste para COVID-19 , Acessibilidade aos Serviços de Saúde/organização & administraçãoRESUMO
Reversing physical disinvestment, e.g., by remediating abandoned buildings and vacant lots, is an evidence-based strategy to reduce urban firearm violence. However, adoption of this strategy has been inconsistent across US cities. Our community-academic partnership sought to support adoption in Toledo, OH, USA, by generating locally relevant analyses on physical disinvestment and firearm violence. We used a spatial case-control design with matching. Physical disinvestment measures were derived from a citywide parcel foot audit conducted by the Lucas County Land Bank in summer 2021. Firearm violence outcomes were incident-level shootings data from the Toledo Police Department from October 2021 through February 2023. Shooting locations were matched to controls 1:4 on poverty rate, roadway characteristics, and zoning type. Exposures were calculated by aggregating parcels within 5-min walking buffers of each case and control point. We tested multiple disinvestment measures, including a composite index. Models were logistic regressions that adjusted for the matching variables and for potential spatial autocorrelation. Our sample included N = 281 shooting locations and N = 1124 matched controls. A 1-unit increase in the disinvestment score, equal to approximately 1 additional disrepair condition for the average parcel within the walking buffer, was associated with 1.68 times (95% CI: 1.36, 2.07) higher odds of shooting incidence. Across all other measures, greater disinvestment was associated with higher odds of shooting incidence. Our finding of a strong association between physical disinvestment and firearm violence in Toledo can inform local action. Community-academic partnership could help increase adoption of violence prevention strategies focused on reversing physical disinvestment.
Assuntos
Armas de Fogo , Humanos , Violência com Arma de Fogo/prevenção & controle , Estudos de Casos e Controles , Ferimentos por Arma de Fogo/prevenção & controle , Ferimentos por Arma de Fogo/epidemiologia , Relações Comunidade-Instituição , Violência/prevenção & controleRESUMO
BACKGROUND: The engagement of community partners in equitable partnerships with academic teams is necessary to achieve health equity. However, there is no standardized approach to support bidirectional engagement among research stakeholders in the context of partnership equity at each phase of the research process. OBJECTIVE: We describe the development of a systematic framework along with competencies and tools promoting bidirectional engagement and equity within community-academic partnerships at each phase of the research process. DESIGN: We conducted a four-step research process between November 2020 and December 2023 for framework development: (1) a narrative literature review; (2) expansion of existing bidirectional, equitable framework; (3) a scientific review with two groups of cognitive interviews (five community engagement researchers and five community leaders and members); and (4) three community-based organization leader focus groups. Thematic analysis was used to analyse focus group data. RESULTS: Using results of each step, the framework was iteratively developed, yielding four phases of the bidirectional engagement and equity (BEE) research framework: Relationship building and assessment of goals and resources (Phase I); form a community-academic partnership based on shared research interests (may include multilevel stakeholders) (Phase II); develop a research team comprising members from each partnering organization (Phase III); and implement the six-step equitable research process (Phase IV). Bidirectional learning and partnership principles are at the core of the partnership, particularly in Phases II-IV. Competencies and tools for conducting an equitable, engaged research process were provided. DISCUSSION: This conceptual framework offers a novel, stepwise approach and competencies for community-academic partners to successfully partner and conduct the research process equitably. CONCLUSION: The BEE research framework can be implemented to standardize the conduct of an equitable, engaged research process within a community-academic partnership, while improving knowledge and trust across partners and, ultimately, an increased return on investment and sustainability to benefit both partners in the area of health outcomes and ultimately health equity. PATIENT OR PUBLIC CONTRIBUTION: The development of this framework was co-led with a community organization in which two leaders in the organization were equitably involved in each phase of the research process, including grant development, study design, participant recruitment, protocol development for focus groups and community and researcher review, framework design and content and dissemination of this manuscript as a co-author. For grant development, the community leader completed the give-get grid components for them as a partner. They also wrote up their lived experience in the research process for the progress report. For the focus groups, one community leader co-led the focus group with the academic partner. For the narrative review, the community leaders did not actively conduct the narrative review but observed the process through the academic partners. One community leader wrote the section 'relationship building' and 'bidirectional learning' sections with the assistance of the academic partner, while they both equally provided input on other sections of the manuscript alongside academic partners. The community leaders have extensive experience in leading programmes, along with partnering with researchers to address health equity issues and improve health outcomes.
Assuntos
Relações Comunidade-Instituição , Grupos Focais , Equidade em Saúde , Participação dos Interessados , Humanos , Pesquisa Participativa Baseada na Comunidade/organização & administração , Comportamento Cooperativo , Participação da Comunidade/métodosRESUMO
BACKGROUND: Black individuals in the U.S. face increasing racial disparities in drug overdose related to social determinants of health, including place-based features. Mobile outreach efforts work to mitigate social determinants by servicing geographic areas with low drug treatment and overdose prevention access but are often limited by convenience-based targets. Geographic information systems (GIS) are often used to characterize and visualize the overdose crisis and could be translated to community to guide mobile outreach services. The current study examines the initial acceptability and appropriateness of GIS to facilitate data-driven outreach for reducing overdose inequities facing Black individuals. METHODS: We convened a focus group of stakeholders (N = 8) in leadership roles at organizations conducting mobile outreach in predominantly Black neighborhoods of St. Louis, MO. Organizations represented provided adult mental health and substance use treatment or harm reduction services. Participants were prompted to discuss current outreach strategies and provided feedback on preliminary GIS-derived maps displaying regional overdose epidemiology. A reflexive approach to thematic analysis was used to extract themes. RESULTS: Four themes were identified that contextualize the acceptability and utility of an overdose visualization tool to mobile service providers in Black communities. They were: 1) importance of considering broader community context; 2) potential for awareness, engagement, and community collaboration; 3) ensuring data relevance to the affected community; and 4) data manipulation and validity concerns. CONCLUSIONS: There are several perceived benefits of using GIS to map overdose among mobile providers serving Black communities that are overburdened by the overdose crisis but under resourced. Perceived potential benefits included informing location-based targets for services as well as improving awareness of the overdose crisis and facilitating collaboration, advocacy, and resource allocation. However, as GIS-enabled visualization of drug overdose grows in science, public health, and community settings, stakeholders must consider concerns undermining community trust and benefits, particularly for Black communities facing historical inequities and ongoing disparities.
Assuntos
Negro ou Afro-Americano , Overdose de Drogas , Grupos Focais , Sistemas de Informação Geográfica , Humanos , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Overdose de Drogas/etnologia , Negro ou Afro-Americano/estatística & dados numéricos , Relações Comunidade-Instituição , Masculino , Feminino , Adulto , Disparidades nos Níveis de Saúde , Participação dos InteressadosRESUMO
BACKGROUND: Taiwan implemented the Cancer Screening Quality Improvement Program (CAQIP) in 2010. The program sought to enhance mass breast cancer screening accessibility. This study aimed to examine socioeconomic disparities in outreach screening utilization pre-CAQIP (2005-2009) and post-CAQIP (2010-2014). METHOD: We conducted a nationwide population-based observational study in Taiwan, analyzing four population databases to evaluate socioeconomic disparities among women aged 50 to 69 years undergoing their first mammography screening pre-CAQIP. Multivariate logistic regression was used to examine changes in utilization of outreach screening pre- and post-CAQIP implementation, and to estimate the Slope Index of Inequity (SII) and Relative Index of Inequity (RII) values. RESULTS: Utilization of outreach screening through mobile mammography units (MMUs) increased from 6.12 to 32.87% between the two periods. Following CAQIP, a higher proportion of screened women were older, less educated, and from suburban or rural areas. The SII and RII for age, income, and urbanization levels decreased post-CAQIP. However, regarding education level, SII was - 0.592 and RII was 0.392 in the pre-CAQIP period, increasing to -0.173 and 0.804 post-CAQIP, respectively. CONCLUSIONS: Our study observed that utilization of outreach screening through MMUs increased after CAQIP. The MMUs made outreach screening services more accessible in Taiwan. Expanding outreach screening services and educational programs to promote mammography uptake in local communities could help reduce the potential effect of socioeconomic disparities, and thus may enhance early detection of breast cancer. Further study could focus on the accessibility of outreach screening and breast cancer outcomes.
Assuntos
Neoplasias da Mama , Detecção Precoce de Câncer , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Mamografia , Fatores Socioeconômicos , Humanos , Mamografia/estatística & dados numéricos , Feminino , Taiwan , Pessoa de Meia-Idade , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , Neoplasias da Mama/diagnóstico por imagem , Idoso , Detecção Precoce de Câncer/estatística & dados numéricos , Melhoria de Qualidade , Política de Saúde , Relações Comunidade-Instituição , Programas de Rastreamento/estatística & dados numéricosRESUMO
BACKGROUND: Recent research highlighting a shortage of pediatric subspecialists in the United States has shown wide variations in the distance from children to the nearest subspecialists but has not accounted for subspecialty outreach clinics, in which specialists may improve access in rural areas by periodically staffing clinics there. This study aimed to determine the impact of pediatric subspecialty outreach clinics on the driving times to the nearest pediatric subspecialists for children in Maine. METHODS: This cross-sectional study utilized administrative data on the schedule and location of pediatric subspecialty clinics in Maine in 2022 to estimate the driving time from each ZIP-code tabulation area to the nearest subspecialist, with and without the inclusion of outreach clinics. Using 2020 census data, we calculated the median and interquartile ranges of driving times for the state's overall child population, as well as for children living in urban and rural areas. RESULTS: Of 207,409 individuals under 20 years old in Maine, 68% were located closer to an outreach location than to a clinical hub. Across the seven subspecialties offering outreach clinics, outreach clinics decreased median driving times to the nearest pediatric subspecialist by 5 to 26 minutes among all children, and by 16 to 46 minutes among rural children. CONCLUSIONS: Pediatric subspecialty outreach clinics can substantially reduce the driving time to the nearest pediatric subspecialist , especially for children living in rural areas. The use of outreach clinics should be accounted for in research describing the geographic access or barriers to care. Expanding the number of outreach clinics should be considered by policymakers hoping to improve access.
Assuntos
Acessibilidade aos Serviços de Saúde , Pediatria , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Estudos Transversais , Criança , Maine , Adolescente , Pré-Escolar , Serviços de Saúde Rural/estatística & dados numéricos , Especialização/estatística & dados numéricos , Relações Comunidade-Instituição , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Instituições de Assistência Ambulatorial/organização & administração , LactenteRESUMO
BACKGROUND: Individuals experiencing homelessness face unique physical and mental health challenges, increased morbidity, and premature mortality. COVID -19 creates a significant heightened risk for those living in congregate sheltering spaces. In March 2020, the COVID-19 Community Response Team formed at Women's College Hospital, to support Toronto shelters and congregate living sites to manage and prevent outbreaks of SARS-CoV-2 using a collaborative model of onsite mobile testing and infection prevention. From this, the Women's College COVID-19 vaccine program emerged, where 14 shelters were identified to co-design and support the administration of vaccine clinics within each shelter. This research seeks to evaluate the impact of this partnership model and its future potential in community-centered integrated care through three areas of inquiry: (1) vaccine program evaluation and lessons learned; (2) perceptions on hospital/community partnership; (3) opportunities to advance hospital-community partnerships. METHODS: Constructivist grounded theory was used to explore perceptions and experiences of this partnership from the voices of shelter administrators. Semi-structured interviews were conducted with administrators from 10 shelters using maximum variation purposive sampling. A constructivist-interpretive paradigm was used to determine coding and formation of themes: initial, focused, and theoretical. RESULTS: Data analysis revealed five main categories, 16 subcategories, and one core category. The core category "access to healthcare is a human right; understand our communities" emphasizes access to healthcare is a consistent barrier for the homeless population. The main categories revealed during a time of confusion, the hospital was seen as credible and trustworthy. However, the primary focus of many shelters lies in housing, and attention is often not placed on health resourcing, solidifying partnerships, accountability, and governance structures therein. Health advocacy, information sharing tables, formalized partnerships and educating health professionals were identified by shelter administrators as avenues to advance intersectoral relationship building. CONCLUSION: Hospital-community programs can alleviate some of the ongoing health concerns faced by shelters - during a time of COVID-19 or not. In preparation for future pandemics, access to care and cohesion within the health system requires the continuous engagement in relationship-building between hospitals and communities to support co-creation of innovative models of care, to promote health for all.
Assuntos
COVID-19 , Acessibilidade aos Serviços de Saúde , Pessoas Mal Alojadas , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Acessibilidade aos Serviços de Saúde/organização & administração , Ontário , Feminino , SARS-CoV-2 , Vacinas contra COVID-19 , Relações Comunidade-Instituição , Teoria Fundamentada , Avaliação de Programas e Projetos de SaúdeRESUMO
Within a small geographic area, Marion County contains a stark spectrum of health outcomes and socioeconomic statuses. The Indiana University Student Outreach Clinic (IUSOC) serves as a safety net provider, offering free health and social services in the Near Eastside neighborhood of Indianapolis. The aim of this study was to characterize the demographics and geographic distribution of the IUSOC's patient population. From January to September 2023, 612 patients visited the IUSOC, and 460 self-identified as Marion County residents. 63.9% of patients were between 45 and 64 years old. 66.8% were Non-Hispanic (NH) Black, and 23.3% were Hispanic. 18.9% spoke Spanish and had limited English proficiency. Based on the Distressed Communities Index (DCI), 58.7% lived in "Distressed" zip codes, indicating economic vulnerability and disparities. The zip code with the greatest number of IUSOC patients had the highest rate of uninsured adults in Marion County. IUSOC patients are primarily middle-aged minorities who live in zip codes with low socioeconomic rankings by DCI. This information can be used to improve community resource referral pathways in the clinic.
Assuntos
Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Relações Comunidade-Instituição , Hispânico ou Latino/estatística & dados numéricos , Indiana , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Provedores de Redes de Segurança/estatística & dados numéricos , Universidades , Negro ou Afro-Americano/estatística & dados numéricos , Brancos/estatística & dados numéricosRESUMO
BACKGROUND: Despite the widespread use of the phrase "harm reduction" and the proliferation of programs based on its principles during the current opioid epidemic, what it means in practice is not universally agreed upon. Harm reduction strategies have expanded from syringe and needle exchange programs that emerged in the mid-1980s primarily in response to the HIV epidemic, to include medication for opioid use disorder, supervised consumption rooms, naloxone distribution, and drug checking technologies such as fentanyl test strips. Harm reduction can often be in tension with abstinence and recovery models to address substance use, and people who use drugs may also hold competing views of what harm reduction means in practice. Street-based outreach workers are increasingly incorporated into harm reduction programs as part of efforts to engage with people more fully in various stages of drug use and nonuse. METHOD: This paper explores how peer outreach workers, called "members," in a street-based naloxone distribution program define and practice harm reduction. We interviewed 15 members of a street-based harm reduction organization in an urban center characterized by an enduring opioid epidemic. Inductive data analysis explored harm reduction as both a set of principles and a set of practices to understand how frontline providers define and enact them. RESULTS: Analysis revealed that when members talked about their work, they often conceptualized harm reduction as a collection of ways members and others can "save lives" and support people who use drugs. They also framed harm reduction as part of a "path toward recovery." This path was complicated and nonlinear but pursued a common goal of life without drug use and its residual effects. These findings suggest the need to develop harm reduction programs that incorporate both harm reduction and recovery to best meet the needs of people who use drugs and align with the value systems of implementers.
Assuntos
Redução do Dano , Naloxona , Antagonistas de Entorpecentes , Grupo Associado , Humanos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Feminino , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Masculino , Adulto , Pesquisa Qualitativa , Relações Comunidade-Instituição , Programas de Troca de AgulhasRESUMO
ABSTRACT: Accessing treatment at ACPA (American Cleft Palate-Craniofacial Association)-approved centers is challenging for individuals in rural communities. This study aims to assess how pediatric plastic surgery outreach clinics impact access for patients with orofacial cleft and craniosynostosis in Mississippi. An isochrone map was used to determine mean travel times from Mississippi counties to the sole pediatric hospital and the only ACPA-approved team in the state. This analysis was done before and after the establishment of two outreach clinics to assess differences in travel times and cost of travel to specialized plastic surgery care. Two sample t-tests were used for analysis.The addition of outreach clinics in North and South Mississippi led to a significant reduction in mean travel times for patients with cleft and craniofacial diagnoses across the state's counties (1.81 hours vs 1.46 hours, P < 0.001). Noteworthy travel cost savings were observed after the introduction of outreach clinics when considering both the pandemic gas prices ($15.27 vs $9.80, P < 0.001) and post-pandemic prices ($36.52 vs $23.43, P < 0.001).The addition of outreach clinics in Mississippi has expanded access to specialized healthcare for patients with cleft and craniofacial differences resulting in reduced travel time and cost savings for these patients. Establishing specialty outreach clinics in other rural states across the United States may contribute significantly to reducing burden of care for patients with clefts and craniofacial differences. Future studies can further investigate whether the inclusion of outreach clinics improves follow-up rates and surgical outcomes for these patients.
Assuntos
Fenda Labial , Fissura Palatina , Acessibilidade aos Serviços de Saúde , Humanos , Mississippi , Fissura Palatina/cirurgia , Fissura Palatina/economia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/economia , Fenda Labial/cirurgia , Fenda Labial/economia , Craniossinostoses/cirurgia , Craniossinostoses/economia , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Procedimentos de Cirurgia Plástica/economia , Relações Comunidade-Instituição , Masculino , Criança , Viagem/estatística & dados numéricosRESUMO
We offered an enrichment program for high school students with the theme, "The Environment, Health, and You" during the Summer of 2022 and the Spring of 2023. We developed several educational modules for high school students that provided them with an opportunity to learn and explore the foundations of physiological systems, nutrient needs to maintain health, and the impact that environmental factors can have on them. The modules included videos, discussion boards, games, readings, and labs. These modules were integrated into the first session: Your Body and Health. On day 1, the first module explored the basic physiology and anatomy of the body with respect to the organization of cells into organ systems. Additionally, the educational content included information on macro- and micronutrients and their impact on body development, nutrition, and metabolism. The nutrition module explored nutrition concepts and various factors that can impact healthy eating patterns, such as food insecurity issues and the consumption of ultraprocessed foods. A lab activity on label reading was included to help empower students to make healthy choices. A total of 43 high school students participated in the program. Overall, the quality of the educational content in the modules was rated highly by the students, and they indicated that the educational experience inspired them to learn more about the physiology and nutrition concepts associated with human metabolism, and the importance of healthy food choices to maintain health.NEW & NOTEWORTHY We describe how we integrated guided learning teaching modules in an enrichment program for high school students with the aim of enhancing their knowledge and skills to empower them to take charge of their own health risks and well-being.