Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 13.634
Filtrar
1.
Adv Ther ; 37(12): 4981-4995, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33044691

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19) can present as a range of symptoms, from mild to critical; lower pulmonary involvement, including pneumonia, is often associated with severe and critical cases. Understanding the baseline characteristics of patients hospitalized with COVID-19 illness is essential for effectively targeting clinical care and allocating resources. This study aimed to describe baseline demographics and clinical characteristics of US patients hospitalized with COVID-19 and pulmonary involvement. METHODS: US patients with COVID-19 and pulmonary involvement during an inpatient admission from December 1, 2019, to May 20, 2020, were identified using the IBM Explorys® electronic health records database. Baseline (up to 12 months prior to first COVID-19 hospitalization) demographics and clinical characteristics and preadmission (14 days to 1 day prior to admission) pulmonary diagnoses were assessed. Patients were stratified by sex, age, race, and geographic region. RESULTS: Overall, 3471 US patients hospitalized with COVID-19 and pulmonary involvement were included. The mean (SD) age was 63.5 (16.3) years; 51.2% of patients were female, 55.0% African American, 81.6% from the South, and 16.8% from the Midwest. The most common comorbidities included hypertension (27.7%), diabetes (17.3%), hyperlipidemia (16.3%), and obesity (9.7%). Cough (27.3%) and dyspnea (15.2%) were the most common preadmission pulmonary symptoms. African American patients were younger (mean [SD], 62.5 [15.4] vs. 67.8 [6.2]) with higher mean (SD) body mass index (33.66 [9.46] vs. 30.42 [7.86]) and prevalence of diabetes (19.8% vs. 16.7%) and lower prevalence of chronic obstructive pulmonary disease (5.6% vs. 8.2%) and smoking/tobacco use (28.1% vs. 37.2%) than White patients. CONCLUSIONS: Among US patients primarily from the South and Midwest hospitalized with COVID-19 and pulmonary involvement, the most common comorbidities were hypertension, diabetes, hyperlipidemia, and obesity. Differences observed between African American and White patients should be considered in the context of the complex factors underlying racial disparities in COVID-19.


Assuntos
Afro-Americanos/estatística & dados numéricos , Infecções por Coronavirus , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Pneumopatias , Doenças não Transmissíveis/epidemiologia , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Demografia , Feminino , Disparidades nos Níveis de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Pneumopatias/diagnóstico , Pneumopatias/etnologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etnologia , Pneumonia Viral/etiologia , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fumar/etnologia , Estados Unidos/epidemiologia
2.
Natl Vital Stat Rep ; 69(10): 1-12, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33054922

RESUMO

Objectives-This report describes the methodology used in the preparation of the 2009-2011 decennial life tables for the United States by race, Hispanic origin, and sex based on the age-specific death rates for the period 2009-2011, appearing in the report, "U.S. Decennial Life Tables for 2009-2011, United States Life Tables" (1). Methods-Data used to prepare these life tables include population data by age on the census date April 1, 2010; deaths occurring in the 3-year period 2009-2011 classified by age at death; births for each of the years 2007-2011; and Medicare data for ages 66-99 for the 3 years 2009-2011. The methods used differ from those applied to the 1999-2001 decennial life tables in the estimation of mortality for ages 66 and over. For the total, white, black, non-Hispanic white, and non-Hispanic black populations, the method developed for the U.S. annual life tables beginning with data year 2008 was used. It consists of the application of the Kannisto logistic model to smooth death rates in the age range 85-99 and predict death rates for ages 100-120 (2,3). For the Hispanic population, which is added to the decennial series for the first time with the 2009-2011 set, the method developed for the U.S. annual life tables beginning with data year 2006 was used. This method consists of using the Brass relational logit model to estimate mortality for ages 80-120 (4).


Assuntos
Tábuas de Vida , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Censos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Medicare , Estados Unidos/epidemiologia
3.
Natl Vital Stat Rep ; 69(8): 1-73, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33054929

RESUMO

Objectives-This report presents period life tables for the United States, based on age-specific death rates for the period 2009-2011. These tables are the most recent in a 110-year series of decennial life tables for the United States. Methods-This report presents complete life tables for the United States by race, Hispanic origin, and sex, based on age- specific death rates during 2009-2011. This is the first set of life tables by Hispanic origin presented in the U.S. decennial life table series. Data used to prepare these life tables include population estimates based on the 2010 decennial census; deaths occurring in the United States to U.S. residents in the 3 years 2009 through 2011; counts of U.S. resident births in the years 2007 through 2011; and population and death counts from the Medicare program for years 2009 through 2011. The methodology used to estimate life tables for the Hispanic population is based on the method first implemented with the 2006 annual U.S. life tables by Hispanic origin. The methodology used to estimate the life tables for all other groups is based on the method first implemented with the 2008 annual U.S. life tables. Results-During 2009-2011, life expectancy at birth was 78.60 years for the total U.S. population, representing an increase of 29.36 years from a life expectancy of 49.24 years in 1900. Between 1900 and 2010, life expectancy increased by 42.88 years for black females (from 35.04 to 77.92), by 39.21 years for black males (from 32.54 to 71.75), by 30.15 years for white females (from 51.08 to 81.23), and by 28.26 years for white males (from 48.23 to 76.49). During 2009-2011, Hispanic females had the highest life expectancy at birth (84.05), followed by non-Hispanic white females (81.06), Hispanic males (78.83), non-Hispanic black females (77.62), non-Hispanic white males (76.30), and non-Hispanic black males (71.41).


Assuntos
Expectativa de Vida/etnologia , Tábuas de Vida , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Censos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Medicare , Estados Unidos/epidemiologia
6.
JAMA Netw Open ; 3(9): e2015470, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32876682

RESUMO

Importance: Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it. Objective: To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities. Design, Setting, and Participants: This cross-sectional study used Medicare data regarding the postacute home health care setting from October 1, 2015, through September 30, 2016. The participants were Medicare fee-for-service and Medicare Advantage beneficiaries who were discharged alive from a hospital with a referral to home health care (2 379 506 discharges). Statistical analysis was performed from July 2019 to June 2020. Exposures: Hospital referral to home health care. Main Outcomes and Measures: Primary outcomes included whether discharges received their first home health care visit within 14 days of hospital discharge and the number of days between hospital discharge and the first home health visit. Differences in the likelihood of receiving home health care across patient, zip code, and hospital characteristics were also examined. Results: Among 2 379 506 discharges from the hospital with a home health care referral, 1 358 697 patients (57.1%) were female, 468 762 (19.7%) were non-White, and 466 383 (19.6%) were dually enrolled in Medicare and Medicaid; patients had a mean (SD) age of 73.9 (11.9) years and 4.1 (2.1) Elixhauser comorbidities. Only 1 284 300 patients (54.0%) discharged from the hospital with a home health referral received home health care services within 14 days of discharge. Of the remaining 1 095 206 patients (46.0%) discharged, 37.7% (896 660 discharges) never received any home health care, while 8.3% (198 546 discharges) were institutionalized or died within 14 days without a preceding home health care visit. Patients who were Black or Hispanic received home health at lower rates than did patients who were White (48.0% [95% CI, 47.8%-48.1%] of Black and 46.1% [95% CI, 45.7%-46.5%] of Hispanic discharges received home health within 14 days compared with 55.3% [95% CI, 55.2%-55.4%] of White discharges). In addition, disadvantaged patients waited longer for their first home health care visit. For example, patients living in high-unemployment zip codes waited a mean of 2.0 days (95% CI, 2.0-2.0 days), whereas those living in low-unemployment zip codes waited 1.8 days (95% CI, 1.8-1.8 days). Conclusions and Relevance: Disparities in the use of home health care remain an issue in the US. As home health care is increasingly presented as a safer alternative to institutional postacute care during coronavirus disease 2019, and payment reforms continue to pressure hospitals to discharge patients home, ensuring the availability of safe and equitable care will be crucial to maintaining high-quality care.


Assuntos
Assistência ao Convalescente/estatística & dados numéricos , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/etnologia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Encaminhamento e Consulta , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Medicaid/estatística & dados numéricos , Medicare , Medicare Part C , Alta do Paciente , Pobreza/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Estados Unidos
7.
Clin Neurol Neurosurg ; 197: 106173, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32877769

RESUMO

People with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, COVID-19, can have neurological problems including headache, anosmia, dysgeusia, altered mental status (AMS), ischemic stroke with or without large vessel occlusion, and Guillen-Barre Syndrome. Louisiana was one of the states hit hardest by the pandemic with just over 57,000 laboratory-confirmed cases of COVID-19 by the end of June 2020. We reviewed the electronic medical records (EMR) of patients hospitalized during the peak of the pandemic, March 1st through March 31st, to document the type and frequency of neurological problems seen in patients with COVID-19 at presentation to the emergency room. Secondary aims were to determine: 1) the frequency of neurological complaints during the hospital stay; 2) whether the presence of any neurological complaint at presentation or any of the individual types of neurological complaints at admission predicted three separate outcomes: death, length of hospital stay, or the need for intubation; and 3) if the presence of any neurological complaint or any of the individual types of neurological complaints developed during hospital stay predicted the previous three outcomes. A large proportion of our sample (80 %) was African American and had hypertension (79 %). Out of 250 patients, 56 (22 %) patients died, and 72 (29 %) patients required intubation. Thirty-four (14 %) had a neurological chief complaint at presentation; the most common neurological chief complaints in the entire sample were altered mental status (AMS) (8 %), headache (2 %), and syncope (2 %). We used a competing risk model to determine whether neurological symptoms at presentation or during hospital stay were predictors of prolonged hospital stay and death. To establish whether neurological symptoms were associated with higher odds of intubation, we used logistic regression. Age was the only significant demographic predictor of death and hospital stay. The HR (95 %CI) for remaining in the hospital for a ten-year increase in age was 1.2, (1.1, 1.3, p < 0.0001), and for death was 1.3, (1.1, 1.5, p < 0.01). There were no demographic characteristics, including age or comorbidities predictive of intubation. Adjusting for age, patients who at presentation had neurological issues as their chief complaint were at significantly increased risk for remaining in the hospital, HR = 1.7, (1.1,2.5, p = 0.0001), and dying, HR = 2.1(1.1,3.8, p = 0.02), compared to patients without any neurological complaint. Of the individual admission complaints, AMS was associated with a significantly prolonged hospital stay, HR = 1.8, (1.0-3.3, p = 0.05). Patients that required dialysis or intubation or had AMS during hospitalization had more extended hospital stays. After adjusting for age, dialysis, and intubation, patients with AMS during hospital stay had a HR of 1.6, (1.1, 2.5, p = 0.01) for remaining in the hospital. Patients who had statistically significant higher odds of requiring intubation were those who presented with any neurological chief complaint, OR = 2.8 (1.3,5.8, p = 0.01), or with headaches OR = 13.3 (2.1,257.0, p = 0.008). Patients with AMS during the hospital stay, as well as those who had seizures, were more likely to need intubation. In the multivariate model, dialysis, OR = 4.9 (2.6,9.4, p < 0.0001), and AMS, OR = 8.8 (3.9,21.2, p < 0.0001), were the only independent predictors of intubation. Neurological complaints at presentation and during the hospital stay are associated with a higher risk of death, prolonged hospital stay, and intubation. More work is needed to determine whether the cause of the neurological complaints was direct CNS involvement by the virus or the other systemic complications of the virus.


Assuntos
Infecções por Coronavirus/fisiopatologia , Intubação Intratraqueal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Doenças do Sistema Nervoso/fisiopatologia , Pneumonia Viral/fisiopatologia , Adulto , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Serviço Hospitalar de Emergência , Grupo com Ancestrais do Continente Europeu , Feminino , Cefaleia/etiologia , Cefaleia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Doenças do Sistema Nervoso/etiologia , Nova Orleans , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Prognóstico , Modelos de Riscos Proporcionais , Respiração Artificial , Convulsões/etiologia , Convulsões/fisiopatologia , Estado Epiléptico/etiologia , Estado Epiléptico/fisiopatologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Síncope/etiologia , Síncope/fisiopatologia
9.
Ann Surg ; 272(4): 556-561, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32932306

RESUMO

OBJECTIVE: To evaluate racial disparities among White and Black pediatric firearm injury patients on a national level. BACKGROUND: Pediatric firearm-related morbidity and mortality are rising in the United States. There is a paucity of data examining racial disparities in those patients. METHODS: The Pediatric Trauma Quality Improvement Program (2017) was queried for pediatric (age ≤17 years) patients admitted with firearm injuries. Patients were stratified by race: White and Black. Injury characteristics were assessed. Outcomes were mortality, hospital length of stay, and discharge disposition. Hierarchical regression models were performed to determine predictors of mortality and longer hospital stays. RESULTS: A total of 3717 pediatric firearm injury patients were identified: Blacks (67.0%) and Whites (33.0%). The majority of patients were male (84.2%). The most common injury intent in both groups was assault (77.3% in Blacks vs in 45.4% Whites; P<0.001), followed by unintentional (21.1% vs 35.4%; P<0.001), and suicide (1.0% vs 14.0%; P<0.001). The highest fatality rate was in suicide injuries (62.6%). On univariate analysis, White children had higher mortality (17.5% vs 9.8%; P<0.001), longer hospital stay [3 (1-7) vs 2 (1-5) days; P = 0.021], and more psychiatric hospital admissions (1.3% vs 0.1%; P<0.001). On multivariate analysis, suicide intent was found to be an independent predictor of mortality (aOR 2.67; 95% CI 1.35-5.29) and longer hospital stay (ß + 4.13; P<0.001), while White race was not. CONCLUSION: Assault is the leading intent of injury in both Black and White children, but White children suffer more from suicide injuries that are associated with worse outcomes. LEVEL OF EVIDENCE: Level III Prognostic.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Estados Unidos/epidemiologia
10.
Ann Surg ; 272(4): 660-667, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32932322

RESUMO

OBJECTIVE: The purpose of this study was to assess the temporal trends in 30-day mortality by race group for patients undergoing coronary artery bypass grafting (CABG) between 2011 and 2018 and to investigate the effect of race and sex on postoperative outcomes after CABG. SUMMARY BACKGROUND DATA: Cardiovascular diseases remain a leading cause of death in the United States with studies demonstrating increased morbidity and mortality for black and female patients undergoing surgery. In the post drug-eluting stent era, studies of racial disparities CABG are outdated. METHODS: We performed a retrospective analysis of the Society for Thoracic Surgeons database for patients undergoing CABG between 2011 and 2018. Primary outcome was 30-day mortality. Secondary outcomes included postoperative length of stay, surgical site infection, sepsis, pneumonia, stroke, reoperation, reintervention, early extubation, and readmission. RESULTS: The study population was comprised of 1,042,506 patients who underwent isolated CABG between 2011 and 2018. Among all races, Black patients had higher rates of preoperative comorbidities. Compared with White patients, Black patients had higher overall mortality (2.76% vs 2.19%, P < 0.001). On univariable regression, Black patients had higher rates of death, infection, pneumonia, and postoperative stroke compared to White patients. On multivariable regression, Black patients had higher odds of 30-day mortality compared to white patients [odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.05-1.18]. Similarly, female patients had higher odds of death compared to males (OR = 1.26, 95% CI 1.21-1.30). CONCLUSIONS: In the modern era, racial and sex disparities in mortality and postoperative morbidity after coronary bypass surgery persist with Black patients and female patients consistently experiencing worse outcomes than White male patients. Although there may be unknown or underappreciated biological mechanisms at play, future research should focus on socioeconomic, cultural, and multilevel factors.


Assuntos
Afro-Americanos/estatística & dados numéricos , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/mortalidade , Stents Farmacológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Sistema de Registros , Estudos Retrospectivos , Distribuição por Sexo , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
11.
J Rural Health ; 36(4): 602-608, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32894612

