Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 8.418
Filtrar
1.
JAMA Netw Open ; 3(1): e1920010, 2020 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-31995215

RESUMEN

Importance: Racial and ethnic disparities in access to health care may result from discrimination. Objectives: To identify differences in the rates at which patients belonging to racial/ethnic minority groups are offered primary care appointments and the number of days they wait for their primary care appointment and to understand the mechanisms by which discrimination occurs. Design, Setting, and Participants: This cross-sectional study used 7 simulated black, Hispanic, and white patient callers to request appointments from 804 randomized primary care offices in 2 urban centers in Texas from November 2017 to February 2018. Data analysis was conducted between February and December 2018. Exposures: Research assistants called randomly assigned offices to schedule an appointment, supplying the same basic information. Race and ethnicity were signaled through callers' names and voices. Main Outcomes and Measures: Appointment offer rates, days to appointment, and questions asked during the call. Results: Of the 7 callers (age range, 18-29 years), 2 (28.6%) self-identified as non-Hispanic black, 3 (42.9%) self-identified as non-Hispanic white, and 2 (28.6%) self-identified as Hispanic. Of the 804 calls they made, 299 (37.2%) were from simulated white callers, 215 (26.7%) were from simulated black callers, and 290 (36.1%) were from simulated Hispanic callers. Overall, 582 callers (72.4%) were offered appointments. In unadjusted models, black and Hispanic callers were more likely to be offered an appointment than white callers (black callers, 32.2 [95% CI, 25.1-39.3] percentage points more likely; P < .001; Hispanic callers, 21.1 [95% CI, 13.7-28.5] percentage points more likely; P < .001). However, after adjusting for whether insurance status was revealed, this statistical significance was lost. In adjusted models, black callers were 44.0 (95% CI, 36.2-51.8) percentage points more likely to be asked about their insurance status than white callers (P < .001), and Hispanic callers were 25.3 (95% CI, 17.1-33.5) percentage points more likely to be asked about their insurance status (P < .001) than white callers. Black and Hispanic callers received appointments further in the future than white callers (black callers: marginal effect estimate, 3.650; 95% CI, 0.579 to 6.721; P = .08; Hispanic callers: marginal effect estimate, 2.644; 95% CI, -0.496 to 5.784; P = .02). Conclusions and Relevance: In this study, black and Hispanic patients were more likely to be offered an appointment, but they were asked more frequently about their insurance status than white callers. Black and Hispanic callers experienced longer wait times than white patients, indicating a barrier to timely access to primary care.


Asunto(s)
Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Citas y Horarios , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Visita a Consultorio Médico/estadística & datos numéricos , Adulto , Femenino , Humanos , Masculino , Cooperación del Paciente/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Estudios Prospectivos , Estados Unidos
3.
Integr Cancer Ther ; 19: 1534735419890682, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31957499

RESUMEN

Background: There is a paucity of research on the long-term impact of stress-reduction in Hispanic/Latina breast cancer (BC) survivors, a growing minority. In this article, we assess the long-term efficacy of an 8-week training program in mindfulness-based stress reduction (MBSR) on quality of life (QoL) in Hispanic BC survivors. Methods: Hispanic BC survivors, within the first 5 years of diagnosis, stages I to III BC, were recruited. Participants were enrolled in bilingual, 8-week intensive group training in MBSR and were asked to practice a- home, daily. They were also provided with audio recordings and a book on mindfulness practices. Patient-reported outcomes for QoL and distress were evaluated at baseline, and every 3 months, for 24 months. Results: Thirty-three self-identified Hispanic women with BC completed the MBSR program and were followed at 24 months. Statistically significant reduction was noted for the Generalized Anxiety Disorder measure (mean change -2.39, P=0.04); and Patient Health Questionnaire (mean change -2.27, P=0.04), at 24 months, compared with baseline. Improvement was noted in the Short-Form 36 Health-related QoL Mental Component Summary with an increase of 4.07 (95% confidence interval = 0.48-7.66, P=0.03). However, there was no significant change in the Physical Component Summary. Conclusions: Hispanic BC survivors who participated in an 8-week MBSR-based survivorship program reported persistent benefits with reduced anxiety, depression, and improved mental health QoL over 24 months of follow-up. Stress reduction programs are beneficial and can be implemented as part of a comprehensive survivorship care in BC patients.


