Low income dynamics and depression over the life course in South Korea.

OBJECTIVES: We examined how experiencing low income multiple times is associated with depressive symptoms over the life course to better understand the influence of low income experience on psychological well-being. METHODS: We employed fixed effects models to estimate the association between low income experience and depressive symptoms using data from a longitudinal survey of a representative sample of adults in Korea (N=6,930). We also considered age variations given different perspectives and social circumstances related to different ages and family stages over the life course that potentially modify the association. RESULTS: Our results revealed that the detrimental influence of low income experience on depressive symptoms slowly declines with additional increments in the number of the exposures. Additionally, although older adults have a higher risk of experiencing low income more than once, the detrimental influence appears more salient among younger adults compared to older individuals. DISCUSSION: We offered some explanations for the diminishing effects of additional experiences of low income on depressive symptoms, and the age group variations in the association in Korea. We also discussued policy implications of our findings.

Racial/Ethnic Disparities in Pain Treatment: Evidence From Oregon Emergency Medical Services Agencies.

BACKGROUND: Despite the critical role that Emergency Medical Services (EMS) provides in the health care system, racial/ethnic treatment disparities in EMS remain relatively unexamined. OBJECTIVE: To investigate racial/ethnic treatment disparities in pain assessment and pain medication administration in EMS. RESEARCH DESIGN: A retrospective analysis was performed on 25,732 EMS encounters from 2015 to 2017 recorded in the Oregon Emergency Medical Services Information System using multivariate logistic regression models to examine the role of patient race/ethnicity in pain assessment and pain medication administration among patients with a traumatic injury. RESULTS: Hispanic and Asian patients were less likely to receive a pain assessment procedure and all racial/ethnic patients were less likely to receive pain medications compared with white patients. In particular, regarding the adjusted likelihood of receiving a pain assessment procedure, Hispanic patients were 21% less likely [95% confidence interval (CI), 10%-30%; P<0.001], Asian patients were 31% less likely (95% CI, 16%-43%; P<0.001) when compared with white patients. Regarding the adjusted likelihood of receiving any pain medications, black patients were 32% less likely (95% CI, 21%-42%; P<0.001), Hispanic patients were 21% less likely (95% CI, 7%-32%; P<0.01), and Asian patients were 24% less likely (95% CI, 1%-41%; P<0.05) when compared with white patients. CONCLUSIONS: Racial/ethnic minorities were more likely to experience disadvantages in EMS treatment in Oregon. Hispanic and Asian patients who requested EMS services in Oregon for traumatic injuries were less likely to have their pain assessed and all racial/ethnicity patients were less likely to be treated with pain medications when compared with white patients.

Does Racial Bias Affect NCI-Funded PIs' Willingness to Mentor Prospective Graduate Students?

Audit studies suggest that racial discrimination disadvantages black individuals in educational/professional advancement. We hypothesized that prospective black male doctoral students would experience greater disparity in responses when seeking access to National Cancer Institute (NCI)-funded principal investigators (PI) compared with prospective white males. Primary aim was to explore response and acceptance rates for black versus white men seeking cancer research mentorship. Identical e-mails were sent to 1,028 randomly selected PIs affiliated with 65 NCI-designated cancer centers from "Lamar Washington" (black; n = 515) or "Brad Anderson" (white; n = 513). Primary outcomes: (i) responses within one week; and (ii) type of response. We used logistic regression to examine effects of condition (black/white) on primary outcomes. Approximately 48.3% and 50.0% of the sample responded to "Lamar" and "Brad," respectively. For responders, 40.9% and 43.7% and "agreed" to meet with Lamar and Brad, respectively. This design did not detect bias by PIs against black prospective male students. Cancer Res; 78(17); 4809-11. ©2018 AACR.

Preliminary Findings of a Technology-Delivered Sexual Health Promotion Program for Black Men Who Have Sex With Men: Quasi-Experimental Outcome Study.

BACKGROUND: Human immunodeficiency virus (HIV) disproportionately affects black men who have sex with men (MSM), yet there are few evidence-based interventions specifically designed for black MSM communities. In response, the authors created Real Talk, a technology-delivered, sexual health program for black MSM. OBJECTIVE: The objective of our study was to determine whether Real Talk positively affected risk reduction intentions, disclosure practices, condom use, and overall risk reduction sexual practices. METHODS: The study used a quasi-experimental, 2-arm methodology. During the first session, participants completed a baseline assessment, used Real Talk (intervention condition) or reviewed 4 sexual health brochures (the standard of care control condition), and completed a 10-minute user-satisfaction survey. Six months later, participants from both conditions returned to complete the follow-up assessment. RESULTS: A total of 226 participants were enrolled in the study, and 144 completed the 6-month follow-up. Real Talk participants were more likely to disagree that they had intended in the last 6 months to bottom without a condom with a partner of unknown status (mean difference=-0.608, P=.02), have anal sex without a condom with a positive man who was on HIV medications (mean difference=-0.471, P=.055), have their partner pull out when bottoming with a partner of unknown HIV status (mean difference=-0.651, P=.03), and pull out when topping a partner of unknown status (mean difference=-0.644, P=.03). Real Talk participants were also significantly more likely to disagree with the statement "I will sometimes lie about my HIV status with people I am going to have sex with" (mean difference=-0.411, P=.04). In terms of attitudes toward HIV prevention, men in the control group were significantly more likely to agree that they had less concern about becoming HIV positive because of the availability of antiretroviral medications (mean difference=0.778, P=.03) and pre-exposure prophylaxis (PReP) (mean difference=0.658, P=.05). There were, however, no significant differences between Real Talk and control participants regarding actual condom use or other risk reduction strategies. CONCLUSIONS: Our findings suggest that Real Talk supports engagement on HIV prevention issues. The lack of behavior findings may relate to insufficient study power or the fact that a 2-hour, standalone intervention may be insufficient to motivate behavioral change. In conclusion, we argue that Real Talk's modular format facilitates its utilization within a broader array of prevention activities and may contribute to higher PReP utilization in black MSM communities.

Postpartum preeclampsia: emergency department presentation and management.

STUDY OBJECTIVE: Postpartum preeclampsia/eclampsia is the presence of hypertension and proteinuria, with or without seizures, occurring up to 4 weeks after delivery. We describe the Emergency Department (ED) presentation, signs and symptoms, results of diagnostic studies, management, and outcome in a cohort of patients diagnosed with postpartum preeclampsia/eclampsia at our institutions, and use this to review the diagnosis and management of postpartum preeclampsia/eclampsia. METHODS: A retrospective chart review was conducted at two urban teaching hospitals. Twenty-two cases were identified via ICD-9 (International Classification of Diseases, 9(th) revision) codes of discharge diagnoses over an 8-year period. Only those patients who initially presented to an ED in the postpartum period after hospital discharge were included. A standardized data tool was used to extract demographic data, signs and symptoms of preeclampsia/eclampsia, ancillary studies previously associated with eclamptic pathology, and outcome during admission. RESULTS: Of the 22 women, over half (55%) had not been diagnosed with preeclampsia in the ante- or peripartum period. Common prodromal symptoms and signs in the postpartum presentation included headache, visual changes, hypertension, edema, proteinuria, elevated uric acid, and elevated liver function tests. All 4 patients who seized had prodromal symptoms. Women presented from 3 to 10 days postpartum (median: 5 days). Only 10 women were primiparas. Nineteen women presented with diastolic blood pressures > 90 mm, and only 3 of these had diastolic blood pressures of 110 mm Hg or greater. CONCLUSIONS: Postpartum preeclampsia/eclampsia often presents to the ED without a history of preeclampsia during the pregnancy. Further, not all women with this diagnosis who present to the ED in the postpartum period will have each of the "classic" features of this disease, including elevated blood pressure, edema, proteinuria, and hyperreflexia. This report is intended to inform emergency physicians of the presentation of preeclampsia/eclampsia in the postpartum period, including symptoms of headache, vision changes, elevated blood pressure, or seizure up to 4 weeks after delivery.

Impairment and severity: how ED physicians decide to override an impaired patient's refusal.

We attempted to identify the contributions of impairment and illness severity in the decision to treat a patient who refuses treatment using case vignettes. We constructed 4 emergency department (ED)-based case vignettes of adults with varied impairment and illness severity who each refused care. Clinician used a 100-mm visual analog scale (VAS) to assess patient impairment, illness severity, and their willingness to override a patient's refusal (WOPR) of treatment. We used correlation and logistic regression to assess the contributions of impairment and illness severity on WOPR. Thirty-seven ED physicians participated. Increasing impairment (r = 0.80) and illness severity (r = 0.81) correlated with WOPR, and an increase of 10 mm of impairment on the VAS (odds ratio, 2.1; 95% confidence interval, 1.5-3.0) and an increase of 10 mm of severity (odds ratio, 1.5; 95% confidence interval, 1.2-2.0) independently predicted a WOPR. Both degrees of impairment and illness severity impact an ED physician's WOPR.