RESUMO

PURPOSE: This study compared the average daily increase in COVID-19 mortality rates by county racial/ethnic composition (percent non-Hispanic Black and percent Hispanic) among US rural counties. METHODS: COVID-19 daily death counts for 1,976 US nonmetropolitan counties for the period March 2-July 26, 2020, were extracted from USAFacts and merged with county-level American Community Survey and Area Health Resource File data. Covariates included county percent poverty, age composition, adjacency to a metropolitan county, health care supply, and state fixed effects. Mixed-effects negative binomial regression with random intercepts to account for repeated observations within counties were used to predict differences in the average daily increase in the COVID-19 mortality rate across quartiles of percent Black and percent Hispanic. FINDINGS: Since early March, the average daily increase in the COVID-19 mortality rate has been significantly higher in rural counties with the highest percent Black and percent Hispanic populations. Compared to counties in the bottom quartile, counties in the top quartile of percent Black have an average daily increase that is 70% higher (IRR = 1.70, CI: 1.48-1.95, P < .001), and counties in the top quartile of percent Hispanic have an average daily increase that is 50% higher (IRR = 1.50, CI: 1.33-1.69, P < .001), net of covariates. CONCLUSION: COVID-19 mortality risk is not distributed equally across the rural United States, and the COVID-19 race penalty is not restricted to cities. Among rural counties, the average daily increase in COVID-19 mortality rates has been significantly higher in counties with the largest shares of Black and Hispanic residents.


Assuntos
Afro-Americanos/estatística & dados numéricos , Betacoronavirus , Infecções por Coronavirus/mortalidade , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Pneumonia Viral/mortalidade , Infecções por Coronavirus/terapia , Feminino , Disparidades nos Níveis de Saúde , Humanos , Pandemias , Pneumonia Viral/terapia , Pobreza/estatística & dados numéricos , Fatores de Risco , População Rural/estatística & dados numéricos , Estados Unidos
12.
PLoS Med ; 17(9): e1003379, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32960880

RESUMO

BACKGROUND: There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). We investigated racial and ethnic disparities in patterns of COVID-19 testing (i.e., who received testing and who tested positive) and subsequent mortality in the largest integrated healthcare system in the United States. METHODS AND FINDINGS: This retrospective cohort study included 5,834,543 individuals receiving care in the US Department of Veterans Affairs; most (91%) were men, 74% were non-Hispanic White (White), 19% were non-Hispanic Black (Black), and 7% were Hispanic. We evaluated associations between race/ethnicity and receipt of COVID-19 testing, a positive test result, and 30-day mortality, with multivariable adjustment for a wide range of demographic and clinical characteristics including comorbid conditions, health behaviors, medication history, site of care, and urban versus rural residence. Between February 8 and July 22, 2020, 254,595 individuals were tested for COVID-19, of whom 16,317 tested positive and 1,057 died. Black individuals were more likely to be tested (rate per 1,000 individuals: 60.0, 95% CI 59.6-60.5) than Hispanic (52.7, 95% CI 52.1-53.4) and White individuals (38.6, 95% CI 38.4-38.7). While individuals from minority backgrounds were more likely to test positive (Black versus White: odds ratio [OR] 1.93, 95% CI 1.85-2.01, p < 0.001; Hispanic versus White: OR 1.84, 95% CI 1.74-1.94, p < 0.001), 30-day mortality did not differ by race/ethnicity (Black versus White: OR 0.97, 95% CI 0.80-1.17, p = 0.74; Hispanic versus White: OR 0.99, 95% CI 0.73-1.34, p = 0.94). The disparity between Black and White individuals in testing positive for COVID-19 was stronger in the Midwest (OR 2.66, 95% CI 2.41-2.95, p < 0.001) than the West (OR 1.24, 95% CI 1.11-1.39, p < 0.001). The disparity in testing positive for COVID-19 between Hispanic and White individuals was consistent across region, calendar time, and outbreak pattern. Study limitations include underrepresentation of women and a lack of detailed information on social determinants of health. CONCLUSIONS: In this nationwide study, we found that Black and Hispanic individuals are experiencing an excess burden of SARS-CoV-2 infection not entirely explained by underlying medical conditions or where they live or receive care. There is an urgent need to proactively tailor strategies to contain and prevent further outbreaks in racial and ethnic minority communities.


Assuntos
Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Grupos Étnicos/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Veteranos/estatística & dados numéricos , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Estudos de Coortes , Infecções por Coronavirus/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/etnologia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
13.
J Pastoral Care Counsel ; 74(3): 196-202, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32967549

RESUMO

Profanity, derived from the Latin for "not sacred," has long been seen as antithetical to spirituality. Social norms around organized religion, respectability, race, gender, etc. compound this perception. In this article, I examine how the use of profanity in Clinical Pastoral Education can help students experience personal, social, and physical freedom. Association of Clinical Pastoral Education outcomes, demographic data, and a student experience provide support for this assertion.


Assuntos
Idioma , Assistência Religiosa/educação , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Homicídio/psicologia , Homicídio/estatística & dados numéricos , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Racismo/psicologia , Racismo/estatística & dados numéricos , Desemprego/psicologia , Desemprego/estatística & dados numéricos , Estados Unidos/epidemiologia
15.
PLoS One ; 15(9): e0238354, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936812

RESUMO

BACKGROUND: African-American men have the lowest 5-year survival rate in the U.S. for colorectal cancer (CRC) of any racial group, which may partly stem from low screening adherence. It is imperative to synthesize the literature evaluating the effectiveness of interventions on CRC screening uptake in this population. MATERIALS AND METHODS: In this systematic review and meta-analysis, Medline, CINAHL, Embase, and Cochrane CENTRAL were searched for U.S.-based interventions that: were published after 1998-January 2020; included African-American men; and evaluated CRC screening uptake explicitly. Checklist by Cochrane Collaboration and Joanna Brigg were utilized to assess risk of bias, and meta-regression and sensitivity analyses were employed to identify the most effective interventions. RESULTS: Our final sample comprised 41 studies with 2 focused exclusively on African-American men. The most frequently adopted interventions were educational materials (39%), stool-based screening kits (14%), and patient navigation (11%). Most randomized controlled trials failed to provide details about the blinding of the participant recruitment method, allocation concealment method, and/or the outcome assessment. Due to high heterogeneity, meta-analysis was conducted among 17 eligible studies. Interventions utilizing stool-based kits or patient navigation were most effective at increasing CRC screening completion, with odds ratios of 9.60 (95% CI 2.89-31.82, p = 0.0002) and 2.84 (95% CI 1.23-6.49, p = 0.01). No evidence of publication bias was present for this study registered with the International Prospective Registry of Systematic Reviews (PROSPERO 2019 CRD42019119510). CONCLUSIONS: Additional research is warranted to uncover effective, affordable interventions focused on increasing CRC screening completion among African-American men. When designing and implementing future multicomponent interventions, employing 4 or fewer interventions types may reduce bias risk. Since only 5% of the interventions solely focused on African-American men, future theory-driven interventions should consider recruiting samples comprised solely of this population.


Assuntos
Afro-Americanos/psicologia , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Educação de Pacientes como Assunto/métodos , Afro-Americanos/estatística & dados numéricos , Neoplasias Colorretais/prevenção & controle , Neoplasias Colorretais/psicologia , Detecção Precoce de Câncer/estatística & dados numéricos , Humanos , Masculino , Prognóstico
16.
PLoS One ; 15(9): e0238356, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991624

RESUMO

BACKGROUND: A lack of patient-centered communication (PCC) with health providers plays an important role in perpetuating disparities in health care outcomes and experiences for minority men. This study aimed to identify factors associated with any racial differences in the experience of PCC among Black and Latino men in a nationally representative sample. METHODS: We employed a cross-sectional analysis of four indicators of PCC representative of interactions with doctors and nurses from (N = 3082) non-Latino White, Latino, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS Health Care Mail in Survey (HCMS). Men's mean age was 66.76 years. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health. RESULTS: Bivariate manova analyses revealed racial differences across each of the four facets of PCC experience such that non-Hispanic white men reported PC experiences most frequently followed by black then Hispanic/Latino men. Multivariate linear regressions predictive of PCC by race/ethnicity revealed that for Black men, fewer PCC experiences were predicted by discriminatory experiences, reporting fewer chronic conditions and a lack of insurance coverage. For Hispanic/Latino men, access to a provider proved key where not having a place of usual care solely predicted lower PCC frequency. IMPLICATIONS: Researchers and health practitioners should continue to explore the impact of inadequate health care coverage, time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive and responsive communication between minority male patients and their health providers.


