Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.226
Filtrar
3.
MMWR Morb Mortal Wkly Rep ; 69(39): 1391-1397, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33001873

RESUMO

Vaccination of pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can decrease the risk for influenza and pertussis among pregnant women and their infants. The Advisory Committee on Immunization Practices (ACIP) recommends that all women who are or might be pregnant during the influenza season receive influenza vaccine, which can be administered at any time during pregnancy (1). ACIP also recommends that women receive Tdap during each pregnancy, preferably during the early part of gestational weeks 27-36 (2,3). Despite these recommendations, vaccination coverage among pregnant women has been found to be suboptimal with racial/ethnic disparities persisting (4-6). To assess influenza and Tdap vaccination coverage among women pregnant during the 2019-20 influenza season, CDC analyzed data from an Internet panel survey conducted during April 2020. Among 1,841 survey respondents who were pregnant anytime during October 2019-January 2020, 61.2% reported receiving influenza vaccine before or during their pregnancy, an increase of 7.5 percentage points compared with the rate during the 2018-19 season. Among 463 respondents who had a live birth by their survey date, 56.6% reported receiving Tdap during pregnancy, similar to the 2018-19 season (4). Vaccination coverage was highest among women who reported receiving a provider offer or referral for vaccination (influenza = 75.2%; Tdap = 72.7%). Compared with the 2018-19 season, increases in influenza vaccination coverage were observed during the 2019-20 season for non-Hispanic Black (Black) women (14.7 percentage points, to 52.7%), Hispanic women (9.9 percentage points, to 67.2%), and women of other non-Hispanic (other) races (7.9 percentage points, to 69.6%), and did not change for non-Hispanic White (White) women (60.6%). As in the 2018-19 season, Hispanic and Black women had the lowest Tdap vaccination coverage (35.8% and 38.8%, respectively), compared with White women (65.5%) and women of other races (54.0%); in addition, a decrease in Tdap vaccination coverage was observed among Hispanic women in 2019-20 compared with the previous season. Racial/ethnic disparities in influenza vaccination coverage decreased but persisted, even among women who received a provider offer or referral for vaccination. Consistent provider offers or referrals, in combination with conversations culturally and linguistically tailored for patients of all races/ethnicities, could increase vaccination coverage among pregnant women in all racial/ethnic groups and reduce disparities in coverage.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Disparidades em Assistência à Saúde/etnologia , Vacinas contra Influenza/administração & dosagem , Gestantes/etnologia , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Estados Unidos , Adulto Jovem
5.
N Z Med J ; 133(1521): 69-76, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32994638

RESUMO

Maori experience poorer health statistics in terms of cancer incidence and mortality compared to non-Maori. For prostate cancer, Maori men are less likely than non-Maori men to be diagnosed with prostate cancer, but those that are diagnosed are much more likely to die of the disease than non-Maori men resulting in an excess mortality rate in Maori men compared with non-Maori. A review of the literature included a review of the epidemiology of prostate cancer; of screening; of access to healthcare and of treatment modalities. Our conclusion was that there are a number of reasons for the disparity in outcomes for Maori including differences in staging and characteristics at diagnosis; differences in screening and treatment offered to Maori men; and general barriers to healthcare that exist for Maori men in New Zealand. We conclude that there is a need for more culturally appropriate care to be available to Maori men.


Assuntos
Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades em Assistência à Saúde , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Neoplasias da Próstata , Adulto , Idoso , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/terapia , Fatores de Risco , Fatores Socioeconômicos
6.
N Z Med J ; 133(1520): 15-26, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994590

RESUMO

AIMS: To explore variations in the use of and timeliness of chemotherapy in patients diagnosed with colorectal cancer in New Zealand. METHODS: This study included patients diagnosed with colorectal cancer in New Zealand between 1 January 2006 and 31 December 2016. The first chemotherapy regime was identified from Pharmaceutical Collection dataset. Logistic regression model was used to estimate the adjusted odds ratio of having chemotherapy by subgroup after adjustment for other factors. RESULTS: 27.8% (6,737/24,217) of colon cancer patients and 43.8% (3,582/8,170) of rectal cancer patients received publicly funded chemotherapy. The uptake and timeliness of chemotherapy has been improving over time. Pacific people were the least likely to receive chemotherapy, followed by Maori and Asian. Younger patients, New Zealand European, patients with metastatic disease and patients in the Southern Cancer Network were more likely to have chemotherapy in less than 10 weeks post-diagnosis. Over half of the advanced colorectal cancer patients who did not receive chemotherapy were aged 80+ years or had a short life expectancy. CONCLUSIONS: Although the uptake and timeliness of chemotherapy for colorectal cancer has been improving, Maori, Pacific, Asian and older patients were less likely to receive chemotherapy and less likely to receive chemotherapy in a timely manner. There is a variation in use of chemotherapy by Region with patients in the Southern Cancer region appearing to be the most likely to receive chemotherapy and to receive it within a timely period.


Assuntos
Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Tratamento Farmacológico/métodos , Disparidades em Assistência à Saúde/etnologia , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/mortalidade , Tratamento Farmacológico/economia , Grupos Étnicos , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Expectativa de Vida/etnologia , Expectativa de Vida/tendências , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Nova Zelândia/etnologia , Fatores de Tempo
11.
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
14.
J Transcult Nurs ; 31(5): 434-443, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32794439

RESUMO

Introduction: Race and ethnicity along with social determinants of health have been identified as risk factors for COVID-19. The purpose of this clinical paper is to provide an overview of the National Coalition of Ethnic Minority Nurse Associations (NCEMNA), present COVID-19 epidemiological data on five racial-ethnic groups, identify culturally congruent health care strategies for each group, and provide directions for practice and research. Method: NCEMNA collaborated to provide a clinical paper that addresses information about COVID-19 and culturally congruent health care in five racial-ethnic groups. Results: Every organization presented common themes across the different groups and unique perspectives that each group is faced with during this challenge. Discussion: This article provides an introduction to the issues that minority groups are facing. It is imperative that data are collected to determine the extent of the impact of COVID-19 in diverse communities in the country.


Assuntos
Betacoronavirus , Infecções por Coronavirus/etnologia , Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Grupos Minoritários/estatística & dados numéricos , Pneumonia Viral/etnologia , Infecções por Coronavirus/prevenção & controle , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Fatores Socioeconômicos , Estados Unidos
17.
Am Surg ; 86(8): 985-990, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32816524

RESUMO

BACKGROUND: In 2014, direct-acting antivirals (DAAs) became available for hepatitis C virus (HCV) with successful results. Since their implementation, the rate of HCV waitlist (WL) for liver transplantation (LT) has decreased, but significant ethnic disparities exist. We hypothesized that the rate of decline for HCV WL for LT is different across the various racial groups. METHODS: We conducted a retrospective cohort study using Organ Procurement and Transplantation Network data reports of adult LT candidates from 2014 to 2018. RESULTS: Overall, there was a decline in HCV WL rates for all ethnic groups (Caucasians, African Americans [AA], and Hispanics). However, the WL rates were significantly higher in AA compared with Caucasians each year, and this trend was continuous across the 5-year period. There were no differences in WL rates between Caucasians and Hispanics. DISCUSSION: The results show that health care disparities related to HCV disproportionately affect AA. The factors associated with this disparity need to be explored further to develop mechanisms to address these differences. By understanding the HCV treatment disparities across racial groups, modifications to HCV treatment nationwide can be adopted. Additional emphasis should be placed on AA to help reduce their WL rate, as well as redistributing resources to promote health care equity.


Assuntos
Antivirais/uso terapêutico , Disparidades em Assistência à Saúde/etnologia , Hepatite C Crônica/cirurgia , Transplante de Fígado , Listas de Espera , Adolescente , Adulto , Afro-Americanos , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Europeu , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/etnologia , Hispano-Americanos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
18.
Spat Spatiotemporal Epidemiol ; 34: 100355, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32807400

RESUMO

Identifying areas with low access to testing and high case burden is necessary to understand risk and allocate resources in the COVID-19 pandemic. Using zip code level data for New York City, we analyzed testing rates, positivity rates, and proportion positive. A spatial scan statistic identified clusters of high and low testing rates, high positivity rates, and high proportion positive. Boxplots and Pearson correlations determined associations between outcomes, clusters, and contextual factors. Clusters with less testing and low proportion positive tests had higher income, education, and white population, whereas clusters with high testing rates and high proportion positive tests were disproportionately black and without health insurance. Correlations showed inverse associations of white race, education, and income with proportion positive tests, and positive associations with black race, Hispanic ethnicity, and poverty. We recommend testing and health care resources be directed to eastern Brooklyn, which has low testing and high proportion positives.


Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Saúde da População Urbana/etnologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Laboratório Clínico/estatística & dados numéricos , Análise por Conglomerados , Infecções por Coronavirus/diagnóstico , Feminino , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pneumonia Viral/diagnóstico , Medição de Risco , Análise Espacial , Saúde da População Urbana/economia , População Urbana
20.
Popul Health Manag ; 23(5): 368-377, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32816644

RESUMO

The use of remote health care services, or telehealth, is a promising solution for providing health care to those unable to access care in person easily and thus helping to reduce health inequalities. The COVID-19 pandemic and resulting stay-at-home orders in the United States have created an optimal situation for the use of telehealth services for non-life-threatening health care use. A retrospective cohort study was performed using Kantar's Claritis™ database, which links insurance claims encounters (Komodo Health) with patient-reported data (Kantar Health, National Health & Wellness Survey). Logistic regression models (odds ratios [OR], 95% confidence intervals [CI]) examined predictors of telehealth versus in-person encounters. Adults ages ≥18 years eligible for payer-complete health care encounters in both March 2019 and March 2020 were identified (n = 35,376). Telehealth use increased from 0.2% in 2019 to 1.9% in 2020. In adjusted models of respondents with ≥1 health care encounter (n = 11,614), age, marital status, geographic residence (region; urban/rural), and presence of anxiety or depression were significant predictors of telehealth compared with in-person use in March 2020. For example, adults 45-46 years versus 18-44 years were less likely to use telehealth (OR 0.684, 95% CI: 0.561-0.834), and respondents living in urban versus rural areas were more likely to use telehealth (OR 1.543, 95% CI: 1.153-2.067). Substantial increases in telehealth use were observed during the onset of the COVID-19 pandemic in the United States; however, disparities existed. These inequalities represent the baseline landscape that population health management must monitor and address during this pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/economia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Telemedicina/estatística & dados numéricos , Adulto , Idoso , Estudos de Coortes , Intervalos de Confiança , Estudos Transversais , Feminino , Pessoal de Saúde/economia , Pessoal de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Razão de Chances , Pandemias/estatística & dados numéricos , Estudos Retrospectivos , Fatores Socioeconômicos , Telemedicina/métodos , Estados Unidos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA