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1.
N C Med J ; 81(2): 126-129, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32132258

RESUMEN

Racial and ethnic disparities in health care occur within broader contexts impacting the youth who present for behavioral health treatment. Clinician bias and clinical uncertainty can influence diagnostic and treatment outcomes. Behavioral health professionals should strive toward effectiveness in the delivery of culturally sensitive interventions to assist in health promotion with youth of color.


Asunto(s)
Disparidades en Atención de Salud/etnología , Trastornos Mentales/diagnóstico , Trastornos Mentales/etnología , Adolescente , Grupos de Población Continentales/psicología , Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/psicología , Grupos Étnicos/estadística & datos numéricos , Humanos
3.
MMWR Morb Mortal Wkly Rep ; 69(11): 298-302, 2020 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-32191686

RESUMEN

In 2017, prescription opioids were involved in 36% of opioid-involved overdose deaths in the United States (1). Prescription opioids can be obtained by prescription or through diversion (the channeling of regulated drugs from legal to illegal sources) (2). Among new heroin users, 66%-83% reported that their opioid use began with the misuse of a prescription opioid (3). "Misuse" is generally defined as drugs taken for a purpose other than that directed by the prescribing physician, in greater amounts, more often, or for a longer duration than prescribed (2). Exposure to prescription opioids can be lessened by ensuring recommended prescribing, thereby potentially reducing the risk for misuse, opioid use disorder, and overdose (4). Sex and age groups with high exposure to prescription opioids are not well defined. Using a retail pharmaceutical database from IQVIA,* nationwide trends in opioid prescription fill rates for adult outpatients by age and sex were examined during 2008-2018. Opioid prescription fill rates were disproportionately higher among men and women aged ≥65 years and women of all ages. For reasons not well understood, these disparities persisted over 11 years even as the opioid fill rate declined for each age group and sex. Interventions to improve prescribing practices by following evidence-based guidelines that include weighing the benefits and risks for using prescription opioids for each patient and adopting a multimodal approach to pain management could improve patient safety while ameliorating pain. These efforts might need to consider the unique needs of women and older adults, who have the highest opioid prescription fill rates.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Analgésicos Opioides/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Estados Unidos , Adulto Joven
5.
Urology ; 136: 17-18, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32033670
10.
Braz Oral Res ; 33: e102, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31939495

RESUMEN

The objective of this study was to evaluate the association between social inequality indicators and oral health conditions in an adult population. This prospective cohort study assessed a probabilistic sampling of adults (aged 20-64 years) living in Piracicaba, São Paulo, Brazil. Oral examinations were performed in 2011 and 2015, conducted at home, and used the decay-missing-filled (DMFT) index of permanent teeth, the Community Periodontal Index (CPI), and the visible biofilm criterion. A questionnaire was administered to determine demographic and socioeconomic aspects and dental services used, and collect oral health-related quality of life (OHRQoL) data. Social inequality indicators were evaluated according to social class (high, middle or low) and type of dental service used (public, health insurance or private), and compared with oral health conditions (visible biofilm, DMFT and incidence of tooth loss, periodontal pockets and bleeding, and OHRQoL), evaluated between 2011 and 2015. Analysis using chi-squared or Fisher tests (p < 0.05) and Cochran's Q test was conducted separately for each category analyzed between 2011 and 2015 (p < 0.05). A total of 143 adults who participated in an earlier study were examined after four years of follow-up. Although the occurrence of oral disease did not decrease over the study period (4 years), there was a reduction in inequality among lower social classes in regard to presence of tooth decay and oral health impact on self-perceived quality of life between 2011 and 2015 (p < 0.05). These results suggest that the Brazilian National Oral Health Policy has achieved its principles, especially that of greater equity.


Asunto(s)
Disparidades en Atención de Salud/estadística & datos numéricos , Salud Bucal/estadística & datos numéricos , Adulto , Brasil/epidemiología , Índice CPO , Femenino , Humanos , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Índice Periodontal , Estudios Prospectivos , Calidad de Vida , Autoimagen , Clase Social , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
11.
Artículo en Alemán | MEDLINE | ID: mdl-31915863

RESUMEN

Today, health inequalities are one of the most important issues in public health worldwide. The digitalisation of healthcare is frequently attributed with the potential to reduce health inequalities. At the same time, effective internet usage is a prerequisite of the successful utilisation of digital health interventions. This might be a new obstacle for those who lack the necessary material resources or individual skills.Evidence on how exactly digital health interventions affect health inequalities is scarce. The aim of this study was to present a narrative review of the available literature. The majority of studies showed an association between the usage of digital health interventions and sociodemographic factors. The utilisation was generally higher among younger people and those with higher education and higher income. Only few studies showed no association. Other studies reported higher utilisation among those with higher levels of health literacy while health literacy showed a social gradient to the disadvantage of those in lower socioeconomic position. With a low overall level of evidence, there is currently no indication that digital health interventions are reducing health inequalities.The studies analysed in this review indicate that existing inequalities persist in the digital realm. Further evidence is needed to create a better understanding of the importance of sociodemographic factors for digital health interventions.