Assuntos
Afro-Americanos/estatística & dados numéricos , Doença Crônica/terapia , Comunicação , Disparidades em Assistência à Saúde , Hispano-Americanos/estatística & dados numéricos , Assistência Centrada no Paciente/normas , Relações Médico-Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Seguimentos , Humanos , Cobertura do Seguro , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Prognóstico , Racismo/estatística & dados numéricos
18.
MMWR Morb Mortal Wkly Rep ; 69(38): 1337-1342, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32970045

RESUMO

During 2018, gay, bisexual, and other men who have sex with men (MSM) accounted for 69.4% of all diagnoses of human immunodeficiency virus (HIV) infection in the United States (1). Moreover, in all 42 jurisdictions with complete laboratory reporting of CD4 and viral load results,* percentages of MSM linked to care within 1 month (80.8%) and virally suppressed (viral load <200 copies of HIV RNA/mL or interpreted as undetected) within 6 months (68.3%) of diagnosis were below target during 2018 (2). African American/Black (Black), Hispanic/Latino (Hispanic), and younger MSM disproportionately experience HIV diagnosis, not being linked to care, and not being virally suppressed. To characterize trends in these outcomes, CDC analyzed National HIV Surveillance System† data from 2014 to 2018. The number of diagnoses of HIV infection among all MSM decreased 2.3% per year (95% confidence interval [CI] = 1.9-2.8). However, diagnoses did not significantly change among either Hispanic MSM or any MSM aged 13-19 years; increased 2.2% (95% CI = 1.0-3.4) and 2.0% (95% CI = 0.6-3.3) per year among Black and Hispanic MSM aged 25-34 years, respectively; and were highest in absolute count among Black MSM. Annual percentages of linkage to care within 1 month and viral suppression within 6 months of diagnosis among all MSM increased (2.9% [95% CI = 2.4-3.5] and 6.8% [95% CI = 6.2-7.4] per year, respectively). These findings, albeit promising, warrant intensified prevention efforts for Black, Hispanic, and younger MSM.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Infecções por HIV/etnologia , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Distribuição por Idade , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/terapia , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Carga Viral/estatística & dados numéricos , Adulto Jovem
20.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32883808

RESUMO

BACKGROUND: Children with isolated neutropenia (absolute neutrophil count [ANC] <1500/µL) are frequently referred to pediatric hematology and oncology clinics for further diagnostic evaluation. Scant literature exists on interventions and outcomes for isolated neutropenia. We hypothesized that children will have resolution of their neutropenia without the need for intervention(s) by a pediatric hematologist and oncologist. METHODS: We performed a 5.5-year institutional review board-approved retrospective chart review of children referred to our pediatric hematology and oncology clinics for isolated neutropenia. Neutropenia was categorized as mild (ANC of 1001-1500/µL), moderate (ANC of 500-1000 µL), severe (ANC of 201-500/µL), or very severe (ANC of ≤200/µL). RESULTS: Among 155 children referred with isolated neutropenia, 45 (29%) had mild neutropenia, 65 (42%) had moderate neutropenia, 30 (19%) had severe neutropenia, and 15 (10%) had very severe neutropenia. Only 29 (19%) children changed to an ANC category lower than their initial referral category. At a median follow-up of 12 months, 101 children had resolution of neutropenia, 40 children had mild neutropenia, 10 children had moderate neutropenia, 3 children had severe neutropenia, and 1 patient had very severe neutropenia. A specific diagnosis was not identified in most (54%) children. The most common etiologies were viral suppression (16%), autoimmune neutropenia (14%), and drug-induced neutropenia (8%). Black children had a 3.5 higher odds of having persistent mild neutropenia. Six (4%) children received granulocyte colony-stimulating factor therapy. CONCLUSIONS: Most children referred for isolated neutropenia do not progress in severity and do not require subspecialty interventions or hospitalizations.


Assuntos
Neutropenia/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Afro-Americanos/estatística & dados numéricos , Anticorpos Antinucleares/análise , Americanos Asiáticos/estatística & dados numéricos , Doenças Autoimunes/complicações , Neutropenia Febril Induzida por Quimioterapia/epidemiologia , Criança , Pré-Escolar , Progressão da Doença , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Seguimentos , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Hematologia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Oncologia , Neutropenia/diagnóstico , Neutropenia/tratamento farmacológico , Neutropenia/etiologia , Remissão Espontânea , Estudos Retrospectivos , Viroses/complicações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA