Tag: nevin manimala

J Health Care Poor Underserved. 2022;33(2):790-805. doi: 10.1353/hpu.2022.0064.

ABSTRACT

OBJECTIVES: Determine if United States graduates of the Latin American Medical School in Cuba: 1) provide primary health care to disadvantaged populations; 2) complete licensing exams and obtain residencies; and 3) accrue additional debt during their medical education.

METHODS: A Qualtrics secure web-based survey was provided to 158 graduates via email, completed anonymously. Responses were compiled and descriptive statistics generated.

RESULTS: Fifty-six valid surveys were returned, for a response rate of 35.4%. Chi-square analysis showed no statistically significant differences between survey respondents and the sampling frame. Most graduates are people of color; 68% work in clinical medicine; of these, 90% are in primary care, with 100% serving disadvantaged populations. Most accrued no further educational loan debt.

CONCLUSIONS: United States graduates of the Latin American Medical School work in primary care with disadvantaged populations. Graduates accrue little additional student loan debt.

PMID:35574877 | DOI:10.1353/hpu.2022.0064

J Health Care Poor Underserved. 2022;33(2):806-818. doi: 10.1353/hpu.2022.0065.

ABSTRACT

OBJECTIVE: We examined the prevalence and correlates of interest in receiving HIV pre-exposure prophylaxis (PrEP) in Latinx migrants at high-risk of HIV infection in Tijuana, Mexico, a migrant sending/receiving community bordering California.

METHODS: In 2016, 870 HIV-seronegative biologically male Latinx migrants ages 18 and older responded to interviewer-administered surveys. Univariate statistics and multivariable analyses were estimated.

RESULTS: In multivariable logistic regression analyses, emerging adults (18-24 years) were significantly less likely than participants ages 45 and older to be interested in PrEP (AOR: 0.35; 95% CI: 0.13, 0.89). Those who ever had sex with another male (AOR: 1.78; 95% CI: 1.13, 2.80), and who recently used illicit drugs (AOR: 1.74, 95% 1.09, 2.75) were significantly more likely to be interested in receiving PrEP.

CONCLUSIONS: Provision of PrEP to migrant males at high-risk of HIV is needed. In Mexico, expanding access to federal health insurance and reducing the costs of PrEP are urgently needed.

PMID:35574878 | DOI:10.1353/hpu.2022.0065

J Health Care Poor Underserved. 2022;33(2):702-713. doi: 10.1353/hpu.2022.0057.

ABSTRACT

Existing research examines the effectiveness of medical home initiatives for Children with medical complexity (CMC), but not their siblings. This research sheds light on the care these siblings receive in the medical home. We assessed the preventative care status and medical home use of the siblings of CMC in four academic pediatric medical homes. We conducted an 18-month retrospective chart review of 236 siblings of CMC and 230 nonsiblings, matched by age and medical home. We found a statistically significant difference in the medical home use of siblings of CMC compared with non-siblings. They are not up to date on well-child care visits and are much less likely to be identified as children with special health care needs (CSHCN). This may lead to omission from registries and fewer interventions for outreach and support. Further attention is needed to develop methods that ensure appropriate care for this vulnerable population.

PMID:35574870 | DOI:10.1353/hpu.2022.0057

J Health Care Poor Underserved. 2022;33(2):580-589. doi: 10.1353/hpu.2022.0048.

ABSTRACT

Medical-legal partnerships (MLPs) add legal professionals, trained specifically to tackle health-related social needs (HRSN), to the health care team. We evaluated the impact on health outcomes and health care utilization of a MLP housed in a large federally qualified health center in Colorado (MLP-CO). Clients screened for I-HELP (Income, Housing, Employment, Legal status, Personal stability) needs were surveyed at baseline and six months post-enrollment. Reasons for legal aid were legal immigration status (46.5%), income (30.8%), personal/family stability (14.8%), housing (4.8%), and education (1.2%). Overall, 61.4% attributed great/moderate improvements in their health care experience to the MLP-CO. Statistically significant improvements were noted for days with poor physical/mental health, and feelings of stress/worry. There was a reduction in emergency department visits, hospitalization days, and missed appointments, but only the latter was statistically significant. In conclusion, MLPs are a promising innovation to achieve the Institute for Healthcare Improvement’s quadruple aim.

PMID:35574861 | DOI:10.1353/hpu.2022.0048

J Health Care Poor Underserved. 2022;33(2):571-579. doi: 10.1353/hpu.2022.0047.

ABSTRACT

Cardiovascular disease (CVD) is a leading cause of mortality among U.S. adults, especially low-income and uninsured adults. Non-Hispanic Black adults, who are overrepresented among low-income and uninsured populations, are disproportionately burdened by CVD mortality compared with non-Hispanic White adults. Medicaid expansion is associated with improved insurance coverage and access to care among low-income adults as well as reduced CVD mortality. It is unclear whether Medicaid expansion has reduced the Black-White disparity in CVD mortality. This study estimated a difference-in-differences model to compare changes in county-level CVD mortality ratios between expansion and non-expansion states. Findings indicate that Medicaid expansion is not associated with a statistically significant reduction in Black-White disparities in CVD mortality (β = -.039; p =.30). In conclusion, Medicaid expansion may be associated with improved health outcomes and access to care overall; however, it is insufficient to overcome other (i.e., social and economic) drivers of racial/ethnic disparities in CVD mortality.