Asunto(s)
Brecha Digital , Disparidades en Atención de Salud , Prestación de Atención de Salud , Alemania , Humanos , Salud Pública , Factores Socioeconómicos
15.
Medicine (Baltimore) ; 99(2): e18625, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914043

RESUMEN

BACKGROUND: Inequality in health and health care remains a rather challenging issue in China, existing both in rural and urban area, and between rural and urban. This study used nationally representative data to assess inequality in both rural and urban China separately and to identify socioeconomic factors that may contribute to this inequality. METHODS: This study used 2008 National Health Services Survey data. Demographic characteristics, income, health status, medical service utilization, and medical expenses were collected. Horizontal inequality analysis was performed using nonlinear regression method. RESULTS: Positive inequity in outpatient services and inpatient service was evident in both rural and urban area of China. Greater inequity of outpatient service use in urban than that in rural areas was evident (horizontal inequity index [HI] = 0.085 vs 0.029). In contrast, rural areas had greater inequity of inpatient service use compared to urban areas (HI = 0.21 vs 0.16). The decomposition analysis found that the household income made the greatest pro-rich contribution in both rural and urban China. However, chronic diseases and aging were also important contributors to the inequality in rural area. CONCLUSION: The inequality in health service in both rural and urban China was mainly attributed to the household income. In addition, chronic disease and aging were associated with inequality in rural population. Those findings provide evidences for policymaker to develop a sustainable social welfare system in China.


Asunto(s)
Utilización de Instalaciones y Servicios/estadística & datos numéricos , Disparidades en Atención de Salud/economía , Aceptación de la Atención de Salud/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , China , Femenino , Gastos en Salud/estadística & datos numéricos , Estado de Salud , Humanos , Renta/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Adulto Joven
17.
Gastroenterology ; 158(2): 354-367, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31682851

RESUMEN

Colorectal cancer (CRC) disproportionately affects people from low socioeconomic backgrounds and some racial minorities. Disparities in CRC incidence and outcomes might result from differences in exposure to risk factors such as unhealthy diet and sedentary lifestyle; limited access to risk-reducing behaviors such as chemoprevention, screening, and follow-up of abnormal test results; or lack of access to high-quality treatment resources. These factors operate at the individual, provider, health system, community, and policy levels to perpetuate CRC disparities. However, CRC disparities can be eliminated. Addressing the complex factors that contribute to development and progression of CRC with multicomponent, adaptive interventions, at multiple levels of the care continuum, can reduce gaps in mortality. These might be addressed with a combination of health care and community-based interventions and policy changes that promote healthy behaviors and ensure access to high-quality and effective measures for CRC prevention, diagnosis, and treatment. Improving resources and coordinating efforts in communities where people of low socioeconomic status live and work would increase access to evidence-based interventions. Research is also needed to understand the role and potential mechanisms by which factors in diet, intestinal microbiome, and/or inflammation contribute to differences in colorectal carcinogenesis. Studies of large cohorts with diverse populations are needed to identify epidemiologic and molecular factors that contribute to CRC development in different populations.


Asunto(s)
Neoplasias Colorrectales/epidemiología , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Factores Socioeconómicos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/prevención & control , Detección Precóz del Cáncer/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Estilo de Vida Saludable , Humanos , Incidencia , Tamizaje Masivo/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Factores de Riesgo
18.
J Stroke Cerebrovasc Dis ; 29(1): 104464, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31699576

RESUMEN

INTRODUCTION: Emergency departments play a key role in the diagnosis and treatment of transient ischemic attacks, but limited data are available about the early management of such patients in emergency wards. Therefore, we aimed to evaluate emergency physicians' management of transient ischemic attack and analyze variations factors. METHODS: A multicenter survey among emergency physicians of the Grand Est region network (Est-RESCUE) was conducted from January 28th to March 28th, 2019. Medical and administrative data were collected by the same network and the national directory of medical resources. RESULTS: Among 542 emergency physicians recipients, 78 answered (14%) and 71 were finally included, practicing in 25 public hospitals homogeneously distributed across the territory, including 3 university hospitals. A cerebral magnetic resonance imaging was obtained for 75%-100% of patients by 4.3% of responders, 36.4% of which were performed within more than 24 hours. A cardiac monitoring was prescribed in 75%-100% of cases by 32.4% of responders. A neurologic consultation was routinely requested by 84.6% of responders practicing in a university hospital and 36.8% of responders practicing in a community hospital (P = .02). Patients were hospitalized in a neurovascular unit in 75%-100% of cases by 17.4% of responders, which happened more likely in university hospitals (P < .001). CONCLUSIONS: Transient ischemic attack suffers from management disparities across territories, due to limited access to technical facilities and neurologic consultations. Therefore, international recommendations are too often not followed. Implementation of territorial neurovascular tracks may help to standardize the management of these patients.


Asunto(s)
Servicio de Urgencia en Hospital/tendencias , Disparidades en Atención de Salud/tendencias , Hospitales/tendencias , Ataque Isquémico Transitorio/terapia , Pautas de la Práctica en Medicina/tendencias , Tiempo de Tratamiento/tendencias , Adulto , Femenino , Francia , Encuestas de Atención de la Salud , Hospitalización/tendencias , Humanos , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/fisiopatología , Masculino , Persona de Mediana Edad , Derivación y Consulta/tendencias , Factores de Tiempo , Resultado del Tratamiento
19.
Urology ; 136: 9-18, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31770548

RESUMEN

For prostate cancer, we review racial differences in incidence, androgen pathways, growth factors, tumor location, rate of definitive treatment, and outcomes. We review the effect of race on risk-stratification and discuss studies of active surveillance in the African American population. For bladder cancer, race- and gender- associated differences in incidence, sex hormone pathways. For renal cell carcinoma, disparities in incidence, genetic factors, tumor pathology, time to presentation, and disease specific survival have been observed. We evaluate the impact of race and ethnicity on tumor pathology and discuss gaps in our current understanding of renal cell carcinoma pathogenesis.


Asunto(s)
Carcinoma de Células Renales/terapia , Disparidades en Atención de Salud , Neoplasias Renales/terapia , Neoplasias de la Próstata/terapia , Neoplasias de la Vejiga Urinaria/terapia , Femenino , Humanos , Masculino
20.
J Surg Res ; 246: 123-130, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31569034

RESUMEN

BACKGROUND: National changes in health care disparities within the setting of trauma care have not been examined within Accountable Care Organizations (ACOs) or non-ACOs. We sought to examine the impact of ACOs on post-treatment outcomes (in-hospital mortality, 90-day complications, and readmissions), as well as surgical intervention among whites and nonwhites treated for spinal fractures. MATERIALS AND METHODS: We identified all beneficiaries treated for spinal fractures between 2009 and 2014 using national Medicare fee for service claims data. Claims were used to identify sociodemographic and clinical criteria, receipt of surgery and in-hospital mortality, 90-day complications, and readmissions. Multivariable logistic regression analysis accounting for all confounders was used to determine the effect of race/ethnicity on outcomes. Nonwhites were compared with whites treated in non-ACOs between 2009 and 2011 as the referent. RESULTS: We identified 245,704 patients who were treated for spinal fractures. Two percent of the cohort received care in an ACO, whereas 7% were nonwhite. We found that disparities in the use of surgical fixation for spinal fractures were present in non-ACOs over the period 2009-2014 but did not exist in the context of care provided through ACOs (odds ratio [OR] 0.75; 95% confidence interval [CI] 0.44, 1.28). A disparity in the development of complications existed for nonwhites in non-ACOs (OR 1.09; 95% CI 1.01, 1.17) that was not encountered among nonwhites receiving care in ACOs (OR 1.32; 95% CI 0.90, 1.95). An existing disparity in readmission rates for nonwhites in ACOs over 2009-2011 (OR 1.34; 95% CI 1.01, 1.80) was eliminated in the period 2012-2014 (OR 0.85; 95% CI 0.65, 1.09). CONCLUSIONS: Our work reinforces the idea that ACOs could improve health care disparities among nonwhites. There is also the potential that as ACOs become more familiar with care integration and streamlined delivery of services, further improvements in disparities could be realized.


Asunto(s)
Organizaciones Responsables por la Atención/estadística & datos numéricos , Fijación de Fractura/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Fracturas de la Columna Vertebral/cirugía , Organizaciones Responsables por la Atención/economía , Anciano , Anciano de 80 o más Años , Grupos de Población Continentales/estadística & datos numéricos , Ahorro de Costo/economía , Ahorro de Costo/estadística & datos numéricos , Grupos Étnicos , Femenino , Fijación de Fractura/efectos adversos , Fijación de Fractura/economía , Gastos en Salud/estadística & datos numéricos , Disparidades en Atención de Salud/organización & administración , Mortalidad Hospitalaria , Humanos , Masculino , Medicare/economía , Medicare/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la Calidad/estadística & datos numéricos , Factores Socioeconómicos , Fracturas de la Columna Vertebral/economía , Estados Unidos/epidemiología
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