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1.
WMJ ; 120(S1): S13-S16, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33819397

RESUMO

BACKGROUND: Our goal was to identify racial and ethnic disparities in health outcome and care measures in Wisconsin. METHODS: We used electronic health record data from 25 health systems submitting to the Wisconsin Collaborative for Healthcare Quality to identify disparities in measures, including vaccinations, screenings, risk factors for chronic disease, and chronic disease management. RESULTS: American Indian/Alaska Native and Black populations experienced substantial disparities across multiple measures. Asian/Pacific Islander, Hispanic/Latino, and White populations experienced substantial disparities for 2 measures each. DISCUSSION: Reducing health disparities is a statewide imperative. Root causes of health disparities, such as systemic racism and socioeconomic factors, should be addressed for groups experiencing multiple disparities, with focused efforts on selected measures when indicated.

2.
WMJ ; 120(S1): S17-S23, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33819398

RESUMO

INTRODUCTION: Maternal and infant racial and ethnic health disparities persist in Wisconsin. The Black infant mortality rate is 3 to 4 times that of White infants. OBJECTIVE: In this study, we used data from the Wisconsin Pregnancy Risk Assessment Monitoring System to examine women's experiences with racism and accessing pre- and postnatal care. METHODS: Data from the 2016-2018 Pregnancy Risk Assessment Monitoring System-an ongoing state-administered surveillance system of new mothers-were used. The total number of non-White respondents was n = 2,571. The data are weighted both for nonsampling and for nonresponse. The prevalence of late entry to prenatal care, inadequate prenatal care, and no postpartum visit in the population of non-White women were calculated. Multivariable logistic regression was used to model the association between racial discrimination in the year prior to birth and perinatal care utilization and satisfaction. RESULTS: Less-than-adequate prenatal care was significantly associated with racial discrimination in bivariate analysis (OR 1.4; 95% CI, 1.02-1.8), but this relationship became marginally significant after adjusting for maternal sociodemographic characteristics (OR 1.3; 95% CI, 0.9-1.7). In contrast, prenatal experience of racial discrimination was associated with about 1.5 times the odds of not receiving a postpartum visit both before and after adjusting for maternal characteristics (OR 1.6; 95% CI, 1.1-2.3). CONCLUSIONS: Completing the postpartum visit has the potential to save mothers' lives; decreasing experiences of racial discrimination in health care settings may be one mechanism for decreasing maternal and infant mortality.

3.
WMJ ; 120(S1): S42-S47, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33819402

RESUMO

INTRODUCTION: Breast cancer is the most common cancer in women in Wisconsin. Evidence demonstrates that non-White racial minorities in the United States exhibit a higher mortality rate and more advanced or aggressive presentations of the disease than their White counterparts. Postmastectomy breast reconstruction remains essential to the treatment and recovery of these patients; however, racial disparities in the receipt of reconstruction are evident. This study evaluates the presence of racial disparities in postoperative outcomes of breast reconstruction at a single institution in Wisconsin. METHODS: An institutional review board-exempt retrospective study of postoperative outcomes was performed using a single institution's National Surgical Quality Improvement Program Registry to identify patients who underwent autologous or prosthesis-based breast reconstruction following mastectomy. Patient demographic, preoperative, operative, and postoperative variables were recorded. Postoperative outcomes in relation to self-reported race were evaluated using univariate analysis and propensity score matching. RESULTS: A total of 1,140 patients were included (1,092 White vs 48 non-White), with fewer non-White patients undergoing reconstruction. Patients of non-White race demonstrated a higher incidence of morbid obesity (4.4% White vs 12.5% non-White, P = 0.010) and bleeding disorders (0.3% White vs 4.2% non-White, P < 0.001). No association between self-reported race and postoperative complication was found. CONCLUSION: This study did not reveal racial disparities in postoperative outcomes of breast reconstruction at a single institution in Wisconsin; however, non-White patients were less likely to undergo reconstruction. Further research into the underlying causes of unequal access to care, influence of insurance, effect of structural racism, and impact of physician- and patient-associated factors is warranted.

4.
WMJ ; 120(S1): S48-S53, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33819403

RESUMO

OBJECTIVE: Acute myocardial infarction (AMI), or heart attack, carries a high inpatient death risk. Few national studies suggest race affects the outcomes of inpatients with AMI. In Wisconsin, an assessment of racial disparity among admissions for AMI is lacking. METHODS: Using the Wisconsin State Inpatient Database from 2016, demographics and outcomes for AMI admissions were analyzed. The goal was to compare demographic and hospitalization characteristics between non-Hispanic White patients and Black, Indigenous, and People of Color (BIPOC). RESULTS: A total of 6,002 non-Hispanic Whites and 546 BIPOC cases were identified. BIPOC were younger than non-Hispanic White inpatients (median age, 59 years vs 68 years, respectively; P < 0.001). Median length of stay was shorter in non-Hispanic White versus BIPOC (2 days vs 3 days; P = 0.021), and mean total charges were higher for BIPOC than non-Hispanic Whites ($74,716 vs $65,384, respectively; P = 0.002). Using a risk-adjusted model, inpatient mortality was increased for patients over 55 years of age (odds ratio [OR] 2.166; 95% CI, 1-3; P = 0.001) and women (OR 1.319; 95% CI, 1-1.6; PP = 0.03). Race (BIPOC vs non-Hispanic White) was not predictive of inpatient death on univariable analysis (OR 0.771; 95% CI, 0.4-1.2; P = 0.283). CONCLUSION: It appears BIPOC have longer hospital stays and incur higher charges than non-Hispanic White patients, though race does not affect mortality risk. Among Wisconsin counties with higher proportions of AMI, these data may enable strategic recommendation of hospitalized patients or permit risk stratification to identify disparity and encourage equitable care.

5.
WMJ ; 120(S1): S74-S77, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33819409

RESUMO

BACKGROUND: Racial health disparities in Wisconsin are profound. Racism occurring within the health care field contributes to disparities. Anti-racist education was identified as a need at 2 family medicine residency programs in urban Milwaukee, Wisconsin. METHODS: A 3-hour program was developed and performed 3 times over 3 years, engaging around 100 participants at 2 residency programs. RESULTS: Thirty-five post-program surveys were completed. Respondents indicated improvement in knowledge, attitude, and awareness of anti-racist health concepts. DISCUSSION: The program established a baseline from which to develop anti-racist health care providers. Presenters reflect on the importance of addressing racism as a health issue, getting to know the community served, supporting team members of Color to thrive, and for health care institutions to address racism in an intentional manner.

6.
J Med Internet Res ; 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33819909

RESUMO

BACKGROUND: In the United States, racial and ethnic minorities are disproportionately affected by COVID-19, with persistent social and structural factors contributing to these disparities. At the intersection of race/ethnicity and gender, women of color may be disadvantaged in terms of COVID-19 outcomes due to their role as essential workers, higher prevalence of pre-existing conditions, increased stress and anxiety from loss of wages and caregiving, and domestic violence. OBJECTIVE: The purpose of this study was to examine racial and ethnic differences in the prevalence of COVID-19 outcomes, stressors, fear, and prevention behaviors among adult women residing in the United States. METHODS: Between May and June 2020, women were recruited into The COPE Study, a web-based cross-sectional study, using advertisements on Facebook; 491 eligible women completed a self-administered internet-based cross-sectional survey. Descriptive statistics were used to examine racial and ethnic differences (White; Asian; Native Hawaiian or other Pacific Islander; Black; Hispanic, Latina or Spanish Origin; American Indian or Alaskan Native; Multiracial or some other race, ethnicity, or origin) on COVID-19 outcomes, stressors, fear, and prevention behaviors. RESULTS: Among our sample of women, 16% (73/470) reported COVID-19 symptoms, 22% (18/82) were concerned about possible exposure from the people they knew who tested positive for COVID-19, and 51.4% (227/442) knew where to get tested; yet only 5.8% (27/469) had been tested. Racial/ethnic differences were observed, with racial/ethnic minority women being less likely to know where to get tested. Significant differences in race/ethnicity were observed for select stressors (food insecurity, not enough money, homeschooling children, unable to have a doctor/telemedicine appointment) and prevention behaviors (handwashing with soap, self-isolation if sick, public glove use, not leaving home for any activities). Although no racial/ethnic differences emerged for the fear of COVID-19 scale, significant racial/ethnic differences were observed for some of the individual scale items (e.g., being afraid of getting COVID-19, sleep loss and heart racing due to worrying about COVID-19). CONCLUSIONS: Low prevalence of COVID-19 testing and knowledge of where to get tested indicate a critical need to expand testing for women in the U.S., particularly among racial/ethnic minority women. Although overall prevalence of engagement in prevention behaviors was high, targeted education and promotion of prevention activities is warranted in communities of color, particularly with consideration for stressors and adverse mental health.