PMID:35574860 | DOI:10.1353/hpu.2022.0047

Stat Med. 2022 May 16. doi: 10.1002/sim.9428. Online ahead of print.

ABSTRACT

In research synthesis, publication bias (PB) refers to the phenomenon that the publication of a study is associated with the direction and statistical significance of its results. Consequently, it may lead to biased (commonly optimistic) estimates of treatment effects. Visualization tools such as funnel plots have been widely used to investigate PB in univariate meta-analyses. The trim and fill procedure is a nonparametric method to identify and adjust for PB. It is popular among applied scientists due to its simplicity. However, most visualization tools and PB correction methods focus on univariate outcomes. For a meta-analysis with multiple outcomes, the conventional univariate trim and fill method can only account for different outcomes separately and thus may lead to inconsistent conclusions. In this article, we propose a bivariate trim and fill procedure to simultaneously account for PB in the presence of two outcomes that are possibly associated. Based on a recently developed galaxy plot for bivariate meta-analysis, the proposed procedure uses a data-driven imputation algorithm to detect and adjust PB. The method relies on the symmetry of the galaxy plot and assumes that some studies are suppressed based on a linear combination of outcomes. The method projects bivariate outcomes along a particular direction, uses the univariate trim and fill method to estimate the number of trimmed and filled studies, and yields consistent conclusions about PB. The proposed approach is validated using simulated data and is applied to a meta-analysis of the efficacy and safety of antidepressant drugs.

PMID:35574857 | DOI:10.1002/sim.9428

Hypertension. 2022 May 16:101161HYPERTENSIONAHA12219256. doi: 10.1161/HYPERTENSIONAHA.122.19256. Online ahead of print.

ABSTRACT

BACKGROUND: Whether the combination of different blood pressure and arterial stiffness (AS) status is independently associated with diabetes has not been fully investigated so far. This study aimed at investigating the status of hypertension and AS in determining diabetes.

METHODS: This prospective cohort study included 11 156 participants from the Kailuan study. AS was measured by brachial-ankle pulse wave velocity. We compared the risk of diabetes between individuals with ideal vascular function (defined as normotension with normal AS), normotension with elevated AS, hypertension with normal AS, and hypertension with elevated AS.

RESULTS: After a median follow-up of 6.16 years, diabetes occurred in 768 participants. Compared with ideal vascular function group, the highest risk of diabetes was observed in hypertension with elevated AS group (hazard ratio, 2.42 [95% CI, 1.93-3.03]), followed by normotension with elevated AS group (hazard ratio, 2.11 [95% CI, 1.68-2.66]), hypertension with normal AS group exhibited the lowest risk of diabetes (hazard ratio, 1.48 [95% CI, 1.08-2.02]). Multiple sensitivity and subgroup analyses yielded similar results. Furthermore, the additional of AS to a conventional model including traditional risk factors had a higher incremental effect on the predictive value for diabetes than the addition of hypertension (the C statistics was 0.707 versus 0.695; the integrated discrimination improvement was 0.65% versus 0.28%; net reclassification improvement was 40.48% versus 34.59%).

CONCLUSIONS: Diabetes is associated with not only hypertension but also AS. Additionally, AS shows a better predictive ability than hypertension in predicting diabetes.

PMID:35574838 | DOI:10.1161/HYPERTENSIONAHA.122.19256

Dementia (London). 2022 May 14:14713012221096986. doi: 10.1177/14713012221096986. Online ahead of print.

ABSTRACT

Poor sleep health is a risk factor for and a common symptom of dementia. Music has been shown to improve sleep across a wide range of clinical and community populations. However, it is unclear whether and to what extent music interventions may also help alleviate sleep problems in people with dementia. This systematic review is the first review examining the effects of music on sleep outcomes among people with dementia. In accordance with PRISMA guidelines, we extracted 187 articles from nine databases (Academic Search Premier, Ageline, APA PsycArticles, PsycINFO, CINAHL, Embase, PubMed, Scopus, and Web of Science). Eight studies were eligible for this systematic review (Range sample sizes: 1-59 people with dementia). Results revealed that assessments of sleep in the current literature were limited and mainly focused on sleep duration, subjective sleep quality, or nighttime sleep disturbances. Intervention delivery, music selection, and findings varied. Positive effects of music on sleep outcomes were observed in six out of the eight studies (75%), specifically there were decreases in nighttime sleep disturbances, increases in daytime alertness, and improvements in sleep quality. The remaining two studies found no statistically significant change in sleep outcomes (i.e., daytime sleepiness and quality). Study limitations included small sample sizes and the use of proxy reporters (e.g., caregiver, researcher, blinded clinician) which may reduce the accuracy of the sleep measures. Future research may want to incorporate objectively measured sleep to better understand the role of sleep in dementia care. More research is needed to determine whether music interventions are effective in improving sleep in people with dementia and whether improvements in sleep can slow the progression of dementia.

PMID:35574812 | DOI:10.1177/14713012221096986

Br J Surg. 2022 May 16:znac128. doi: 10.1093/bjs/znac128. Online ahead of print.

ABSTRACT

BACKGROUND: Recent findings support the hypothesis of sex-related differences in inflammatory and immunological responses to trauma. The aim of this study was to address sex-specific aspects in patients who underwent pancreatic surgery.

METHODS: This retrospective study used data from the German StuDoQ registry. Patients who underwent pancreatic surgery between 2010 and 2020 were stratified according to procedure (pancreatic head resection, distal pancreatectomy (DP), total pancreatectomy (TP)). Each cohort underwent propensity score matching (PSM) with the co-variables BMI, ASA, age, coronary heart disease (CHD), diabetes, hypertension with medication, and histology to level the distribution of co-morbidities between men and women. The main outcomes were morbidity and mortality.

RESULTS: The total cohort consisted of 10 224 patients (45.3 per cent women). Men had higher ASA grades, and more often had CHD, diabetes, and hypertension with medication. Women had fewer overall complications (57.3 versus 60.1 per cent; P = 0.005) and a lower mortality rate (3.4 versus 4.9 per cent; P < 0.001). Rates of pancreatic surgery-specific complications, such as clinically relevant postoperative pancreatic fistula (POPF) (grade B/C: 14 versus 17 per cent; P < 0.001), delayed gastric emptying (grade B/C: 7.8 versus 9.2 per cent; P = 0.014), and postpancreatectomy haemorrhage (grade B/C: 7.1 versus 9.0 per cent; P < 0.001), were also lower in women. After PSM, 8358 patients were analysed. In the pancreatic head resection cohort (5318 patients), women had fewer complications (58.6 versus 61.4 per cent; P = 0.044), a lower in-hospital mortality rate (3.6 versus 6.1 per cent; P < 0.001), and less often had clinically relevant POPF (11.6 versus 16.2 per cent; P < 0.001). After DP, the clinically relevant POPF rate was lower in women (22.5 versus 27.3 per cent; P = 0.012). In the TP cohort, men more often developed intra-abdominal abscess requiring drainage (5.0 versus 2.3 per cent; P = 0.050).

CONCLUSION: Women had favourable outcomes after pancreatic surgery.

PMID:35574811 | DOI:10.1093/bjs/znac128

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2022 Mar;34(3):294-300. doi: 10.3760/cma.j.cn121430-20220112-00050.

ABSTRACT

OBJECTIVE: To investigate the static and dynamic trends of scientific research efficiency of the critical care medicine in hospitals affiliated S university during the 13th Five-Year Plan period.

METHODS: Based on the scientific research data of 16 hospitals affiliated to Beijing S University from 2014 to 2020, the scientific research investment funds and the number of physicians involved in scientific research were selected as input evaluation indexes, and the number of science citation index (SCI) papers, Chinese science citation database (CSCD) papers, and the number of masters and doctors trained were selected as output evaluation indexes, and the evaluation index system of scientific research efficiency of critical care medicine was constructed. SPSS version 23.0 software was used for descriptive data statistics, and data envelopment analysis (DEA)-BCC model and DEA-Malmquist index model of DEAP 2.1 software were used for static and dynamic evaluation of its scientific research efficiency from 2016 to 2020, respectively.

RESULTS: (1) The scientific research technical efficiency (TE) of critical care medicine in 16 hospitals affiliated with S universities varied greatly from 2016 to 2020, but pure technical efficiency (PTE) and scale efficiency (SE) were at a good level, and 6-11 affiliated hospitals in critical care medicine kept DEA effective for 5 consecutive years. (2) Dynamic analysis of their total factor productivity (TFP) of scientific research from 2016 to 2020 showed a trend of rising and then falling and then rising again. The mean value was 0.985. The technical efficiency change (TEC) showed a decreasing and then increasing trend, and the technical progress change (TC) showed a slow increasing and then decreasing trend, with a mean value of 0.953. While the mean values of TEC, pure technical efficiency change (PTEC) and scale efficiency change (SEC) were above 1, which showed that the growth of total factor productivity index of research and innovation depended more on the technical efficiency index.

CONCLUSIONS: The “gain effect” and “catch-up effect” of scientific research efficiency in the specialty of critical care medicine in hospitals affiliated S universities are obvious, but the “growth effect” is not obvious. “Although the research efficiency of the 13th Five-Year Plan period has been significantly improved, there is still much room for improvement in scientific and technological innovation and international academic influence.

PMID:35574749 | DOI:10.3760/cma.j.cn121430-20220112-00050