Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 60.482
Filtrar
1.
Braz. j. biol ; 84: e253497, 2024. tab, graf
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1355892

RESUMO

Abstract This research aimed to estimate the length-weight ratio (LWR) of the stingray Potamotrygon wallacei, known locally as the cururu, which was caught in streams and lakes in the middle Negro River region, Amazonas, Brazil. The stingrays were captured during the night (from 11 pm to 1 am) near the shores of streams and lakes, through active search using wooden canoes, head lanterns and scoop nets. The samplings were carried out in November 2017 (5 days), February (8 days), March (3 days) and April (2 days) of 2018, totaling 18 days of sampling. The total fresh weight was measured to 0.1 g of accuracy and the disc width to 0.1 cm accuracy. The parameters a and b of the equation W=a.DWb were estimated. This study provides new maximum length data for the cururu stingray.


Resumo Esta pesquisa teve como objetivo estimar a relação peso-comprimento (LWR) da arraia Potamotrygon wallacei, conhecida localmente como cururu, que foi capturada em igarapés e lagos na região do médio Rio Negro, Amazonas, Brasil. As arraias foram capturadas durante a noite (das 23h-1h) nas margens dos igarapés e lagos, por meio de busca ativa utilizando canoas de madeira, lanternas de cabeça e puçás. As coletas foram realizadas nos meses de novembro de 2017 (5 dias), fevereiro (8 dias), março (3 dias) e abril (2 dias) de 2018, totalizando 18 dias de amostragem. Foram medidos o peso fresco total com precisão de 0,01 g e a largura do disco com precisão de 0,1 cm. Os parâmetros a e b da equação W= a.DWb foram estimados. Este estudo prover novos dados de comprimento máximo para a arraia cururu.


Assuntos
Humanos , Animais , Rajidae , Rosa , Afro-Americanos , Brasil , Rios
2.
J Interpers Violence ; 38(1-2): NP288-NP310, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35350920

RESUMO

African American women survivors of intimate partner violence disproportionately experience homicide due, in part, to the racism and racial discrimination they experience during their help-seeking process. Yet, existing scholarship neglects to examine how this multiply-marginalized population of women navigate sociocultural barriers to obtain crisis services and supports from the domestic violence service provision system. Fundamental to developing culturally-salient interventions is more fully understanding their help-seeking behavior. We conducted 30 in-depth, semi-structured interviews with women who self-identified as African American. Constructivist grounded theory methodology was employed. Sensitizing concepts from the Transtheoretical Model of Change and Intersectionality theories, along with Agency framework were conceptually bound. The Theory of Help-Seeking Behavior emerged from the data. This nascent theory provides practitioners and researchers with a theoretical model to examine African American women's nuanced help-seeking efforts.


Assuntos
Violência Doméstica , Comportamento de Busca de Ajuda , Violência por Parceiro Íntimo , Feminino , Humanos , Afro-Americanos , Sobreviventes
3.
J Surg Res ; 281: 89-96, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36137357

RESUMO

INTRODUCTION: Given the disparate effects of the COVID-19 pandemic on people of color, we hypothesized that patients of color experienced a disproportionate increase in trauma during the COVID-19 pandemic. MATERIALS AND METHODS: We compared trauma patients arriving in the 3 y before our statewide stay-at-home mandate on March 20, 2020 (PRE) to those arriving in the year afterward (POST). In addition to race/ethnicity, we assessed patient demographics and other clinical variables. Chi-squared, Fisher's exact, and Mann-Whitney U tests were used for univariate analyses. A multivariable logistic regression was performed to assess for associations with mortality. RESULTS: During the study period, 8583 patients were included in the PRE group and 2883 were included in the POST group. There were increases in penetrating trauma (PRE 14.7%, POST 23.1%; P < 0.001) and mortality rates (PRE 3.20%, POST 4.60%; P < 0.001). From PRE to POST, the percentage of Black patients increased from 35.0% to 38.3% (P = 0.01) and the percentage of Hispanic patients increased from 19.2% to 23.0% (P < 0.001). After a multivariable analysis, Asian patients experienced an independent increase in mortality from PRE to POST (odds ratio 2.00, 95% confidence interval 1.13-3.54, P = 0.02). CONCLUSIONS: Penetrating trauma and mortality rates increased during the pandemic. There was a simultaneous increase in the percentage of Black and Hispanic trauma patients. Asian patient mortality increased significantly after the start of the pandemic independent of other variables. Identifying racial/ethnic disparities is the first step in finding ways to improve dissimilar outcomes.


Assuntos
COVID-19 , Ferimentos Penetrantes , Humanos , Estados Unidos , COVID-19/epidemiologia , Pandemias , Brancos , Afro-Americanos , Hispânico ou Latino
4.
Hematol Oncol Clin North Am ; 37(1): 1-15, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36435603

RESUMO

There has been a 40% decline in breast cancer age-adjusted death rate since 1990. Black American women have not experienced as great a decline; indeed, the Black-White disparity in mortality in the United States is greater today than it has ever been. Certain states (areas of residence), however, do not see such dramatic differences in outcome by race. This latter finding suggests much more can be done to reduce disparities and prevent deaths. Interventions to get high-quality care (screening, diagnostics, and treatment) involve understanding the needs and concerns of the patient and addressing those needs and concerns. Patient navigators are 1 way to improve outcomes.


Assuntos
Neoplasias da Mama , Estados Unidos/epidemiologia , Feminino , Humanos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Brancos , Afro-Americanos , Programas de Rastreamento
5.
J Interpers Violence ; 38(1-2): NP1279-NP1298, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35442820

RESUMO

Although many African American IPV survivors need services, they often do not access care. Hopelessness may partially explain low rates in help-seeking for this population and serve as a significant barrier to care for African American IPV survivors particularly those who have had prior legal system involvement. In a sample of 185 African American women, we first examined whether hopelessness mediated the relation between IPV and barriers to services. If such a mediation effect was found, we then would explore whether legal system involvement moderated the mediated effect of hopelessness on the relation between IPV and barriers to services. As anticipated, hopelessness partially served to explain (i.e., mediated) the relation between IPV and barriers to services. Further, this mediated effect was moderated by legal system involvement such that when legal system involvement was included as a moderator, hopelessness mediated the association between IPV and barriers to services only for those survivors who had been involved with the legal system. These results underscore the critical role of hopelessness as a barrier to accessing services for African American IPV survivors, especially those with prior involvement with the legal system. Recommendations are offered that underscore the importance of interventions that empower African American women who have survived violence instead of penalizing them.


Assuntos
Afro-Americanos , Violência por Parceiro Íntimo , Feminino , Humanos , Violência , Sobreviventes
6.
J Interpers Violence ; 38(1-2): NP2112-NP2134, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35532032

RESUMO

This study examined how the COVID-19 pandemic affected sexual assault healthcare services in a predominately African American U.S. city. In mixed methods research design, we used quantitative interrupted time series modeling to evaluate changes in service rates for three core post-assault healthcare services-medical forensic exams (MFEs), medical advocacy MFE accompaniment, and counseling-from January 2019 through June 2021. We also conducted qualitative interviews with 12 sexual assault advocates to understand how their clients were impacted by COVID and how their agency adapted services to respond to the needs of their community. Both the quantitative and qualitative data revealed marked disruptions in service provision. The number of MFEs, medical advocacy accompaniments, and counseling sessions significantly decreased during the pandemic's initial surge, and survivors feared seeking hospital-based health care due to concerns that they might contract COVID-19 in hospital emergency departments. The number of MFEs performed by program staff did not return to pre-pandemic levels during this study's observation period, but the number of medical advocacy accompaniments and counseling sessions did significantly rebound. Counseling services eventually exceeded pre-pandemic levels as agency staff supported clients with both assault- and COVID-related trauma and loss. These results underscore the need for community-based sexual assault healthcare services, so that if public health emergencies limit the availability, accessibility, and safety of hospital emergency department care, sexual assault survivors have other settings for obtaining post-assault health care.


Assuntos
COVID-19 , Vítimas de Crime , Delitos Sexuais , Humanos , Afro-Americanos , Pandemias , Delitos Sexuais/psicologia , Vítimas de Crime/psicologia , Sobreviventes/psicologia , Atenção à Saúde
7.
Sci Total Environ ; 857(Pt 2): 159450, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36252672

RESUMO

BACKGROUND: African Americans (AAs) experience high rates of adverse pregnancy outcomes relative to Whites. Differential in utero exposure to environmental chemicals and psychosocial stressors may explain some of the observed health disparities, as exposures to per- and polyfluoroalkyl substances (PFAS) and experiences of discrimination have been linked to adverse birth outcomes. Few studies have examined chemicals and non-chemical stressors together as an exposure mixture, which may better reflect real-life exposure patterns. Here, we adapted methods designed for the analysis of exposure mixtures to examine joint effects of PFAS and psychosocial stress on birth outcomes among AAs. METHODS: 348 participants from the Atlanta African American Maternal-Child cohort were included in this study. Four PFAS were measured in first trimester serum samples. Self-report questionnaires were administered during the first trimester and were used to assess psychosocial stress (perceived stress, depression, anxiety, gendered racial stress). Quantile g-computation and Bayesian kernel machine regression (BKMR) were used to estimate the joint effects between PFAS and psychosocial stressors on gestational age at delivery and birthweight for gestational age z-scores. All models were adjusted for maternal education, maternal age, parity, and any alcohol, tobacco and marijuana use. RESULTS: Our analytic sample included a socioeconomically diverse group of pregnant women, with 79 % receiving public health insurance. In quantile g-computation models, a simultaneous one-quartile increase in all PFAS, perceived stress, depression, anxiety, and gendered racial stress was associated with a reduction in birthweight z-scores (mean %change per quartile increase = -0.24, 95 % confidence interval = -0.43, -0.06). BKMR similarly showed that increasing all exposures in the mixture was associated with a modest decrease in birthweight z-scores, but not a reduced length of gestation. DISCUSSION: Using methods designed for analyzing exposure mixtures, we found that a simultaneous increase in in utero PFAS and psychosocial stressors was associated with reduced birthweight for gestational age z-scores.


Assuntos
Ácidos Alcanossulfônicos , Poluentes Ambientais , Fluorcarbonetos , Humanos , Gravidez , Feminino , Afro-Americanos , Peso ao Nascer , Resultado da Gravidez/epidemiologia , Teorema de Bayes , Poluentes Ambientais/toxicidade
8.
Braz J Biol ; 82: e264210, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36350939

RESUMO

Fishing plays a prominent role in the socioeconomic scope of the Negro River basin and is considered one of the main extractive activities in the region. The objective of this study was to describe the socioeconomic aspects of commercial fishers of edible fish who work in the municipality of Barcelos, in the middle Negro River region, as well as to highlight the scenario of the fishing activity from the point of view of the fishers. The information was collected between January and December 2016 in the municipality of Barcelos, state of Amazonas, via semi-structured questionnaires. Most interviewees were male (71.14%), aged between 18 and 82 years and a mean age of 48 years. With a low level of education, 45.0% had only incomplete elementary education and 15% were illiterate. The fishing tackle most used by fishermen was the gillnet, especially by urban fishermen (70%). Among the fishing sites, the main one was the Demeni River (50%). Commercial fishing for edible fish in Barcelos focused on Characiformes, Perciformes and Siluriformes fish. The main difficulties faced by the activity are related to the seasonality of the level of rivers and local tributaries, as well as the lack of buyers and low selling price of fish, in addition to conflicts over the use of fishing resources. Commercial fishing for edible fish is an activity of great socioeconomic importance for riverside families in the Middle River Negro basin, which needs greater attention from the public authorities. Therefore, it is expected that the information contained in this study can help in the decision-making process for the management of local fisheries resources and contribute to the resumption of growth and sustainability of commercial edible fish fisheries.


Assuntos
Conservação dos Recursos Naturais , Rios , Humanos , Animais , Masculino , Feminino , Brasil , Afro-Americanos , Caça , Pesqueiros , Fatores Socioeconômicos , Peixes
9.
BMC Public Health ; 22(1): 2033, 2022 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-36344953

RESUMO

To facilitate maximum uptake of the COVID-19 vaccine, the roles of medical trust and mistrust of healthcare professionals must be examined. Previous work suggests that trust and mistrust may have differential impacts on vaccination intention via vaccine necessity and concerns. Multigroup structural equation modeling was utilized to test whether vaccine necessity and concerns mediated the associations between trust in providers and health information, mistrust of providers, and willingness to get the COVID-19 vaccine. The model was found to be invariant across Black and White respondents. Trust in providers and trust in healthcare information exerted indirect effects on intentions through vaccine necessity, while mistrust of providers exerted indirect effects through vaccine concerns. Unlike previous work, the forms of trust did not influence vaccine concerns. The findings have implications for future communication efforts from healthcare professionals and health messengers.


Assuntos
COVID-19 , Vacinas , Humanos , Confiança , Vacinas contra COVID-19 , Intenção , Afro-Americanos , Conhecimentos, Atitudes e Prática em Saúde , COVID-19/prevenção & controle , Vacinação
10.
Rehabil Psychol ; 67(4): 437-448, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36355638

RESUMO

PURPOSE/OBJECTIVE: The purpose of this study was to conduct an initial evaluation of the quantitative and qualitative outcomes of the African American Alzheimer's Caregiver Training and Support Project 2 (ACTS2). Quantitative objectives focused on assessing changes in caregiver depression and health status, as well as the severity of caregiving and self-care problems from pre- to postintervention. Secondary quantitative analyses examined posttreatment changes in social support and caregiver burden. Qualitative objectives included examining caregivers' perceptions of the effectiveness of in-session training activities, quality of relationships among group participants and their facilitator, and appraisals of spiritual elements of the program. RESEARCH METHOD/DESIGN: Nine African American family caregivers of older adults with dementia completed the ACTS2 lay pastoral care facilitator-led, telephone cognitive-behavioral intervention. The 12-week training program included seven skills-building groups and five individual problem-solving sessions. RESULTS: Significant improvements were found on the majority of dependent measures, including caregiver depression, health status, problem severity, and social support. Qualitative analysis highlighted the value caregivers placed on relationships with coparticipants and group facilitators, the role of spirituality in the program, and the importance of goal setting for improving caregiver distress and self-care. CONCLUSIONS/IMPLICATIONS: Convergence was found between quantitative and qualitative findings, particularly improvements in caregiver distress, health status, and social support. Overall, the findings of the pilot study were promising. Replication using a randomized controlled design with a larger sample size is needed to test the reliability of the findings. The benefits of tailoring intervention to caregivers' sociocultural preferences and spiritual values are also addressed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Doença de Alzheimer , Cuidadores , Humanos , Idoso , Projetos Piloto , Afro-Americanos , Reprodutibilidade dos Testes
11.
Genes (Basel) ; 13(11)2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36421824

RESUMO

SNPs in ABCA7 confer the largest genetic risk for Alzheimer's Disease (AD) in African Americans (AA) after APOE ε4. However, the relationship between ABCA7 and cognitive function has not been thoroughly examined. We investigated the effects of five known AD risk SNPs and 72 CpGs in ABCA7, as well as their interactions, on general cognitive function (cognition) in 634 older AA without dementia from Genetic Epidemiology Network of Arteriopathy (GENOA). Using linear mixed models, no SNP or CpG was associated with cognition after multiple testing correction, but five CpGs were nominally associated (p < 0.05). Four SNP-by-CpG interactions were associated with cognition (FDR q < 0.1). Contrast tests show that methylation is associated with cognition in some genotype groups (p < 0.05): a 1% increase at cg00135882 and cg22271697 is associated with a 0.68 SD decrease and 0.14 SD increase in cognition for those with the rs3764647 GG/AG (p = 0.004) and AA (p = 2 × 10-4) genotypes, respectively. In addition, a 1% increase at cg06169110 and cg17316918 is associated with a 0.37 SD decrease (p = 2 × 10-4) and 0.33 SD increase (p = 0.004), respectively, in cognition for those with the rs115550680 GG/AG genotype. While AD risk SNPs in ABCA7 were not associated with cognition in this sample, some have interactions with proximal methylation on cognition.


Assuntos
Doença de Alzheimer , Polimorfismo de Nucleotídeo Único , Humanos , Idoso , Afro-Americanos/genética , Cognição , Transportadores de Cassetes de Ligação de ATP/genética , Doença de Alzheimer/genética
12.
PLoS One ; 17(11): e0276742, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36417366

RESUMO

BACKGROUND: Racial/ethnic disparities during the first six months of the COVID-19 pandemic led to differences in COVID-19 testing and adverse outcomes. We examine differences in testing and adverse outcomes by race/ethnicity and sex across a geographically diverse and system-based COVID-19 cohort collaboration. METHODS: Observational study among adults (≥18 years) within six US cohorts from March 1, 2020 to August 31, 2020 using data from electronic health record and patient reporting. Race/ethnicity and sex as risk factors were primary exposures, with health system type (integrated health system, academic health system, or interval cohort) as secondary. Proportions measured SARS-CoV-2 testing and positivity; attributed hospitalization and death related to COVID-19. Relative risk ratios (RR) with 95% confidence intervals quantified associations between exposures and main outcomes. RESULTS: 5,958,908 patients were included. Hispanic patients had the highest proportions of SARS-CoV-2 testing (16%) and positivity (18%), while Asian/Pacific Islander patients had the lowest portions tested (11%) and White patients had the lowest positivity rates (5%). Men had a lower likelihood of testing (RR = 0.90 [0.89-0.90]) and a higher positivity risk (RR = 1.16 [1.14-1.18]) compared to women. Black patients were more likely to have COVID-19-related hospitalizations (RR = 1.36 [1.28-1.44]) and death (RR = 1.17 [1.03-1.32]) compared with White patients. Men were more likely to be hospitalized (RR = 1.30 [1.16-1.22]) or die (RR = 1.70 [1.53-1.89]) compared to women. These racial/ethnic and sex differences were reflected in both health system types. CONCLUSIONS: This study supports evidence of disparities by race/ethnicity and sex during the COVID-19 pandemic that persisted even in healthcare settings with reduced barriers to accessing care. Further research is needed to understand and prevent the drivers that resulted in higher burdens of morbidity among certain Black patients and men.


Assuntos
COVID-19 , Etnicidade , Adulto , Humanos , Feminino , Masculino , Teste para COVID-19 , COVID-19/diagnóstico , COVID-19/epidemiologia , Brancos , Afro-Americanos , Pandemias , SARS-CoV-2
13.
J Prim Care Community Health ; 13: 21501319221135949, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36373680

RESUMO

INTRODUCTION: Community engagement is key to improving the quality of primary health care (PHC), with asset-based interventions shown to have a positive impact on equity and health outcomes. However, there tends to be a disconnect between community-based interventions and PHC, with a lack of evidence on how to develop sustainable community-primary care partnerships. This paper reports on the formative phases of 2 studies exploring the feasibility of embedding community assets, namely places of worship and barbershops, into the PHC pathway for the prevention and control of NCDs in deprived settings. It describes the participatory approach used to map and gather contextual readiness information, including the enablers and constrainers for collaborative partnerships with PHC. METHODS: Grounded in community-based participatory research, we used elements of ground-truthing and participatory mapping to locate and gather contextual information on places of worship and barbershops in urban and rural communities. Local knowledge, gathered from community dialogs, led to the creation of sampling frames of these community assets. Selected places of worship were administered a 66-item readiness questionnaire, which included domains on governance and financing, congregation profile, and existing health programs and collaborations. Participating barbershops were administered a 40-item readiness questionnaire, which covered barbers' demographic information, previous training in health promotion, and barbers' willingness to deliver health promotion activities. RESULTS: Fourteen barbershops were identified, of which 10 participated in the readiness survey, while 240 places of worship were identified, of which 14 were selected and assessed for readiness. Contextual differences were found within and between these assets regarding governance, accessibility, and reach. Key enablers for both include training in health promotion, an overwhelming enthusiasm for participation and recognition of the potential benefits of a community-primary care partnership. Lack of previous collaborations with the formal health system was common to both. CONCLUSION: The participatory approach extended reach within underserved communities, while the readiness data informed intervention design and identified opportunities for partnership development. Contextual differences between community assets require comprehensive readiness investigations to develop suitably tailored interventions that promote reach, acceptance, and sustainability.


Assuntos
Afro-Americanos , Barbearia , Humanos , Estudos de Viabilidade , Guiana , Promoção da Saúde , Atenção Primária à Saúde
14.
Oncol Nurs Forum ; 49(6): 509-524, 2022 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-36413731

RESUMO

PROBLEM IDENTIFICATION: Significant cancer disparities exist between Black and White patients. One important contributor to patient outcomes disparities is patient-clinician communication. Conversations between clinicians and Black patients are often shorter and less detailed compared to White patients. LITERATURE SEARCH: A systematic literature search was conducted. Databases were searched to identify studies that included (a) participants with a cancer diagnosis, (b) information specific to Black or African American participants, and (c) information on patient-clinician communication. A total of 67 articles underwent full review; 24 studies met inclusion criteria. DATA EVALUATION: Each included study was scored for level of evidence, and common themes were identified across studies using the Matrix Method. SYNTHESIS: The following themes were identified: relationship building, building trust, empowering patients for shared decision-making, addressing topics of patient concern, and consideration of community and family. IMPLICATIONS FOR RESEARCH: Results identify several ways that nurses can improve communication with Black patients. Research aimed at identifying interpersonal strategies to mitigate cancer disparities is needed.


Assuntos
Oncologia , Neoplasias , Humanos , Afro-Americanos , Comunicação
15.
Crit Care ; 26(1): 341, 2022 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-36335405

RESUMO

BACKGROUND: Sepsis is a severe systemic inflammatory response to infections that is accompanied by organ dysfunction and has a high mortality rate in adult intensive care units. Most genetic studies have identified gene variants associated with development and outcomes of sepsis focusing on biological candidates. We conducted the first genome-wide association study (GWAS) of 28-day survival in adult patients with sepsis. METHODS: This study was conducted in two stages. The first stage was performed on 687 European sepsis patients from the GEN-SEP network and 7.5 million imputed variants. Association testing was conducted with Cox regression models, adjusting by sex, age, and the main principal components of genetic variation. A second stage focusing on the prioritized genetic variants was performed on 2,063 ICU sepsis patients (1362 European Americans and 701 African-Americans) from the MESSI study. A meta-analysis of results from the two stages was conducted and significance was established at p < 5.0 × 10-8. Whole-blood transcriptomic, functional annotations, and sensitivity analyses were evaluated on the identified genes and variants. FINDINGS: We identified three independent low-frequency variants associated with reduced 28-day sepsis survival, including a missense variant in SAMD9 (hazard ratio [95% confidence interval] = 1.64 [1.37-6.78], p = 4.92 × 10-8). SAMD9 encodes a possible mediator of the inflammatory response to tissue injury. INTERPRETATION: We performed the first GWAS of 28-day sepsis survival and identified novel variants associated with reduced survival. Larger sample size studies are needed to better assess the genetic effects in sepsis survival and to validate the findings.


Assuntos
Estudo de Associação Genômica Ampla , Sepse , Adulto , Humanos , Estudo de Associação Genômica Ampla/métodos , Brancos , Sepse/genética , Afro-Americanos , Polimorfismo de Nucleotídeo Único , Peptídeos e Proteínas de Sinalização Intracelular/genética
16.
J Natl Compr Canc Netw ; 20(11): 1255-1266.e11, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36351338

RESUMO

BACKGROUND: Racial disparities exist in receipt of guideline-concordant treatment of ovarian cancer (OC). However, few studies have evaluated how various dimensions of healthcare access (HCA) contribute to these disparities. METHODS: We analyzed data from non-Hispanic (NH)-Black, Hispanic, and NH-White patients with OC diagnosed in 2008 to 2015 from the SEER-Medicare database and defined HCA dimensions as affordability, availability, and accessibility, measured as aggregate scores created with factor analysis. Receipt of guideline-concordant OC surgery and chemotherapy was defined based on the NCCN Guidelines for Ovarian Cancer. Multivariable-adjusted modified Poisson regression models were used to assess the relative risk (RR) for guideline-concordant treatment in relation to HCA. RESULTS: The study cohort included 5,632 patients: 6% NH-Black, 6% Hispanic, and 88% NH-White. Only 23.8% of NH-White patients received guideline-concordant surgery and the full cycles of chemotherapy versus 14.2% of NH-Black patients. Higher affordability (RR, 1.05; 95% CI, 1.01-1.08) and availability (RR, 1.06; 95% CI, 1.02-1.10) were associated with receipt of guideline-concordant surgery, whereas higher affordability was associated with initiation of systemic therapy (hazard ratio, 1.09; 95% CI, 1.05-1.13). After adjusting for all 3 HCA scores and demographic and clinical characteristics, NH-Black patients remained less likely than NH-White patients to initiate systemic therapy (hazard ratio, 0.86; 95% CI, 0.75-0.99). CONCLUSIONS: Multiple HCA dimensions predict receipt of guideline-concordant treatment but do not fully explain racial disparities among patients with OC. Acceptability and accommodation are 2 additional HCA dimensions which may be critical to addressing these disparities.


Assuntos
Neoplasias Ovarianas , Brancos , Idoso , Humanos , Estados Unidos/epidemiologia , Feminino , Afro-Americanos , Disparidades em Assistência à Saúde , Medicare , Carcinoma Epitelial do Ovário/terapia , Neoplasias Ovarianas/terapia , Acesso aos Serviços de Saúde
17.
Med Care ; 60(12): 872-879, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36356289

RESUMO

BACKGROUND: Enrollment in high-quality Medicare Advantage (MA) plans, measured by a 5-star quality rating system, was lower among racial and ethnic minority enrollees than White enrollees partly due to fewer high-quality plans available in their counties of residence. This may contribute to racial and ethnic disparities in ambulatory care sensitive condition (ACSC) hospitalizations. OBJECTIVE: We examined whether there were racial and ethnic disparities in ACSC hospitalizations among MA enrollees overall and by star rating. METHODS: Using the Medicare enrollment and claims data for 2016, we identified White, Black, Hispanic, and Asian/Pacific Islander enrollees in MA plans. We estimated racial and ethnic disparities in ACSC hospitalizations (per 10,000 enrollees) overall and by star rating. RESULTS: We found that the adjusted rates of ACSC hospitalizations were significantly higher among Black enrollees than White enrollees overall [39.4 (95% confidence interval: 36.3-42.5)]. However, no significant disparities were found among Hispanic and Asian/Pacific Islander enrollees. The adjusted rates of ACSC hospitalizations were higher in lower-rated plans than higher-rated plans in all racial and ethnic groups. The significant disparities in ACSC hospitalizations by star rating were the most pronounced between White and Black enrollees. We found suggestive evidence that enrollment in lower-rated plans was associated with higher disparities in ACSC hospitalizations between White and Black enrollees. CONCLUSIONS: Substantial disparities in ACSC hospitalizations exist between White and Black enrollees in MA plans, especially for lower-rated plans. Policies aimed at reducing racial disparities in ACSC hospitalizations could include improving access to high-rated plans.


Assuntos
Etnicidade , Medicare Part C , Idoso , Estados Unidos , Humanos , Condições Sensíveis à Atenção Primária , Afro-Americanos , Grupos Minoritários , Hospitalização
18.
J Am Heart Assoc ; 11(22): e026676, 2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36326048

RESUMO

Background Compared with White Americans, Black Americans have a greater prevalence of cardiac events following percutaneous coronary intervention. We evaluated the association between race and neighborhood income on post-percutaneous coronary intervention cardiac events and assessed whether income modifies the effect of race on this relationship. Methods and Results Consecutive patients (n=23 822) treated with percutaneous coronary intervention from January 1, 2000, to December 31, 2016, were included. All-cause mortality and major adverse cardiac event were assessed at 3 years. Extended 10-year follow-up was performed for those residing locally (n=1285). Neighborhood income was derived using median adjusted annual gross household income reported within the patient's zip code. We compared differences in treatment and outcomes, adjusting for race, income, and their interaction. In total, 3173 (13.3%) patients self-identified as Black Americans, and 20 649 (86.7%) self-identified as White Americans. Black Americans had a worse baseline cardiac risk profile and lower neighborhood income compared with White Americans. Although risk profile improved with increasing income in White Americans, no difference was observed across incomes among Black Americans. Despite similar long-term outpatient cardiology follow-up and medication prescription, risk profiles among Black Americans remained worse. At 3 years, unadjusted all-cause mortality (18.0% versus 15.2%; P<0.001) and major adverse cardiac event (37.3% versus 34.6%; P<0.001) were greater among Black Americans and with lower income (both P<0.001); race, income, and their interaction were not significant predictors in multivariable models. At 10-year follow-up, increasing income was associated with improved outcomes only in White Americans but not Black Americans. In multivariable models for major adverse cardiac event, income (hazard ratio [HR], 0.97 [95% CI, 0.96-0.98]; P=0.005), Black race (HR, 1.77 [95% CI, 1.58-1.96]; P=0.006), and their interaction (HR, 0.98 [95% CI, 0.97-0.99]; P=0.003) were significant predictors. Similar findings were observed for cardiac death. Conclusions Early 3-year post-percutaneous coronary intervention outcomes were driven by worse risk factor profiles in both Black Americans and those with lower neighborhood income. However, late 10-year outcomes showed an independent effect of race and income, with improving outcomes with greater income limited to White Americans. These findings illustrate the importance of developing novel care strategies that address both risk factor modification and social determinants of health to mitigate disparities in cardiac outcomes.


Assuntos
Afro-Americanos , Intervenção Coronária Percutânea , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Brancos , Renda , Fatores de Risco
19.
JAMA ; 328(19): 1974-1977, 2022 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-36378215

RESUMO

This study evaluates and compares US trends between 2010 and 2019 in per-capita primary care physician supply by county-level racial and ethnic minority concentration, poverty, rurality, and region.


Assuntos
Médicos de Atenção Primária , Serviços de Saúde Rural , Humanos , Afro-Americanos , Médicos de Atenção Primária/provisão & distribuição , Características de Residência , Estados Unidos
20.
Front Public Health ; 10: 960098, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36388371

RESUMO

Background: Although changes in overall physical activity (PA) have been identified in adolescents, the trend in sports participation is still understudied. It is widely believed that monitoring the changes in sports participation is conducive to promote the development of sports activities. The purpose of this research was to identify the changes in sports participation in adolescents over the past years. Methods: This research selected secondary data from 2011, 2013, 2015, 2017, and 2019 Youth Risk Behavior Surveillance (YRBS). Logistic regression models were applied to discuss and analyze the secular changes across the years of data. The change differences in sports participation by sex, grade, and race/ethnicity were also explored via separate logistic regression. Results: A declined overall trend could be observed in sports participation in adolescents, the prevalence of sport participation was 58.4% in 2011 and 57.4% in 2019. The declining trend was also observed in grades 10 (62.3% in 2011 and 57.9% in 2019) and 12 (52.5% in 2011 and 49.8% in 2019) adolescents, and an increase could be observed in grade 11 (56.2% in 2011 and 59.1% in 2019) adolescents, but few changes were found in grade 9 (61.4% in 2011 and 61.9% in 2019) adolescents. Only white adolescents reported an increasing prevalence of sports participation, slight declines in sports participation were observed in black or African American, Hispanic/Latino, and other adolescents. Conclusions: The declining trend in sports participation could be seen in adolescents between 2011 and 2019, but it should also note that large variations of trends in sport participation by subgroups were also found.


Assuntos
Esportes , Adolescente , Humanos , Exercício Físico , Afro-Americanos , Negros , Etnicidade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...