Asunto(s)
Neoplasias de la Mama/terapia , Supervivientes de Cáncer/psicología , Hispanoamericanos/psicología , Atención Plena/métodos , Calidad de Vida/psicología , Estrés Psicológico/terapia , Adaptación Psicológica , Adulto , Neoplasias de la Mama/etnología , Neoplasias de la Mama/psicología , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Salud Mental , Persona de Mediana Edad , Estadificación de Neoplasias , Medición de Resultados Informados por el Paciente , Sentido de Coherencia , Estrés Psicológico/psicología , Resultado del Tratamiento
4.
N C Med J ; 81(1): 14-22, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31908326

RESUMEN

BACKGROUND The Zika virus (ZIKV) epidemic that began in 2015 presented a risk for ZIKV infection among persons who traveled to ZIKV-affected countries. Latinas in North Carolina and their sexual partners may be exposed to ZIKV when traveling to these regions.METHODS We administered a cross-sectional survey, measuring ZIKV risk and knowledge, to a convenience sample of 262 reproductive-age Latinas attending a Federally Qualified Health Center in rural North Carolina. We described ZIKV risk and knowledge in the sample, and compared responses between those who were pregnant or recently pregnant, and those who were not pregnant. We further identified factors associated with 1) awareness of ZIKV and 2) high knowledge of ZIKV sequelae and prevention among those who were aware of ZIKV, using log-binomial regression.RESULTS Two-thirds of participants had ever heard of ZIKV, which was positively associated with educational attainment. Most participants aware of ZIKV had moderate/high knowledge of ZIKV transmission (92.5%) and symptoms (73.2%), but knowledge of preventing sexual and congenital transmission was limited. Travel was infrequent among pregnant or recently pregnant participants (5.4%) and their partners (7.1%). Despite low risk for ZIKV infection, participants were willing to practice ZIKV prevention.LIMITATIONS Our study is limited by a lack of generalizability to Latinas in other regions of the country, self-reporting bias, and lack of survey validation as an indicator of English language proficiency.CONCLUSIONS Providers should identify patients likely to become pregnant and travel to high-risk areas, inquire about partner travel history, and offer culturally appropriate ZIKV risk counseling.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud/etnología , Hispanoamericanos/psicología , Enfermedad Relacionada con los Viajes , Infección por el Virus Zika/etnología , Estudios Transversales , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , North Carolina , Embarazo , Factores de Riesgo , Servicios de Salud Rural
5.
MMWR Morb Mortal Wkly Rep ; 69(2): 25-29, 2020 Jan 17.
Artículo en Inglés | MEDLINE | ID: mdl-31945037

RESUMEN

Birth defects are a leading cause of infant mortality in the United States, accounting for 20.6% of infant deaths in 2017 (1). Rates of infant mortality attributable to birth defects (IMBD) have generally declined since the 1970s (1-3). U.S. linked birth/infant death data from 2003-2017 were used to assess trends in IMBD. Overall, rates declined 10% during 2003-2017, but decreases varied by maternal and infant characteristics. During 2003-2017, IMBD rates decreased 4% for infants of Hispanic mothers, 11% for infants of non-Hispanic black (black) mothers, and 12% for infants of non-Hispanic white (white) mothers. In 2017, these rates were highest among infants of black mothers (13.3 per 10,000 live births) and were lowest among infants of white mothers (9.9). During 2003-2017, IMBD rates for infants who were born extremely preterm (20-27 completed gestational weeks), full term (39-40 weeks), and late term/postterm (41-44 weeks) declined 20%-29%; rates for moderate (32-33 weeks) and late preterm (34-36 weeks) infants increased 17%. Continued tracking of IMBD rates can help identify areas where efforts to reduce IMBD are needed, such as among infants born to black and Hispanic mothers and those born moderate and late preterm (32-36 weeks).


Asunto(s)
Anomalías Congénitas/mortalidad , Mortalidad Infantil/tendencias , Afroamericanos/estadística & datos numéricos , Anomalías Congénitas/etnología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Disparidades en el Estado de Salud , Hispanoamericanos/estadística & datos numéricos , Humanos , Lactante , Mortalidad Infantil/etnología , Recien Nacido Extremadamente Prematuro , Recién Nacido , Posmaduro , Recien Nacido Prematuro , Masculino , Estados Unidos/epidemiología
6.
Medicine (Baltimore) ; 99(2): e18525, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914025

