Type 2 Diabetes Mellitus in Latinx Populations in the United States: A Culturally Relevant Literature Review.

Type 2 diabetes mellitus (T2DM) affects a large number of the American population. When compared to their representation in the general American population, a disproportionate number of Latinx individuals are affected. Within the Latinx American population, T2DM prevalence rates vary among individuals based on their country of origin. Deaths from T2DM among Latinx American population are also more compared to other ethnicities. This disparity underlines the importance of understanding the cultural considerations of T2DM disease presentation and management in Latinx communities, including risk factors, socioeconomic variables, and other social determinants of health such as access to care. There are various modifiable and non-modifiable risk factors for the development of T2DM, regardless of race. Staple foods in the diet of Latinx American communities, such as tortillas, rice, and beans, can cause spikes in blood sugar levels and can lead to obesity, which predisposes patients to develop T2DM. Latinx American populations suffer from lower access to healthcare than the general population due to many reasons, including language proficiency, immigration status, socioeconomic status, and level of acculturation. This study utilized the format of a commentary, while incorporating elements of a scoping review for data collection, to further explore these disparities and their impact on these populations. Understanding the cultural beliefs of Latinx individuals and how these beliefs contribute to the perceived development of T2DM is essential to properly treat these unique populations. Despite high rates of T2DM affecting Latinx individuals, non-adherence to prescribed diabetes medications is high among these populations. Interventions in the form of culturally tailored preventative education, in addition to active T2DM management, are necessary to combat the toll of this disease on Latinx Americans. Generic interventional techniques and methods should be replaced entirely by those that acknowledge, highlight, and utilize the sociocultural characteristics of Latinx Americans.

Associations of Stay-at-Home Order Enforcement With COVID-19 Population Outcomes: An Interstate Statistical Analysis.

In the United States, state governors initially enacted coronavirus diseases 2019 (COVID-19)-mitigation policies with limited epidemiologic data. One prevailing legislative approach, from March to May 2020, was the implementation of "stay-at-home" (SAH) executive orders. Although social distancing was encouraged, SAH orders varied between states, and the associations between potential legal prosecution and COVID-19 outcomes are currently unknown. Here, we provide empirical evidence on how executive enforcement of movement restrictions may influence population health during an infectious disease outbreak. A generalized linear model with negative binomial regression family compared COVID-19 outcomes in states with law-enforceable stay-at-home (eSAH) orders versus those with unenforceable or no SAH orders (uSAH), controlling for demographic factors, socioeconomic influences, health comorbidities, and social distancing. COVID-19 incidence was less by 1.22 cases per day per capita in eSAH states compared with uSAH states (coefficient = -1.22, 95% confidence interval (CI): -1.83, -0.61; P < 0.001), and each subsequent day without an eSAH order was associated with a 0.03 incidence increase (coefficient = 0.03, 95% CI: 0.03, 0.04; P < 0.001). Daily mortality was 1.96 less for eSAH states per capita (coefficient = -1.96, 95% CI: -3.25, -0.68; P = 0.004). Our findings suggest allowing the enforcement of public health violations, compared with community education alone, is predictive of improved COVID-19 outcomes.

Factors Associated With Avoidable Emergency Department Visits in Broward County, Florida.

Background Improper utilization of emergency departments (EDs) in the United States is an issue that places a large burden on the healthcare system. Previous studies have shown that differences in race, gender, and income level have been associated with avoidable ED visits. Broward County, Florida, is diverse with people from many different socioeconomic backgrounds. The objective of this study is to determine the impact that race/ethnicity, gender, and payment methods have on the rates of avoidable ED visits at hospitals in Broward County, Florida. Methods This study utilized a dataset from the Broward Regional Health Planning Council that included ED visits in Broward County in 2019. Secondary data analysis was conducted utilizing a one-way analysis of variance (ANOVA) with post-hoc analysis to compare the proportions of non-emergent, emergent primary care-treatable, and emergent preventable ED visits amongst different race/ethnicities, genders, and payment/insurance methods. Results Compared to non-Hispanic white patients, non-Hispanic black and Hispanic patients had higher mean rates of non-emergent ED visits. Women had greater mean rates compared to men for non-emergent ED visits; males had higher mean rates than females for emergent primary care-treatable and emergent preventable. Patients covered by Medicaid had greater mean rates of non-emergent and emergent primary care-treatable visits compared to patients using other payment or insurance methods. Conclusions This study identified demographics within Broward County associated with avoidable ED visits. To reduce the burden of ED overutilization on the healthcare system, healthcare providers must better educate the at-risk populations about proper ED use. In addition, a comprehensive assessment of social determinants of health in patients overutilizing the ED will allow for better alignment of resources and policy changes to improve healthcare access and community health.

Cardiovascular Disease in the Indo-Caribbean Population: A Scoping Review.

At the beginning of the 20th century, there was a shift in disease patterns from that of communicable disease to noncommunicable disease (NCD). As a result, cardiovascular disease (CVD) has emerged as a leading cause of morbidity and mortality worldwide. Its incidence and effect on various populations at a molecular level as well as clinical implications have been heavily studied; however, its role in morbidity and mortality in the Indo-Caribbean population is often overlooked. The Caribbean diaspora is a vibrant and heterogeneous culture, encompassing individuals with ancestries from across the world including the Indian subcontinent and Africa. Abundant research is consistently conducted on these populations, but limited research exists on how the interplay between genetics and environment translates to the manifestation of various diseases in the Indo-Caribbean population. This scoping review aims to identify and assess the current literature within the past 10 years conducted on CVD in Indo-Caribbeans in order to gain a thorough understanding of disease and management to improve health outcomes. Additionally, this review aimed to identify gaps in research that require further study to gain a better understanding of relevant variables affecting disease outcomes in the Indo-Caribbean population. Multiple health databases were queried, and the initial search yielded over 3,000 results. However, after screening with the inclusion and exclusion criteria established, the final search included less than 1% of the papers initially searched. This search yielded data that included treatment and management of myocardial infarction, hypertension, and atherosclerosis, but notably did not yield papers that discussed the relationship between social determinants of health and CVD in Indo-Caribbeans. Florida and New York are prominent states that have robust Indo-Caribbean populations; the lack of research renders these states vulnerable to improving health outcomes in these patients. The authors call for increased focus on this population in research studies and efforts to improve the quality of the data collected through stratification by ethnicity. Robust data may allow for improvement in the treatment and management of CVD in Indo-Caribbeans, which offers a more proactive rather than reactive approach to decreasing morbidity and mortality.

Effectiveness of PitchSafe on Knowledge and Attitude of Baseball-Related Concussion.

Background Traumatic brain injuries (TBIs), specifically concussions, affect many athletes and have dangerous immediate and long-term sequelae. Lack of awareness surrounding concussion impedes prevention, identification, and treatment. This study aims to assess parental knowledge and attitudes regarding concussions in youth baseball before and after administering an educational intervention called PitchSafe. PitchSafe is a short video that contains examples of baseball-related head injuries such as collisions, falls, and direct hits by baseballs; the signs and symptoms of a concussion; testimony from a former baseball player who sustained a TBI playing baseball; and a brochure detailing the potential signs, symptoms, and treatment plans associated with concussions. Methodology The Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS) was used to assess three indices of parental understanding of concussion: Concussion Knowledge Index (CKI), Concussion Attitudes Index (CAI), and signs and symptoms of concussions (SS). The RoCKAS was administered at baseline and after the PitchSafe tool was administered. Parents were re-assessed one year following the initial distribution of survey materials utilizing the long-term follow-up (LTFU) RoCKAS. A paired sample t-test was conducted to compare the baseline, post-intervention (PI), and LTFU CKI, CAI, and SS among participants. Results The mean scores for CKI were 68% ± 12%, 76% ± 4%, and 76% ± 5% for baseline, PI, and LTFU, respectively. The mean scores for SS were 46% ± 20%, 62% ± 14%, and 64% ± 16% for baseline, PI, and LTFU, respectively. The mean scores for CAI were 87% ± 6%, 91% ± 5%, and 92% ± 4% for baseline, PI, and LTFU, respectively. Conclusions PitchSafe increased youth baseball parents' long-term knowledge of concussions, ability to identify signs and symptoms of concussions, and may promote safer attitudes toward concussions. These findings support more widespread use of educational tools through social media and in clinical settings.

Culturally Sensitive Health Education in the Caribbean Diaspora: A Scoping Review.

CONTEXT: The Caribbean diaspora in the United States is a diverse community that is afflicted with high morbidity and mortality due to preventable chronic diseases. OBJECTIVE: Our goal is to determine which culturally sensitive health and nutrition educational modalities have the highest efficacy for improving general health in the Caribbean diaspora. METHODS: A scoping literature review was performed on the MEDLINE, CINAHL, and Web of Science databases using terms related to health and nutrition in the Caribbean population. Original, peer-reviewed research published from 2010 to 2020, which took place in the U.S. and Caribbean countries, were included in our review. RESULTS: We identified a total of nine articles that met our inclusion criteria. Rate differences for individual education program features were calculated to assess the likelihood of a positive impact on diet, physical activity, and diabetes. CONCLUSION: Our review helps to identify key educational modalities targeting diabetes, diet, and physical activity levels that can be used to meet the health and nutritional needs of the Caribbean diaspora population.

Racial and Ethnic Disparities in COVID-19 Outcomes: Social Determination of Health.

As of 18 October 2020, over 39.5 million cases of coronavirus disease 2019 (COVID-19) and 1.1 million associated deaths have been reported worldwide. It is crucial to understand the effect of social determination of health on novel COVID-19 outcomes in order to establish health justice. There is an imperative need, for policy makers at all levels, to consider socioeconomic and racial and ethnic disparities in pandemic planning. Cross-sectional analysis from COVID Boston University's Center for Antiracist Research COVID Racial Data Tracker was performed to evaluate the racial and ethnic distribution of COVID-19 outcomes relative to representation in the United States. Representation quotients (RQs) were calculated to assess for disparity using state-level data from the American Community Survey (ACS). We found that on a national level, Hispanic/Latinx, American Indian/Alaskan Native, Native Hawaiian/Pacific Islanders, and Black people had RQs > 1, indicating that these groups are over-represented in COVID-19 incidence. Dramatic racial and ethnic variances in state-level incidence and mortality RQs were also observed. This study investigates pandemic disparities and examines some factors which inform the social determination of health. These findings are key for developing effective public policy and allocating resources to effectively decrease health disparities. Protective standards, stay-at-home orders, and essential worker guidelines must be tailored to address the social determination of health in order to mitigate health injustices, as identified by COVID-19 incidence and mortality RQs.

Caribbean Diaspora Healthy Nutrition Outreach Project (CDHNOP): A Qualitative and Quantitative Approach to Caribbean Health.

Background: Obesity prevention and its associated co-morbidities such as diabetes require a multi-tiered, culturally sensitive, population-based approach. South Florida's tri-county area is home to approximately 75% of Florida's total Caribbean immigrant population. This project is the first Caribbean-focused intervention using the Go-Slow-Whoa or GSW format which designates whether a food or beverage should be chosen frequently (Go - green), less often (Slow - yellow), or rarely (Whoa - red) based on the content of nutrients, sodium, fat, and sugar. Specific Aims: 1. To create and evaluate culturally appropriate nutrition materials for the Caribbean diaspora population in Broward County (i.e. tailor existing GSW evidence-based materials for this population). 2. To quantify which social determinants of health are most relevant to this population. Methods: Mixed methods were utilized in this study. The qualitative, exploratory arm consisted of semi-structured focus groups that included 38 subjects from five Caribbean countries most represented in South Florida: Jamaica, Haiti, Trinidad and Tobago, Cuba and Dominican Republic. The quantitative arm employed descriptive and inferential statistics to analyze social determinants of health (SDOH) obtained from a modified National Association of Community Health Centers' PRAPARE survey. Intercept survey data was also collected from a convenience sample of 24 Caribbean immigrants in Broward County. Findings: Analysis revealed a lack of culturally appropriate foods and exercise examples in the current GSW materials. At 92% and 82% respectively, an overwhelming majority of our intercept surveys indicated that our revised, culturally appropriate materials were helpful in making positive food and beverage choices. Further study is required to determine which SDOH variables are relevant to this population. Conclusions: Health disparities and inequity in the healthy living education of our Caribbean subpopulation are best addressed using an inclusive research frame that captures the cultural essence and preferences of this understudied community.

Assessment of Burnout: A Pilot Study of International Women Physicians.

INTRODUCTION: Physician burnout, wellness, and resilience have become increasingly important topics of discussion worldwide. While studies have assessed burnout globally in various individual countries, few studies directly compare or analyze gender-based physician burnout among different global regions. METHODS: Female physicians attending the Medical Women's International Association (MWIA) Centennial Congress completed the Copenhagen Burnout Inventory (CBI) which evaluates personal-, work-, and patient-related burnout using a scale of 0 to 100. Results were analyzed using descriptive statistics and 1-way ANOVA to compare burnout scores amongst women physicians from different global regions. RESULTS: Of 100 physicians invited to participate, 76 provided responses and 71 met the inclusion criteria. Mean burnout scores were highest amongst women from Africa in all categories. Mean work-related, patient-related, and personal-related burnout scores were significantly lower for physicians in Europe compared to Africa (p = 0.05) when evaluated using a 1-way ANOVA, with no statistically significant differences between other regions. DISCUSSION: The data suggests that there may be regional differences in the prevalence of burnout in women physicians. Various factors could play a role in explaining the higher burnout scores in female physicians in Africa, including younger average age, establishing practice during childbearing years, and significant physician shortage. Through this study, we have begun to explore the cultural and geographical context related to women's mental and physical wellbeing in the medical field. Further research should focus on the gender-specific contributors to burnout among different global regions, so that methods can be implemented on a systemic level to alleviate burnout.