Disparities in healthcare services in women with endometriosis with public vs private health insurance.

BACKGROUND: The goals of health disparities research are to identify facilitators and barriers to healthcare use to help eliminate health inequalities. There are few studies on disparities in healthcare access and use trends for patients with endometriosis that may lead to differences in appropriate care based on socioeconomic status. OBJECTIVE: This retrospective, cross-sectional study was conducted to compare health services use patterns and prevalence of co-morbidities of women with endometriosis with public (government-based) vs private (purchased or provided by employer) health insurance. STUDY DESIGN: A total of 342 deidentified datasets (171 randomly-selected cases per study group) from women with endometriosis 14-50 years old who were members of one health insurance company that provides both public and private health insurance coverage in Puerto Rico were analyzed. Patients were defined as having at least 1 endometriosis-related medical claim (ICD-9-617.xx; International Classification of Diseases, Ninth Revision, Clinical Modification) during the 3-year study period. RESULTS: Medical service (eg, hospital, laboratory, pathology, and radiology) use trends were 3 times lower in the public vs the private sector. Women in the public sector were 3.5 times less likely to have a laparoscopy, 2.7 times more likely to be prescribed opioid/narcotics, and were the only study subjects reporting emergency department use. Obstetrics and gynecology services were used >2-fold less by women in the public (29.5%) vs the private sector (70.5%) (P=.087). CONCLUSIONS: We report significant differences in the use trends of endometriosis-related medical services and prescriptions, indicating differences in healthcare access based on socioeconomic parameters. Our results support the development of public health programs to promote access to healthcare for patients with endometriosis irrespective of socioeconomic status and promote health disparity research in other healthcare systems.

Assessing the living environment of persons displaced following a strong earthquake sequence in Puerto Rico, 2020.

In the public health portfolio of disaster tools, rapid needs assessments are essential intelligence data mining resources that can assess immediate needs in almost all hazard scenarios. Following prolonged and unusual seismic activity that caused significant structural damage, mainly in the southwest part of the island of Puerto Rico, thousands of area residents were forced to leave their homes and establish improvised camps. The austere environmental exposure and limited access to safety and hygiene services prompted public health authorities to request assistance with conducting a rapid needs assessment of those encampments. This report summarizes the design, organization, and execution of a rapid needs assessment of improvised camps following a strong sequence of earthquakes in Puerto Rico.

Implementing a hospital based injury surveillance system in Zambia: a preliminary report.

The University Teaching Hospital in Lusaka, Zambia, is the nation's premier tertiary referral hospital and a teaching centre for the University of Zambia as well as a research centre of excellence. It was one of the five sites chosen as part of a multinational injury surveillance project conceived to provide preliminary data in response to observations made by public health agencies such as the World Health Organization, and the United States Centres for Disease Control and Prevention (CDC) on the paucity of such data from third world settings. The study covering a period of 6 months from January 2007 to June 2007, used a pre-tested survey instrument crafted by the Ponce School of Medicine in Puerto Rico in close consultation with the CDC and the Pan-American Health Organization (PAHO). A 24-hour system collected a total of 2714 cases, with due care taken to ensure that all the parameters were entered as required.

A multinational injury surveillance system pilot project in Africa.

This paper describes the development of a pilot project to test the implementation of an epidemiological surveillance system for intentional (violent) and non-intentional injuries, at emergency departments in selected hospitals in five African countries applying the World Health Organization's guidelines. We outline obstacles and opportunities encountered during the process. By definition, a surveillance system systematically collects, reviews, and evaluates information to understand the context in which specific injuries occur. Implementation in diverse sociocultural environments in Zambia, Uganda, Democratic Republic of the Congo, Nigeria, and Kenya has provided an opportunity to gather reliable data on injuries for comparisons between these countries. Analysis of the detailed information may permit researchers to generate evidence-based recommendations. Addressed to public authorities, and health authorities in particular, they can help address injury incidence in their communities from a public health perspective.

Motor vehicle accident fatalities trends, Puerto Rico 2000-2007.

Motor vehicle accident fatalities (MVAF) are an important cause of death that affects millions of people worldwide. Using the Puerto Rico Institute of Forensic Science database, this study accessed the mortality trends of MVAF in Puerto Rico from 2000 to 2007. Descriptive statistics, age-adjusted mortality rates, geographical analysis, and annual percentage change were calculated. An annual mean of 559 MVAF occurred during the study period. The overall MVAF mortality rate declined from 2000 to 2007 (16.6 and 12.4 per 100,000 population, respectively)-mortality rates annually decreased 3%. Most MVAF (80.2%) occurred in men, showing a risk four times higher than women (23.6 and 5.4 deaths per 100,000 populations, respectively). Drivers aged 20-24 years and pedestrians older than 75 years had the highest risk of death. This study emphasizes the need of public health efforts to focus on the prevention of MVAF in the most affected groups.