Assessing Physicians' Recommendations for Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) Testing Among Minority Populations in Greater Philadelphia and New York City.

Deaths from liver cancer are on the rise and disproportionately affect minority racial/ethnic groups. In this study, we examined associations between physicians' recommendations for hepatitis B virus (HBV) and hepatitis C virus (HCV) screening and sociodemographic and lifestyle factors among minority populations in the areas of Greater Philadelphia and New York City. Using Poisson regression with robust variance estimation, we evaluated potential associations for 576 Hispanic American (HA), African American (AA), and Asian Pacific American (APA) adults, using blood tests as an outcome measure, with adjustment for sociodemographic factors We found that APAs (34.2%) were most likely to have a physician recommend HBV and HCV screening tests (34.2% and 27.1%, respectively), while HAs were least likely to receive an HBV recommendation (15.0%) and AAs were least likely to receive an HCV recommendation (15.3%). HAs were significantly likely to have never received a blood test for either HBV or HCV (RR = 1.25, 95% CI: 1.05, 1.49). APAs were significantly more likely to receive a screening recommendation for HBV (RR = 1.10, 95%CI: 1.01, 1.20) and to have a blood test (RR = 1.57, 95% CI: 1.06, 2.33). Our findings show that, among HAs, AAs, and APAs, physician recommendations are strongly associated with patients undergoing blood tests for HBV and HCV and that minority populations should increasingly be recommended to screen for HBV and HCV, especially given their elevated risk.

Advancement of research on nurse practitioners: Setting a research agenda.

BACKGROUND: Primary care delivered by nurse practitioners (NPs) helps to meet the United States' growing demand for care and improves patient outcomes. Yet, barriers impede NP practice. Knowledge of these barriers is limited, hindering opportunities to eliminate them. PURPOSE: We convened a 1.5-day conference to develop a research agenda to advance evidence on the primary care NP workforce. METHODS: Thirty experts gathered in New York City for a conference in 2022. The conference included plenary sessions, small group discussions, and a prioritization process to identify areas for future research and research questions. DISCUSSION: The research agenda includes top-ranked research questions within five categories: (a) policy regulations and implications for care, quality, and access; (b) systems affecting NP practice; (c) health equity and the NP workforce; (d) NP education and workforce dynamics, and (e) international perspectives. CONCLUSION: The agenda can advance evidence on the NP workforce to guide policy and practice.

Moving Forward Into the Future: Nurses and Nurse Leaders at Leading US Public Health System Implementing Foundational Transformation to Advance Health Equity.

The nation's largest public health care system, New York City Health + Hospitals (NYC H + H), is engaged in a fundamental transformation of its nursing culture, actualizing many of the recommendations in the National Academies, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. NYC H + H and its more than 9600+ nurses and 970+ social workers share a common public health mission, vision, and values to deliver essential health care services to the most vulnerable and disadvantaged members of society, regardless of ethnicity, culture, creed, gender, age, sexual orientation, income, immigration, or insurance status. This mission dovetails with all of the recommendations in the Future of Nursing report. Systemwide implementation of these recommendations is proceeding, with some programs further advanced than others. This article highlights the system's diversity, equity, and inclusion initiatives; nursing professional development; collaboration with academic partners; labor contract provisions to support recruitment and retention campaigns; technological advances to remove barriers to patient care; and nurse residency program and professional-shared governance implementation. NYC H + H safeguards 1.4 million patients annually, caring for 1 in every 6 New Yorkers through 11 essential hospitals, 5 post-acute care facilities, more than 70 community centers, and correctional health services in city jails.

Workers not Paid for Sick Leave after Implementation of the New York City Paid Sick Leave Law.

This study examined factors associated with being paid for sick leave after implementation of the New York City (NYC) paid sick leave law. A random sample of NYC residents was surveyed by telephone multiple times over a 2-year period. Participants (n = 1195) reported socio-demographics, awareness of the law, income, work hours per week, and payment for sick time off work. In the year after implementation of the law, part-time workers were significantly more likely to attend work while sick than full-time workers (relative risk = 1.25, 95% CI = 1.1, 1.4). Seventy percent of workers who missed work due to illness (n = 249) were paid for sick leave. Part-time workers, respondents not aware of the benefit (30% of workers), and workers without a college degree were the least likely to be paid for sick days. More than one third (37%) of persons not paid for sick leave worked in retail, food service, or health care. Although 70% of respondents were paid for sick leave after implementation of the law, part-time workers and workers with low education were least likely to access the benefit and more likely to work while sick. The disparity in paid sick leave may have public health consequences as many persons not paid for sick leave had occupations that carry a high risk of disease transmission to others.

Outcome-based ventilation: A framework for assessing performance, health, and energy impacts to inform office building ventilation decisions.

This article presents an outcome-based ventilation (OBV) framework, which combines competing ventilation impacts into a monetized loss function ($/occ/h) used to inform ventilation rate decisions. The OBV framework, developed for U.S. offices, considers six outcomes of increasing ventilation: profitable outcomes realized from improvements in occupant work performance and sick leave absenteeism; health outcomes from occupant exposure to outdoor fine particles and ozone; and energy outcomes from electricity and natural gas usage. We used the literature to set low, medium, and high reference values for OBV loss function parameters, and evaluated the framework and outcome-based ventilation rates using a simulated U.S. office stock dataset and a case study in New York City. With parameters for all outcomes set at medium values derived from literature-based central estimates, higher ventilation rates' profitable benefits dominated negative health and energy impacts, and the OBV framework suggested ventilation should be ≥45 L/s/occ, much higher than the baseline ~8.5 L/s/occ rate prescribed by ASHRAE 62.1. Only when combining very low parameter estimates for profitable impacts with very high ones for health and energy impacts were all outcomes on the same order. Even then, however, outcome-based ventilation rates were often twice the baseline rate or more.

Speakers of the House Calls.

Emblem Health and the Coalition of Asian-American IPA, a large physician group, wants to break down the language barrier to better help Asian American patients. The idea is that traditional health plan home-visit programs can too often turn out to be disruptive, rather than helpful.

Awareness of Paid Sick Leave among New York City Restaurant Workers.

Restaurant workers are less likely to have paid sick leave (PSL) benefits than other professions, despite the fact that they handle food and interact with the public. In this study, we collected and analyzed quantitative and qualitative data on PSL awareness among New York City's restaurant workers and the factors that produced these levels of awareness. We found that 62% of surveyed workers were aware of NYC's law, and that successful outreach requires building broad awareness and ensuring trustworthy sources of information with multiple points of contact. Our research also highlights the importance of immigrant populations in PSL outreach.

Maimonides Reincarnated.

The writings of Maimonides, the 12th-century physician, Talmudic and philosophic scholar, are remarkably relevant for modern medicine. Whereas the specific medical recommendations are obviously outdated, Maimonides' perceptive insights into professional responsibilities and medical ethics remain as useful guides even in our postmodern era.

Thomas Linwood Bennett, MD: one of New York City's first prominent physician anesthetists.

Thomas Linwood Bennett (1868-1932) was one of New York City's first prominent physician anesthetists. He was the first dedicated anesthetist at the Hospital for the Ruptured and Crippled, subsequently renamed Hospital for Special Surgery. He subsequently practiced at multiple institutions throughout New York City as one of the first physicians in the United States to dedicate his entire practice to the emerging field of anesthesia. Bennett was considered the preeminent anesthetist of his time, excelling at research, innovation, education, and clinical care.

Lessons learned? Nurses and health demonstration projects in New York City, 1920-1935.

This historical case study looks at two foundation-funded health demonstration projects in New York City from 1920 to 1935. It specifically examines the disciplinary interests, the work, and the aspirations of nurses and social workers as they tried to provide coordinated and cost-effective care to the individuals and families with whom they worked. It attends to the processes--not just the outcomes--involved in the coming together and moving apart of the different organizations, disciplinary interests, knowledge domains, and spheres of public and private responsibilities involved in caring for those in need. It locates the problems of coordination within disciplinary tensions as nurses and social worker--working within a web of gender, class, race, and power--sought to advance their own disciplinary interests even as they searched for better ways to care for the families in their charge.

Dr. Max Wolf: A New York city physician rescued from the Holocaust by Albert Goring.

Dr. Max Wolf and his wife Margareta were native Austrians. Dr. Wolf was educated in Austria and enjoyed a successful practice of his speciality in Vienna. One of his patients was Albert Goring, the brother of the infamous Nazi, Hermann Goring. This relationship would have a notable effect in Dr. Wolf and his wife escaping the eventual Holocaust after the "Anschluss". Leaving Vienna Dr. Wolf and his wife eventually arrived in New York and began a new life becoming a prominent physician in America.

Interventions to Reduce the Impact of Client Death on Home Care Aides: Employers' Perspectives.

For home care agencies and aides, the death of clients has important, yet often unrecognized, workforce implications. While research demonstrates that client death can cause grief and job insecurity for aides, we currently lack home care agencies' perspectives on this issue and approaches to addressing it. This study uses key informant interviews with leaders from a diverse sample of eight New York City home care agencies to explore facilitators and barriers to agency action. We found that agencies engaged primarily in a range of informal, reactive practices related to client death, and relatively few targeted and proactive efforts to support aides around client death. While leaders generally acknowledged a need for greater aide support, they pointed to a lack of sustainable home care financing and policy resources to fund this. We recommend increased funding to support wages, paid time off, and supportive services, and discuss implications for future research.

Healthy families Brooklyn: working with health advocates to develop a health promotion program for residents living in New York City housing authority developments.

Decreasing health disparities must increase access to care, improve health education and ease navigating the health care system. Community Health Workers (CHW) take on these tasks in professional and culturally competent manners. The Healthy Families Brooklyn (HFB) Program serves residents in two public housing developments in Brooklyn, NY. Healthy Families Advocates (HFA), a type of CHW, are at the core of HFB. Curriculum development for, training of and services provided by the 10 HFA over 19 months are described. Pre and post knowledge assessments of HFAs are analyzed. Data from HFA surveys regarding training were analyzed using grounded theory methods. HFA served 172 unique clients at 222 visits. Services offered include accessing public benefits, health education, and connection to hospitals. There was a significant increase between pre and post assessment knowledge scores (P < 0.01). Taking temperature, building trust, and communicating care and connection emerged as themes related to interpersonal skills used by the HFA. The HFA are committed to moving clients forward in their health knowledge and behaviors. Themes from the HFA survey closely mirrored the HFA training curriculum. Lessons learned pertaining to training needs, data collection, and supervision are explored. The HFB program is a model way of working in communities in New York City and expansion with faith-based groups and other housing development communities is underway. Engaging communities to improve access, screening, prevention and treatment is paramount to the nation's health and the success of the 2010 Affordable Care Act. CHW's role in this mission is integral.

Workplace and safety perceptions among New York City employees after the 9/11 attacks.

This study examined associations of individual characteristics on perceived workplace conditions and safety in a volunteer sample of 254 employees from businesses in New York City's World Trade Center (WTC) towers and other area workplaces who completed structured diagnostic and disaster-specific interviews an average of 35 months after the September 11, 2001 (9/11) terrorist attacks. WTC workplace employees perceived greater workplace responsiveness to their post-9/11 needs relative to employees of other workplaces, independent of individual demographic and other disaster-related variables; they also reported lower perceived safety at work. Thus, employee disaster-related workplace location, an organizational-level variable, was a powerful determinant of individual perceptions of the postdisaster workplace and its responsiveness, suggesting the importance of organizational disaster planning and response in helping workers adjust to the postdisaster workplace environment and promoting personal healing and recovery.

Martha Wollstein: A pioneer American female clinician-scientist.

Martha Wollstein was not only the first fully specialized pediatric perinatal pathologist practicing exclusively in a North America children's hospital, she also blazed another pathway as a very early pioneer female clinician-scientist. Wollstein provided patient care at Babies Hospital of New York City from 1891 until her retirement in 1935, and also simultaneously worked for many years as a basic scientist at the prestigious Rockefeller Institute for Medical Research. Wollstein published over 65 papers, many frequently cited, during her career on a wide range of topics including pediatric and infectious diseases. Wollstein was a rare female in the field of pathology in an era when just a relatively small number of women became doctors in any medical specialty. Wollstein was born into an affluent Jewish American family in New York City in 1868 and graduated from the Women's Medical College in 1889. This paper explores her family support and ethnic and religious background, which helped facilitate her professional success. During her time, she was recognized internationally for her research and was respected for her medical and scientific skills; unfortunately today her important career has been largely forgotten.

An Emergency Medicine Residency for Nurse Practitioners: The New York Presbyterian-Weill Cornell Medicine Experience.

Growing numbers of nurse practitioners (NPs) are entering emergency medicine at a time when emergency departments are experiencing an increasing practice intensity and acuity. In this context, to further prepare NPs for a career in emergency medicine, postgraduate educational programs have emerged in the United States: from post-master's programs with 300-400 clinical hours in emergency medicine to intense residency or fellowship tracks with 2,000-3,000 clinical hours of training. This article describes the development and general organization of one such residency at New York Presbyterian Hospital-Weill Cornell Medical Center, while also noting several broader trends in emergency medicine and emergency NPs in the workforce.

Home Health Aides' Perceptions of Quality Care: Goals, Challenges, and Implications for a Rapidly Changing Industry.

Home care payment models, quality measures, and care plans are based on physical tasks workers perform, ignoring relational care that supports clients' cognitive, emotional, and social well-being. As states seek to rein in costs and improve the efficiency and quality of care, they will need to consider how to measure and support relational care. In four focus groups ( n = 27) of unionized, agency-based New York City home health aides, workers reported aide-client relationships were a cornerstone of high-quality care, and building them required communication, respect, and going the extra mile. Since much of this care was invisible outside the worker-client relationship, aides received little supervisory support and felt excluded from the formal care team. Aligning payment models with quality requires understanding the full scope of services aides provide and a quality work environment that offers support and supervision, engages aides in patient care, and gives them a voice in policy decisions.