7.
Ethn Health ; : 1-24, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-33820458

RESUMO

BACKGROUND: . Indian subcontinent exhibits considerable degree of ethnic heterogeneity in cardiovascular disease (CVD) risks. Given the importance of ethnicity, the present multi-ethnic study was conducted to find out the differences in body composition patterning and its influence on CVD risk variables. OBJECTIVE: . Owing to considerable ethnic heterogeneity among Asian Indians the study was performed to determine the association of variability between body composition and CVD risk factors at the micro-level among different tribes by sex, province, and generation. METHODS.: Nine tribes from three different states (provinces) were considered. Anthropometric measurements, body composition, adiposity, blood pressure, and fasting blood glucose was measured using standard technique. Body composition was measured using BIA method by means of body fat monitor. Mean differences of the body composition measures were analysed by ANOVA. Stepwise multiple regressions were done with CVD risk variables as dependent and body composition profiles as independent variables to find out the significant predictors. Those were then loaded for principal component factor analyses (PCFA). RESULTS: . Tribal subjects of both sexes and from both younger and older generations in Gujarat had significantly higher percentage body fat, subcutaneous fat-whole body, and subcutaneous fat-trunk as compared to tribal subjects of Odisha, and West Bengal, as well as significantly lower skeletal mass-whole body and skeletal mass-trunk. PCFA showed two components: (i) percentage body fat with muscle mass; and (ii) visceral fat with resting metabolism. These two components cumulatively explained 80-90% of the total variance associated with CVD risk variables, across the nine tribes. CONCLUSION: . Tribal subjects of Gujarat had higher CVD risks with significantly higher fat mass and lower muscle mass followed by the tribal subjects of Odisha, and West Bengal respectively. The younger generation are equally at risk as their older counterparts. The CVD risks are developing at a much faster rate resulting in a serious public health threat, even in traditional societies. Body composition measures could be considered as a better non-invasive technique for early intervention and proper risk management among the Asian Indians in general and tribal populations in particular.

8.
Am J Prev Med ; 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33820665

RESUMO

INTRODUCTION: Potentially avoidable hospitalizations are disproportionately experienced by racial and ethnic minorities and expose these groups to unnecessary iatrogenic harm (including the risk of nosocomial COVID-19) and undue financial burden. In working toward an overarching goal of eliminating racial and ethnic health disparities, it is important to understand whether and to what extent potentially avoidable hospitalizations have changed by race and ethnicity during the COVID-19 pandemic. METHODS: This single-center pre-post study included patients admitted to any UCLA Health hospital for an ambulatory care-sensitive condition between March-August 2019 (prepandemic period) and March-August 2020 (postpandemic period). Investigators measured the change in the number of potentially avoidable hospitalizations (defined per the Agency for Healthcare Research and Quality guidelines) stratified by race and ethnicity and calculated the 95% CIs for these hospitalizations using a cluster bootstrap procedure. RESULTS: Between March 1, 2020 and August 31, 2020, 347 of 4,838 hospitalizations (7.2%) were potentially avoidable, compared with 557 of 6,248 (8.9%) during the same 6-month period in 2019. Potentially avoidable hospitalizations decreased by 50.3% (95% CI=41.2, 60.9) among non-Hispanic Whites but only by 8.0% (95% CI= -16.2, 39.9) among African Americans (50.3% vs 8.0%, p=0.015). CONCLUSIONS: Racial disparities in potentially avoidable hospitalizations increased during the COVID-19 pandemic at a large urban health system. Given that the prepandemic rates of potentially avoidable hospitalizations were already higher among racial and ethnic minorities, especially among African Americans, this finding should cause alarm and lead to further exploration of the complex factors contributing to these disparities.

10.
Artigo em Inglês | MEDLINE | ID: mdl-33821449

RESUMO

Emerging evidence suggests that vicarious racial experiences of discrimination may negatively influence child health. Few studies have focus on childhood asthma symptoms and potential moderators of such relationship. METHODS: We used two population-based cross-sectional studies from the Social Change Allergy and Asthma in Latin America project in Salvador, Brazil. A total of 1003 children and mothers interviewed in 2006 were included, of whom 873 were reached again in 2013. Vicarious racial discrimination was assessed in mothers by applying the Experiences of Discrimination scale. Data on wheeze and environmental exposures were collected with standardized questionnaires. Levels of allergen-specific IgE were measured to identify atopy. Generalized estimating equations were used to estimate the association between maternal discrimination and wheezing and asthma phenotypes. Interaction terms were evaluated to identify whether mothers' mental health and family social support modified such associations. RESULTS: Children whose mothers reported racial discrimination had greater odds of have asthma symptoms (OR 1.75; 95% CI 1.15-2.67) and non-atopic asthma (OR 1.92; 95% CI 1.09-3.40). When we considered effect modification by social support, we found a higher ORs when the level of social support was lower (OR 2.43; 95% IC 1.19-4.97) than when the level of social support was higher (OR 1.12; CI 0.64-1.96). CONCLUSION: Maternal discrimination was associated with asthma symptoms and with non-atopic phenotype among their children. Enjoying wider social support network appears to buffer the effect on asthmatic symptoms. Intervention on childhood asthma needs to incorporate strategies that target the family.

11.
Artigo em Inglês | MEDLINE | ID: mdl-33821483

RESUMO

AIM: The current study is a descriptive-comparative study and aims to determine intercultural sensitivity and ethnocentrism levels among nurses and nursing students. METHOD: The study was conducted with 207 nurses working at a State Hospital and 211 nursing students studying at a University between November 30, 2019, and January 20, 2020. The data were collected using a descriptive characteristics form, the Intercultural Sensitivity Scale, and the Ethnocentrism Scale. FINDINGS: It was found that both nurses and nursing students (73.4% and 60.7%, respectively) struggled to communicate with foreign patients and experienced problems with cultural differences (49.8% and 22.7%, respectively). A statistically significant negative correlation was found for the nurses and nursing students in terms of their intercultural sensitivity and ethnocentrism scores (p < .05). PRACTICAL IMPLICATION: Nurses and student nurses should interact with people from different cultures to improve refugee health care.

12.
Subst Use Misuse ; : 1-8, 2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33821743

RESUMO

PURPOSE: Little is known about racial/ethnic minority substance use and disorder-related disparities among sexual minorities as compared to their heterosexual counterparts. This study aimed to understand the associations between sexual minority status and substance use and disorders among U.S. adults stratified by race/ethnicity. Methods: We analyzed data from a sample of U.S. adults (n = 35,981) surveyed during the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions-III. Respondents were categorized into four sexual minority statuses: heterosexual, gay/lesbian, bisexual, and conflicting. Respondents' substance (tobacco, alcohol, and marijuana) use and disorders were also assessed using standard measures. Weighted multivariable logistic regressions were used to examine the relationships between sexual minority status and substance use and disorders, stratified by race/ethnicity, adjusting for socio-demographic characteristics. Results: Sexual minority adults experienced a higher prevalence of substance use and disorders than heterosexuals. For example, bisexuals were more likely than heterosexuals to use marijuana (AOR = 3.45, 95% CI = 2.64-4.50) and have tobacco use disorders (AOR = 2.58, 95% CI = 2.02-3.28). These associations were stronger among racial/ethnic minorities. For instance, bisexual non-Hispanic Blacks were more than twice as likely (AOR = 3.17, 95% CI = 2.16-4.65) to be current tobacco users than their heterosexual counterparts; while this association was weaker for bisexual non-Hispanic Whites (AOR = 1.99, 95% CI = 1.47-2.71). Conclusion: Sexual minority adults, especially those who are also racial/ethnic minorities, experience a significantly higher burden of substance use and disorders than heterosexuals. Efforts to screen and treat substance use and disorders among this particular population are critically needed to improve their health outcomes and reduce health disparities.

13.
Ann Behav Med ; 2021 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-33821886

RESUMO

BACKGROUND AND PURPOSE: Hispanic ethnic density (HED) is associated with salubrious health outcomes for Hispanics, yet recent research suggests it may also be protective for other groups. The purpose of this study was to test whether HED was protective for other racial-ethnic groups. We tested whether social support or neighborhood social integration mediated the association between high HED and depressive symptoms (CES-D) and physical morbidity 5 years later. Lastly, we tested whether race-ethnicity moderated both main and indirect effects. METHODS: We used Waves 1 (2005-2006), and 2 (2010-2011) from The National Social Life, Health, and Aging Project, a national study of older U.S. adults. Our sample was restricted to Wave 1 adults who returned at Wave 2, did not move from their residence between waves, and self-identified as Hispanic, non-Hispanic White (NHW), or non-Hispanic Black (NHB; n = 1,635). We geo-coded respondents' addresses to a census-tract and overlaid racial-ethnic population data. Moderated-mediation models using multiple imputation (to handle missingness) and bootstrapping were used to estimate indirect effects for all racial-ethnic categories. RESULTS: Depressive symptoms were lower amongst racial-ethnic minorities in ethnically (Hispanic) dense neighborhoods; this effect was not stronger in Hispanics. HED was not associated with physical morbidity. Sensitivity analyses revealed that HED was protective for cardiovascular events in all racial-ethnic groups, but not arthritis, or respiratory disease. Social support and neighborhood social integration were not mediators for the association between HED and outcomes, nor were indirect effects moderated by race-ethnicity. CONCLUSIONS: This study offers some evidence that HED may be protective for some conditions in older adults; however, the phenomena underlying these effects remains a question for future work.

14.
Environ Entomol ; 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33822009

RESUMO

Whether increased natural enemy density or adding a second natural enemy species will provide superior pest suppression in greenhouse augmentative biological control is unknown for many commercially available natural enemy species. In this study, we use sweetpotato whiteflies, Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae), on poinsettias, Euphorbia pulcherrima Willd. ex Klotzsch (Malpighiales: Euphorbiaceae), to determine whether adding Amblyseius swirskii (Athias-Henriot) (Acari: Phytoseiidae) to Eretmocerus eremicus Rose and Zolnerowich (Hymenoptera: Aphelinidae) is better for B. tabaci suppression compared with either natural enemy alone, both with and without challenges with whitefly immigration or delayed natural enemy releases. The number of whiteflies on caged poinsettias treated with different natural enemy release rates (single or double rate), natural enemy species (one or two species), natural enemy delayed release (weeks 4 and 8), and whitefly immigration treatments (introduced at week 4 or week 8) was censused biweekly for 16 wk. Both species used in combination provided similar or better suppression of whiteflies compared with either natural enemy alone. Both species combined also provided superior suppression of whiteflies when challenged with whitefly immigration or delays in natural enemy releases compared with E. eremicus alone. Whitefly immigration or delays in E. eremicus releases did not increase whitefly populations, suggesting that suppression of whiteflies by E. eremicus alone is relatively robust. This study found no evidence for negative interactions between E. eremicus and A. swirskii for suppressing B. tabaci.

15.
Clin Infect Dis ; 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33822023

RESUMO

BACKGROUND: Since the introduction of remdesivir and dexamethasone for severe COVID-19 treatment, few large multi-hospital system US studies have described clinical characteristics and outcomes of minority COVID-19 patients who present to the emergency department (ED). METHODS: This cohort study from the Cerner Real World Database (87 US health systems) from December 1, 2019 to September 30, 2020 included PCR-confirmed COVID-19 patients who self-identified as non-Hispanic Black (Black), Hispanic White (Hispanic), or non-Hispanic White (White). The main outcome was hospitalization among ED patients. Secondary outcomes included mechanical ventilation, intensive care unit care, and in-hospital mortality. Descriptive statistics and Poisson regression compared sociodemographics, comorbidities, receipt of remdesivir, receipt of dexamethasone, and outcomes by racial/ethnic groups and geographic region. RESULTS: 94,683 COVID-19 patients presented to the ED. Blacks comprised 26.7% and Hispanics 33.6%. Nearly half (45.1%) of ED patients presented to hospitals in the South. 31.4% (n=29,687) were hospitalized. Lower proportions of Blacks were prescribed dexamethasone (29.4%; n=7,426) compared to Hispanics (40.9%; n=13,021) and Whites (37.5%; n=14,088). Hospitalization risks, compared to Whites, were similar in Blacks (Risk Ratio (RR)=0.94; 95% CI:0.82, 1.08; p=0.4)) and Hispanics RR=0.99 (95% CI:0.81, 1.21; p=0.91), but risk of in-hospital mortality was higher in Blacks, RR=1.18 (95% CI:1.06, 1.31; p=0.002) and Hispanics, RR=1.28 (95% CI: 1.13, 1.44; p < 0.001). CONCLUSIONS: Minority patients were overrepresented among COVID-19 ED patients, and while they had similar risks of hospitalization as Whites, in-hospital mortality risk was higher. Interventions targeting upstream social determinants of health are needed to reduce racial/ethnic disparities in COVID-19.

17.
Ambio ; 2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33825159

RESUMO

Non-migration is an adaptive strategy that has received little attention in environmental migration studies. We explore the leveraging factors of non-migration decisions of communities at risk in coastal Bangladesh, where exposure to both rapid- and slow-onset natural disasters is high. We apply the Protection Motivation Theory (PMT) to empirical data and assess how threat perception and coping appraisal influences migration decisions in farming communities suffering from salinization of cropland. This study consists of data collected through quantitative household surveys (n = 200) and semi-structured interviews from four villages in southwest coastal Bangladesh. Results indicate that most respondents are unwilling to migrate, despite better economic conditions and reduced environmental risk in other locations. Land ownership, social connectedness, and household economic strength are the strongest predictors of non-migration decisions. This study is the first to use the PMT to understand migration-related behaviour and the findings are relevant for policy planning in vulnerable regions where exposure to climate-related risks is high but populations are choosing to remain in place.

18.
Acad Psychiatry ; 2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33825171

RESUMO

OBJECTIVE: The objective of this study was to examine trends in racial/ethnic and gender representation among US psychiatry residency applicants compared with non-psychiatry applicants. METHODS: Using publicly available applicant data, racial/ethnic and gender distributions of psychiatry residency applicants from 2008 to 2019 were examined and compared with non-psychiatry residency applicants. Both longitudinal trends within both cohorts and cross-sectional, between-group differences were examined. RESULTS: From 2008 to 2019, the percentage of female, American Indian/Alaskan Native (AIAN), Black, Hispanic, and Native Hawaiian/Other Pacific Islander (NHPI) psychiatry and non-psychiatry residency applicants increased (p<.001). Within each year, Black and Asian applicants comprised a larger percentage of psychiatry applicants compared with non-psychiatry applicants (p<.001). Between 2008 and 2019, Black psychiatry and non-psychiatry applicants increased from 9.1% to 11.6% and 6.6% to 7.6%, respectively; Asian psychiatry and non-psychiatry applicants decreased from 39.5% to 30.5% and 27.5% to 26.6%, respectively; White psychiatry and non-psychiatry applicants increased from 26.7% to 38.2% and 42.7% to 49.2%, respectively. CONCLUSIONS: Racial/ethnic and gender characteristics of US psychiatry residency applicants represent the future of the US psychiatric workforce. The US psychiatry residency applicant pool has become increasingly diverse from 2008 to 2019. Initiatives should work to enhance representation of psychiatry applicants from historically marginalized backgrounds, and simultaneously to recruit and retain a diverse psychiatric workforce following residency training.

19.
Artigo em Inglês | MEDLINE | ID: mdl-33825228

RESUMO

Young people from migrant and ethnic minority backgrounds are recognised as emerging priority populations for reducing alcohol and other drug (AOD)-related harms in Australia. Limited research has investigated how service providers address AOD challenges in migrant communities. In this qualitative study, we interviewed 15 service providers from AOD, migrant support, community and other health services in a diverse region of Melbourne. Interviews explored the challenges that service providers faced and the strategies they implemented to engage with young migrants in relation to AOD use. Thematic analysis was used to generate four themes: stigma as a barrier to service delivery, intergenerational differences between young people and parents, the need for outreach and establishing trust and understanding over time. Service providers believed that stigma prevented many young people from migrant backgrounds having open conversations about their AOD use with family members and professionals. Participants perceived that some parents had less AOD-related knowledge and lower English language proficiency than their children creating challenges for effective communication. Service providers recognised the importance of engaging with young people in settings where they felt comfortable rather than expecting them to approach their service. Participants also acknowledged the need to invest time in establishing trust and understanding with young migrants so they could facilitate conversations about AOD use as relationships evolved. Although service providers had a strong understanding of young people's needs, they found it challenging to build relationships in the context of funding and time constraints. Our results indicate the need for long-term funding and timelines that enable service providers to build strong relationships with young migrants, their families and their broader cultural communities to facilitate access to AOD support.

20.
ANZ J Surg ; 2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33825324

RESUMO

BACKGROUND: Previous studies have demonstrated a high incidence of acute pancreatitis (AP) in New Zealand, with Maori having the highest reported incidence worldwide. It is possible that barriers to healthcare exist for rural and Maori patients, leading to poorer outcomes. The aim of this study is to compare differences in severity and outcomes in patients with AP with regards to rurality and ethnicity. METHODS: Multicentre retrospective study of all adults aged >16 years who were admitted to any hospital with AP in Northland between 1 January 2014 and 31 December 2018 was performed. Pancreatitis severity was classified using the Revised Atlanta classification. The primary outcome of interest was the difference in severity of pancreatitis with regards to rurality and ethnicity. Secondary outcomes of interest included clinical outcomes, aetiology of AP and re-presentation rates. RESULTS: A total of 468 patients were included. There was no difference found between rural and urban or Maori and non-Maori patients with regards to disease severity, length of stay, mortality or intensive care unit admission rate. A significant difference in aetiology was found between Maori and non-Maori patients, with a higher rate of gallstone pancreatitis in Maori. There was no difference in local complications or number of re-presentations between groups. CONCLUSION: This study showed no difference in the severity or outcomes of AP across rural and urban patients in the Northland region of New Zealand. Secondary outcomes were broadly comparable between groups, with a higher rate of gallstone pancreatitis found in Maori compared to non-Maori.

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