RESUMEN

Human immunodeficiency virus (HIV) testing is important for prevention and treatment. Ending the HIV epidemic is unattainable if significant proportions of people living with HIV remain undiagnosed, making HIV testing critical for prevention and treatment. The Centers for Disease Control and Prevention (CDC) recommends routine HIV testing for persons aged 13 to 64 years in all health care settings. This study builds on prior research by estimating the extent to which HIV testing occurs during physician office and emergency department (ED) post 2006 CDC recommendations.We performed an unweighted and weighted cross-sectional analysis using pooled data from 2 nationally representative surveys namely National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2009 to 2014. We assessed routine HIV testing trends and predictive factors in physician offices and ED using multi-stage statistical survey procedures in SAS 9.4.HIV testing rates in physician offices increased by 105% (5.6-11.5 per 1000) over the study period. A steeper increase was observed in ED with a 191% (2.3-6.7 per 1000) increase. Odds ratio (OR) for HIV testing in physician offices were highest among ages 20 to 29 ([OR] 7.20, 99% confidence interval [CI: 4.37-11.85]), males (OR 1.34, [CI: 0.91-0.93]), African-Americans (OR 2.97, [CI: 2.05-4.31]), Hispanics (OR 1.80, [CI: 1.17-2.78]), and among visits occurring in the South (OR 2.06, [CI: 1.23-3.44]). In the ED, similar trends of higher testing odds persisted for African Americans (OR 3.44, 99% CI 2.50-4.73), Hispanics (OR 2.23, 99% CI 1.65-3.01), and Northeast (OR 2.24, 99% CI 1.10-4.54).While progress has been made in screening, HIV testing rates remains sub-optimal for ED visits. Populations visiting the ED for routine care may suffer missed opportunities for HIV testing, which delays their entry into HIV medical care. To end the epidemic, new approaches for increasing targeted routine HIV testing for populations attending health care settings is recommended.


Asunto(s)
Epidemias/prevención & control , Infecciones por VIH/epidemiología , VIH/aislamiento & purificación , Tamizaje Masivo/métodos , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Estudios Transversales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/etnología , Infecciones por VIH/prevención & control , Encuestas de Atención de la Salud/métodos , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Consultorios Médicos/estadística & datos numéricos , Pruebas Serológicas/métodos , Pruebas Serológicas/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto Joven
7.
Urology ; 137: 66-71, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31883879

RESUMEN

OBJECTIVE: To determine if disparities in quality of surgical care exist between Hispanics and non-Hispanics undergoing radical cystectomy for bladder cancer. MATERIALS AND METHODS: An observational cohort study was conducted retrospectively on patients who underwent radical cystectomy for urothelial carcinoma of the bladder at our institution between January 2005 and July 2018. Data was collected on demographic, clinical, and pathological characteristics of patients, including self-reported ethnicity. Univariable and multivariable logistic or linear regression analyses were used to evaluate the association of ethnicity with receipt of neoadjuvant chemotherapy, utilization of laparoscopic surgery, number of lymph nodes removed, and continent urinary diversion. RESULTS: We identified 507 patients in our database out of which, 136 (27%) were Hispanic and 371 (73%) were non-Hispanic. Compared to non-Hispanics, Hispanics had a higher body mass index (26.9 kg/m2 vs 28.2 kg/m2, P = .006) and lived further away from site of surgery (34 vs 96 miles, P = .02). No significant differences were observed in receipt of neoadjuvant chemotherapy, laparoscopic surgery, or number of lymph nodes removed during cystectomy between ethnicity groups. However, Hispanics were less likely than non-Hispanics to receive a continent urinary diversion on multivariable analysis (odds ratio 0.30, 95% confidence interval 0.10 - 0.92, P = .03). CONCLUSION: Disparity exists in the delivery of continent urinary diversions for Hispanic patients undergoing radical cystectomy for bladder cancer. Further investigation is needed to determine the potential causes for this disparity in care delivered.


Asunto(s)
Cistectomía , Disparidades en Atención de Salud/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/estadística & datos numéricos , Anciano , Estudios de Cohortes , Cistectomía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
8.
J Surg Res ; 245: 198-204, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31421362

RESUMEN

BACKGROUND: Race and insurance status have been shown to predict outcomes in pediatric bicycle traumas. It is unknown how these factors influence outcomes in adult bicycle traumas. This study aims to evaluate the association, if any, between race and insurance status with mortality in adults. METHODS: This retrospective cohort study used the National Trauma Data Bank Research Data Set for the years 2013-2015. Multivariate logistic regression models were used to determine the independent association between patient race and insurance status on helmet use and on outcomes after hospitalization for bicycle-related injury. These models adjusted for demographic factors and comorbid variables. When examining the association between race and insurance status with outcomes after hospitalization, injury characteristics were also included. RESULTS: A study population of 45,063 met the inclusion and exclusion criteria. Multivariate regression demonstrated that black adults and Hispanic adults were significantly less likely to be helmeted at the time of injury than white adults [adjusted odds ratio of helmet use for blacks 0.25 (95% CI 0.22-0.28) and for Hispanics 0.33 (95% CI 0.30-0.36) versus whites]. Helmet usage was also independently associated with insurance status, with Medicare-insured patients [AOR 0.51 (95% CI 0.47-0.56) versus private-insured patients], Medicaid-insured patients [AOR 0.18 (95% CI 0.17-0.20)], and uninsured patients [AOR 0.29 (95% CI 0.27-0.32)] being significantly less likely to be wearing a helmet at the time of injury compared with private-insured patients. Although patient race was not independently associated with hospital mortality among adult bicyclists, we found that uninsured patients had significantly higher odds of mortality [AOR 2.02 (AOR 1.31-3.12)] compared with private-insured patients. CONCLUSIONS: Minorities and underinsured patients are significantly less likely to be helmeted at the time of bicycle-related trauma when compared with white patients and those with private insurance. Public health efforts to improve the utilization of helmets during bicycling should target these subpopulations.


Asunto(s)
Ciclismo/lesiones , Disparidades en Atención de Salud/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Heridas y Traumatismos/mortalidad , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Conjuntos de Datos como Asunto , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Dispositivos de Protección de la Cabeza/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Puntaje de Gravedad del Traumatismo , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Estados Unidos/epidemiología , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/terapia , Adulto Joven
9.
BMC Public Health ; 19(1): 1710, 2019 Dec 19.
Artículo en Inglés | MEDLINE | ID: mdl-31856774

RESUMEN

BACKGROUND: While PWID of Puerto Rican origin have been migrating to the US for decades, the range of factors influencing their migration to the US and the resources they draw on to do so are not well understood. This is particularly true for rural Puerto Rican PWID, and the present study is the first empirical research to document migration patterns among this population. The specificities of their migration raise important challenges that need to be documented in order to implement more effective harm reduction policies at home (Puerto Rico) and abroad (US). METHODS: This paper draws from data obtained employing a modified NHBS survey which was administered to (N =296) PWID in four rural municipalities of Puerto Rico with participants 18 years or older. The primary dependent variables for this paper are the number of times a person has lived in the continental US, and if they are planning on moving to the continental US in the future. RESULTS: Findings suggest that 65% of the sample reported ever lived in the US and that 49% are planning on moving in the future. The number of times living in the US is associated with higher education and older age, but not with self-reported positive HIV or HCV statuses. Planning to move to the US is associated with knowing PWID who have moved or plan to move, negatively associated with age, and is not associated with HIV or HCV status. Around one third of those that lived in the US reported having some sort of support, with the majority receiving support from family sources. No participant received help to enter HIV/HCV treatment. CONCLUSIONS: A multi-region approach to prevention is required to make a dent in curbing HIV/HCV transmission in this population. Understanding PWID migration patterns, risk behaviors, and health care needs in the US is now more important than ever as natural disasters prompted by human-made climate change will only increase in the future, raising demands not only for service providers but also harm reduction policies to cope with an increasing influx of "climate refugees" as PWID move across national borders.


Asunto(s)
Emigración e Inmigración/estadística & datos numéricos , Hispanoamericanos/psicología , Población Rural/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/etnología , Adolescente , Adulto , Anciano , Femenino , Reducción del Daño , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Puerto Rico/etnología , Factores de Riesgo , Apoyo Social , Estados Unidos/epidemiología , Adulto Joven
10.
MMWR Morb Mortal Wkly Rep ; 68(40): 873, 2019 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-31851655

RESUMEN

National Latinx AIDS Awareness Day, October 15, is observed each year to focus on the continuing and disproportionate impact of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) on Hispanics/Latinos in the United States. In 2017, 26% of newly diagnosed HIV infections occurred in Hispanics/Latinos (1). Seventy-five percent of these newly diagnosed HIV infections in Hispanics/ Latinos were in men who have sex with men (MSM), and an additional 3% were in MSM who inject drugs (1).


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/etnología , Conocimientos, Actitudes y Práctica en Salud/etnología , Hispanoamericanos/psicología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Aniversarios y Eventos Especiales , Hispanoamericanos/estadística & datos numéricos , Humanos , Estados Unidos/epidemiología
11.
Sleep Health ; 5(6): 532-538, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31708438

RESUMEN

BACKGROUND: Suboptimal sleep has been documented in at-risk groups such as urban minority children, particularly those with asthma. It is therefore critical to examine differences in sleep outcomes across specific racial and ethnic groups and to identify factors that contribute to such variations in sleep outcomes to inform tailored interventions to improve sleep health. OBJECTIVES: The objectives were to examine racial/ethnic differences in sleep outcomes among urban children with and without asthma and to evaluate the extent to which asthma status and aspects of sleep hygiene and the sleep environment contribute to racial/ethnic differences in sleep outcomes in this sample. METHODS: Two hundred and sixteen African American, Latino, or non-Latino white (NLW) urban children, ages 7-9 years, with (n = 216) and without asthma (n = 130) and their primary caregivers were included. Objective sleep duration and efficiency were assessed via actigraphy. Asthma status was assessed by a study clinician. Caregiver-reported sleep hygiene and exposure to noise were assessed using a questionnaire. RESULTS: Minority children in the sample had, on average, shorter sleep duration compared to NLW children during the monitoring period (mean difference Latino vs NLW = -22.10, SE = 5.02; mean difference AA vs NLW = -18.69, SE = 5.28) Additionally, several racial/ethnic group differences in sleep outcomes emerged and were dependent on whether or not children had asthma. Specifically, Latinos had lower mean number of awakenings compared to NLWs but only among control participants with no asthma. Furthermore, specific aspects of sleep hygiene and exposure to nighttime noise in the home and neighborhood contributed to racial/ethnic differences in sleep outcomes. CONCLUSION: Considering urban stressors and asthma status when treating pediatric populations is important, as factors related to urban stress and asthma management may influence sleep hygiene practices and sleep outcomes.


Asunto(s)
Afroamericanos/estadística & datos numéricos , Asma/etnología , Disparidades en el Estado de Salud , Hispanoamericanos/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Sueño , Salud Urbana/etnología , Cuidadores , Niño , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Masculino , New England , Higiene del Sueño , Encuestas y Cuestionarios , Factores de Tiempo
12.
Health Serv Res ; 54 Suppl 2: 1409-1418, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31667831

RESUMEN

OBJECTIVE: To examine experiences of racial/ethnic discrimination among Latinos in the United States, which broadly contribute to their poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey including 803 Latinos and a comparison group of 902 non-Hispanic white US adults, conducted January-April 2017. METHODS: We calculated the percent of Latinos reporting discrimination in several domains, including health care. We used logistic regression to compare the Latino-white difference in odds of discrimination, and among Latinos only to examine variation by socioeconomic status and country of birth. PRINCIPAL FINDINGS: One in five Latinos (20 percent) reported experiencing discrimination in clinical encounters, while 17 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A notable share of Latinos also reported experiencing discrimination with employment (33 percent applying for jobs; 32 percent obtaining equal pay/promotions), housing (31 percent), and police interactions (27 percent). In adjusted models, Latinos had significantly higher odds than whites for reporting discrimination in health care visits (OR: 3.18, 95% CI: 1.61, 6.26) and across several other domains. Latinos with college degrees had significantly higher odds of reporting discrimination in multiple domains than those without college degrees, with few differences between foreign-born and US-born Latinos. CONCLUSIONS: Latinos in the United States report experiencing widespread discrimination in health care and other areas of their lives, at significantly higher levels than whites. Being born in the United States and earning a college degree are not protective against discrimination, suggesting that further health and social policy efforts to eliminate discrimination are needed.


Asunto(s)
Disparidades en Atención de Salud/etnología , Hispanoamericanos/estadística & datos numéricos , Racismo/estadística & datos numéricos , Determinantes Sociales de la Salud/etnología , Factores Socioeconómicos , Adolescente , Adulto , Anciano , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/psicología , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Racismo/psicología , Encuestas y Cuestionarios , Teléfono , Estados Unidos
13.
MMWR Morb Mortal Wkly Rep ; 68(43): 967-973, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31671083

RESUMEN

Among the 47,600 opioid-involved overdose deaths in the United States in 2017, 59.8% (28,466) involved synthetic opioids (1). Since 2013, synthetic opioids, particularly illicitly manufactured fentanyl (IMF), including fentanyl analogs, have been fueling the U.S. overdose epidemic (1,2). Although initially mixed with heroin, IMF is increasingly being found in supplies of cocaine, methamphetamine, and counterfeit prescription pills, which increases the number of populations at risk for an opioid-involved overdose (3,4). With the proliferation of IMF, opioid-involved overdose deaths have increased among minority populations including non-Hispanic blacks (blacks) and Hispanics, groups that have historically had low opioid-involved overdose death rates (5). In addition, metropolitan areas have experienced sharp increases in drug and opioid-involved overdose deaths since 2013 (6,7). This study analyzed changes in overdose death rates involving any opioid and synthetic opioids among persons aged ≥18 years during 2015-2017, by age and race/ethnicity across metropolitan areas. Nearly all racial/ethnic groups and age groups experienced increases in opioid-involved and synthetic opioid-involved overdose death rates, particularly blacks aged 45-54 years (from 19.3 to 41.9 per 100,000) and 55-64 years (from 21.8 to 42.7) in large central metro areas and non-Hispanic whites (whites) aged 25-34 years (from 36.9 to 58.3) in large fringe metro areas. Comprehensive and culturally tailored interventions are needed to address the rise in drug overdose deaths in all populations, including prevention strategies that address the risk factors for substance use across each racial/ethnic group, public health messaging to increase awareness about synthetic opioids in the drug supply, expansion of naloxone distribution for overdose reversal, and increased access to medication-assisted treatment.


Asunto(s)
Analgésicos Opioides/envenenamiento , Grupos de Población Continentales/estadística & datos numéricos , Sobredosis de Droga/etnología , Sobredosis de Droga/mortalidad , Grupos Étnicos/estadística & datos numéricos , Drogas Sintéticas/envenenamiento , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Distribución por Edad , Anciano , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto Joven
14.
Dermatol Surg ; 45(12): 1635-1648, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31702594

RESUMEN

BACKGROUND: Racial/ethnic variations in skin structure and function may contribute to differential manifestations of facial aging in various races/ethnicities. OBJECTIVE: To examine self-assessed differences in facial aging in women by race/ethnicity and Fitzpatrick skin phototypes. METHODS: Women aged 18 to 75 years in the United States, Canada, the United Kingdom, and Australia compared their features against photonumeric rating scales depicting degrees of severity for 10 facial aging characteristics. Impact of race/ethnicity (black, Hispanic, Asian, and Caucasian) and skin phototypes on severity was assessed. RESULTS: In total, 3,267 women completed the study. Black women reported the least severe facial aging; Caucasian women reported the most severe facial aging, with Asian and Hispanic women falling between these groups. Similarly, women with a skin phototype V/VI reported lesser aging severity than women with phototypes I through IV. More than 30% of black women did not report the presence of moderate/severe aging of facial areas until 60 to 79 years; most Hispanics and Asians did not report moderate/severe facial aging until 50 to 69 years and Caucasians, 40 to 59 years. CONCLUSION: In this diverse sample, black women reported less severe aging of facial features compared with Hispanic, Asian, and Caucasian women. These results were supported by Fitzpatrick skin phototype analyses.


Asunto(s)
Envejecimiento/psicología , Autoevaluación , Envejecimiento de la Piel , Adolescente , Adulto , Grupo de Ascendencia Continental Africana/psicología , Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Anciano , Envejecimiento/etnología , Grupo de Ascendencia Continental Asiática/psicología , Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , Australia , Canadá , Estudios Transversales , Grupo de Ascendencia Continental Europea/psicología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Cara , Femenino , Hispanoamericanos/psicología , Hispanoamericanos/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Reino Unido , Estados Unidos , Adulto Joven
15.
Med Care ; 57(12): 924-929, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31730566

RESUMEN

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.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Grupos de Población Continentales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Grupos Étnicos , Disparidades en Atención de Salud/etnología , Dolor/tratamiento farmacológico , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Analgésicos/uso terapéutico , Analgésicos Opioides/administración & dosificación , Americanos Asiáticos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Oregon , Dolor/etiología , Dimensión del Dolor , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Heridas y Traumatismos/complicaciones
16.
Eat Behav ; 35: 101336, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31731234

RESUMEN

The Power of Food Scale (PFS) is an instrument designed to examine individual differences in the drive to eat for pleasure (as opposed to in response to physiological hunger) and the effect of living in an obesogenic environment. Previous research supports the validity and reliability of the PFS, however, it had yet to be validated in an ethnically diverse college sample. The purpose of the current study was to test the factor structure and measurement invariance of the PFS across gender, ethnicity, and weight status. A sample of 432 college students completed the PFS (males=113, females = 319; non-Hispanic white=181, Hispanic=251; non-overweight=302, overweight=130). Confirmatory factor analysis was used to test a second-order, 3-factor (food available, food present, food tasted) structure of the PFS in each group separately (males, females, Hispanic, non-Hispanic white, non-overweight, and overweight) and tests of measurement invariance were conducted to test the equivalency of the measure across gender, ethnicity, and weight status. Results supported the measure's original factor structure (second-order, 3-factor model) and indicated that the measure is equivalent across each of these groups, respectively. Although the small, unbalanced groups may impact the stability of the findings, the results nonetheless suggest that the PFS is a psychometrically valid measure in a diverse college sample, and that mean comparisons on this measure are meaningful across gender, ethnicity, and weight status. Given the measurement invariance of the PFS, there is support for use of the PFS among diverse college students in future work.


Asunto(s)
Conducta Alimentaria/psicología , Estudiantes/psicología , Encuestas y Cuestionarios , Adolescente , Adulto , Grupo de Ascendencia Continental Europea/psicología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Análisis Factorial , Conducta Alimentaria/etnología , Femenino , Hispanoamericanos/psicología , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , New Mexico , Sobrepeso/etnología , Sobrepeso/psicología , Psicometría , Reproducibilidad de los Resultados , Factores Sexuales , Estudiantes/estadística & datos numéricos , Universidades , Adulto Joven
17.
BMC Public Health ; 19(1): 1429, 2019 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-31672141

RESUMEN

BACKGROUND: The feminization and ethnic diversification of HIV infection, has resulted in a call for gender- and culture-specific prevention strategies for at-risk groups including Latinos in the United States. The steadily changing demographic profile of the AIDS epidemic challenges prevention strategies to remain relevant and up-to-date, particularly in populations of women midlife and older where an understanding of risk remains under explored. As the CDC requests country-specific HIV risk profiles for Latino communities in the US, understanding the socio-economic, behavioral and personal risk reasons of HIV risk for older Dominican women is critical for prevention. METHODS: We conducted focus group discussions informed by the Theory of Gender and Power (TGP). The three constructs of the TGP: 1) Affective influences/social norms; 2) Gender-specific norms and. 3) Power and Authority guided the thematic analysis and identified themes that described the socio-cultural and contextual reasons that that contribute to perceptions of HIV risk. RESULTS: Sixty Dominican American women ages 57-73 participated in our focus group discussions. Sexual Division of Labour: 1) Economic Dependence; 2) Financial Need and 3) Education and Empowerment. Sexual Division of Power: 4) HIV Risk and 5) Relationship Dynamics. Cathexis: Affective Influences/Social Norms: 6) HIV/AIDS Knowledge and 7) Prevention and Testing. Importantly, participants were concerned about partner fidelity when visiting the Dominican Republic, as the country accounts for the second highest HIV rates in the Caribbean. CONCLUSIONS: Our results confirm previous findings about perceptions of HIV risk and provide additional insight into aging-related aspects of HIV risk for Latino women midlife and older.


Asunto(s)
Actitud Frente a la Salud/etnología , Infecciones por VIH/etnología , Infecciones por VIH/psicología , Hispanoamericanos/psicología , Anciano , República Dominicana/etnología , Femenino , Grupos Focales , Hispanoamericanos/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Medición de Riesgo , Conducta Sexual/etnología , Parejas Sexuales/psicología , Estados Unidos
18.
Cancer Causes Control ; 30(12): 1327-1339, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31655944

RESUMEN

PURPOSE: Lifestyle factors may have a synergistic effect on health. We evaluated the correlates of poor adherence to a healthy lifestyle among a diverse sample of colorectal cancer (CRC) survivors to inform future lifestyle promotion programs. METHODS: Lifestyle questions from a cross-sectional survey were completed by 283 CRC survivors (41% Hispanic, 40% rural, 33% low income). Adherence to recommendations (yes/no) for physical activity, fruit and vegetable servings/day, avoiding tobacco, and healthy weight was summed to create an overall lifestyle quality score. Polytomous logistic regression was used to evaluate correlates of good (reference group), moderate, and poor overall lifestyle quality. Potential correlates included sociodemographic characteristics, cancer-related factors, and indicators of health and well-being. RESULTS: CRC survivors with poor adherence were 2- to 3.4-fold significantly more likely to report multiple comorbidities, poor physical functioning, fatigue, anxiety/depressive symptoms, and poor social participation. In multivariable analyses, poor physical functioning was the only significant correlate of poor adherence to lifestyle recommendations, compared to good adherence [OR (95% CI) 3.4 (1.8-6.4)]. The majority of survivors, 71% and 78%, indicated interest in receiving information on exercise and eating a healthy diet, respectively. CONCLUSION: Future lifestyle promotion programs for CRC survivors should carefully consider indicators of physical and psychosocial health and well-being, especially poor physical functioning, in the design, recruitment, and implementation of these health programs.


Asunto(s)
Supervivientes de Cáncer/estadística & datos numéricos , Neoplasias Colorrectales/epidemiología , Estilo de Vida Saludable , Anciano , Ansiedad/epidemiología , Estudios Transversales , Depresión/epidemiología , Ejercicio , Fatiga/epidemiología , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
19.
Am Surg ; 85(10): 1166-1170, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31657317

RESUMEN

Youth and young adult interpersonal violence (IPV) is a unique clinical challenge which merits study. This study defined the demographics and clinical outcomes of youth and young adult victims of IPV presenting to our hospital while examining violent injury recidivism. We reviewed patients aged 10 to 30 years admitted to our trauma bay as a victim of gunshot wound (GSW), stabbing wound, or blunt assault from 1998 to 2015 (n = 12,549). Logistic regression analysis was conducted to compare patient mortality across demographic characteristics, and Cox proportional hazards regression was used to determine risk factors for recidivism. Male (92%) and Hispanic patients (75%) constituted the majority of admissions. We observed differences in the mortality rate by gender (9% in males vs 5% in females, P < 0.001), race/ethnicity (5% non-Hispanic white vs 9% Hispanic, P = 0.001), insurance status (3% insured vs 10% uninsured, P < 0.001), and mechanism of injury (13% GSW, 2% stabbing wound, and 0.3% blunt assault, P < 0.001). Male gender, younger age, GSW, and amphetamine placed patients at higher risk for IPV recidivism (P < 0.05). This study demonstrates the need to better understand how demographics and economics are associated with youth and young adult IPV. In addition, future IPV prevention and intervention initiatives can be tailored to suit the unique needs of our population.


Asunto(s)
Víctimas de Crimen/estadística & datos numéricos , Reincidencia/estadística & datos numéricos , Heridas por Arma de Fuego/mortalidad , Heridas no Penetrantes/mortalidad , Heridas Punzantes/mortalidad , Adolescente , Adulto , Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , Niño , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Violencia con Armas/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Humanos , Seguro de Salud/estadística & datos numéricos , Masculino , Oportunidad Relativa , Reincidencia/etnología , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Heridas por Arma de Fuego/epidemiología , Heridas por Arma de Fuego/etnología , Heridas no Penetrantes/epidemiología , Heridas no Penetrantes/etnología , Heridas Punzantes/epidemiología , Heridas Punzantes/etnología , Adulto Joven
20.
Health Serv Res ; 54 Suppl 2: 1467-1471, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31650534

RESUMEN

OBJECTIVE: To summarize findings from this Special Issue, which examine reported experiences of discrimination among six underrepresented groups in public opinion research-blacks, Latinos, Native Americans, Asian Americans, lesbian, gay, bisexual, transgender, or queer (LGBTQ) adults, and women. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey of 3453 US adults, conducted January-April 2017. METHODS: We calculated the percent of adults reporting discrimination in several domains, including health care. PRINCIPAL FINDINGS: In health care encounters, 32 percent of black adults reported discrimination, as did 23 percent of Native Americans, 20 percent of Latinos, 18 percent of women, 16 percent of LGBTQ adults, and 13 percent of Asian Americans. Significant shares also reported experiencing racial, gender, or LGBTQ identity-based violence against themselves or family members, including 51 percent of LGBTQ adults, 42 percent of blacks, 38 percent of Native Americans, and 21 percent of women. At least one in seven blacks (22 percent), LGBTQ adults (18 percent), Latinos (17 percent), and Native Americans (15 percent) reported avoiding health care for themselves or family members over concerns of anticipated discrimination or unfair treatment. CONCLUSIONS: Taken together, this polling effort illustrates the significant and widespread level of discrimination against many groups in America today, as well as the complex manifestation of these experiences across different groups and different areas of life. While it is beyond the scope of these results to make specific recommendations for how to end discrimination in each area of life we studied, this Special Issue provides important evidence that more research and practice on discrimination are sorely needed in health services research.


Asunto(s)
Disparidades en Atención de Salud/etnología , Racismo/estadística & datos numéricos , Minorías Sexuales y de Género/estadística & datos numéricos , Determinantes Sociales de la Salud/etnología , Adulto , Afroamericanos/estadística & datos numéricos , Americanos Asiáticos/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Indios Norteamericanos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Racismo/psicología , Encuestas y Cuestionarios , Teléfono , Estados Unidos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA