Natural History of Occult Hernias in Adults at a Safety-Net Hospital

Background: Several studies have examined the risk of cardiovascular disease (CVD) among larger racial and ethnic groups such as Hispanics and African-Americans in the United States, but limited information is available on smaller subgroups such as Armenians. According to the World Health Organization, Armenia ranks eighth in CVD rates among all countries however it is unclear if Armenian immigrants living in the US have the same high rates of disease. This study examined whether being of Armenian descent increased the risk of having a positive exercise treadmill test (ETT) among patients treated at a safety net hospital in Los Angeles County. Methods: Data on patients who received an ETT from 2008-2011 were used to conduct a retrospective analysis of the relationship between Armenian ethnicity and ETT result as a surrogate measure for CVD. A multivariate logistic regression analysis was used to estimate the odds ratios (OR) for having a positive ETT among Armenians relative to non-Armenians, adjusting for the following pre-specified covariates: gender, age, diabetes, hypertension, hyperlipidemia, smoking, family history of coronary artery disease (CAD), and patient history of CAD. Results: A total of 5,297 patients, ages 18 to 89, were included. Of these, 13% were Armenian and 46% were male, with an average age of 53 years. Armenians had higher odds of having a positive ETT than non-Armenians (Crude OR=1.30, p=0.037, CI:1.02,1.66). After adjusting for CV risk factors, Armenians were still significantly more likely to have a positive ETT than non-Armenians (OR=1.33, p=0.029, CI:1.03,1.71). CAD (OR 2.02, p<0.001, CI:1.38,2.96), and hyperlipidemia (OR=1.31, p=0.008, CI:1.07,1.60) were also significantly associated with a positive ETT. Conclusion: Armenians have a higher likelihood of having a positive ETT than non-Armenians. This relationship appears to be independent of traditional CV risk factors and suggests a role for cultural and/or genetic influences.

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Natural history of postpartum hematocrit recovery in an urban, safety-net population

American Journal of Obstetrics & Gynecology MFM ◽

10.1016/j.ajogmf.2021.100541 ◽

2021 ◽

pp. 100541

Author(s):

Alexandra S RAGSDALE ◽

Lisa R THIELE ◽

John J BYRNE ◽

Amanda C ZOFKIE ◽

Donald D MCINTIRE ◽

...

Keyword(s):

Natural History ◽

Safety Net ◽

Urban Safety ◽

History Of

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Monitoring and developing volunteer patient navigation intervention to improve mammography compliance in a safety net hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.62 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 62-62

Author(s):

Anitha Srinivasan ◽

Judith Zwillenberg ◽

Anisha Chadda ◽

Hannah Gissel ◽

Michael Lettera ◽

...

Keyword(s):

Family History ◽

Patient Navigation ◽

Compliance Rate ◽

Intervention Group ◽

Safety Net ◽

Fisher Exact Test ◽

Exact Test ◽

Safety Net Hospital ◽

History Of ◽

History Of Cancer

62 Background: Mammography screening is crucial for cancer detection. Screening rates have been declining in patients of low socioeconomic status and minorities, supporting the need for intervention at our safety-net hospital. Methods: Patients with a primary care provider order for screening mammograms over a one month period were monitored for 90 day compliance. This analysis determined compliance rate and optimal intervention period. A prospective randomized trial was done to improve compliance using a volunteer patient navigator. All patients received educational material and were randomly assigned to the control or intervention group. The latter were further educated on breast cancer and mammograms and, if amenable, were escorted to a walk-in mammogram. The study period was 3 weeks with 49 participants-24 patients in the control and 25 patients in the intervention group. The principal outcome was the 14 day mammography compliance rate. Secondary analysis examined efficacy of the study with respect to patient demographics, prior mammography compliance, family history of cancer, beliefs on mammography and past medical history and analyzed using GraphPad Prism 7. Results: Analysis revealed a noncompliance rate of 52% with majority compliance occurring within two weeks of order placement. The patient navigation intervention significantly improved compliance by 34% (42% in the control group, 76% in the intervention group, p < 0.05 Fisher exact test). Intervention significantly improved compliance in patients with low susceptibility to cancer belief, who understood benefits of mammography and early diagnosis (p < 0.05 Fisher exact test), had a prior mammogram (p < 0.05 Fisher exact test), a family history of cancer (p < 0.01 Fisher exact test), hyperlipidemia (p < 0.05 Fisher exact test), and those employed (p < 0.05 Fisher exact test). Conclusions: A system to monitor compliance and intervene using patient navigation significantly improved mammography compliance of patients in a safety net urban hospital. The relatively straightforward design of the volunteer based intervention makes it affordable, easily replicable and perhaps beneficial at other institutions.

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MP14-02 THE NATURAL HISTORY OF MEN ON ACTIVE SURVEILLANCE WITH LOW-RISK PROSTATE CANCER AT A SAFETY-NET, COUNTY HOSPITAL

The Journal of Urology ◽

10.1016/j.juro.2017.02.466 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

E. Charles Osterberg ◽

Nynikka Palmer ◽

Catherine Harris ◽

Gregory Murphy ◽

Sarah Blaschko ◽

...

Keyword(s):

Prostate Cancer ◽

Natural History ◽

Active Surveillance ◽

Safety Net ◽

Low Risk ◽

County Hospital ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer ◽

History Of

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Abstract 049: De Novo Postpartum Hypertension In A Safety-net Hospital: Incidence And Risk Factors

Circulation ◽

10.1161/circ.143.suppl_1.049 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Samantha E Parker ◽

Ayodele Ajayi ◽

Christina Yarrington

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Maternal Morbidity ◽

De Novo ◽

Medical Center ◽

Safety Net ◽

Chronic Hypertension ◽

Increased Risk ◽

Safety Net Hospital ◽

History Of

Introduction: Postpartum hypertension can be persistent, following a pregnancy complicated by hypertension, or new onset ( de novo ), following a normotensive pregnancy. The postpartum period is traditionally defined as six weeks after delivery, yet accruing evidence shows that hypertension underlies the majority of severe maternal morbidity events through a year postpartum. While guidelines for enhanced monitoring of women at risk of persistent postpartum hypertension exist, less is known about risk factors for de novo postpartum hypertension. The aim of this study is to estimate the incidence of and identify risk factors for de novo postpartum hypertension among a diverse safety-net hospital population through the entire year postpartum. Hypothesis: We assessed the hypothesis that women with de novo postpartum hypertension share similar demographic and reproductive characteristics to women at increased risk of cardiovascular related maternal morbidity. Methods: We conducted a cohort study of 8,531 deliveries at Boston Medical Center from 2016-2018. Data on demographics, reproductive history, and labor and delivery were obtained from medical records. All documented blood pressure measures from pregnancy through 12 months postpartum were extracted. Women with chronic hypertension or hypertensive disorders of pregnancy were excluded. De novo postpartum hypertension was defined as two separate blood pressure readings with systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg at least 48 hours after delivery. Severe de novo hypertension was defined using criteria of SBP ≥160 and/or DPB ≥110. We examined the distribution of demographic and pregnancy characteristics among women with and without de novo postpartum hypertension. Secondary analyses restricting to women with healthcare visits after six weeks postpartum were also conducted. Results: Among the 6,631 women without a history of hypertension, 10% (n=660) developed de novo postpartum hypertension; a third of whom had severe hypertension (n=225). Compared to women without de novo hypertension; cases were more likely to be non-Hispanic Black; delivered via cesearean section; have had a preterm delivery; and be multiparous. In analyses restricted to women with visits extending past six weeks postpartum (n=3,272), the incidence of de novo postpartum hypertension was 16.6%. Approximately 30% of these cases were diagnosed after the traditionally used six week period. Conclusion: In conclusion, 1 in 10 women with normotensive pregnancies experience de novo hypertension in the year after delivery, with a third of these cases developing after six weeks. Opportunities to monitor and manage women at the highest risk of de novo hypertension throughout the entire year postpartum could mitigate cardiovascular related maternal morbidity.

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Monitoring and Developing a Volunteer Patient Navigation Intervention to Improve Mammography Compliance in a Safety Net Hospital

Journal of Oncology Practice ◽

10.1200/jop.18.00424 ◽

2019 ◽

Vol 15 (4) ◽

pp. e389-e398

Author(s):

Ilana G. Margulies ◽

Judith Zwillenberg ◽

Anisha Chadda ◽

Hannah Gissel ◽

Michael Lettera ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Family History ◽

Patient Navigation ◽

Controlled Trial ◽

Safety Net ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial ◽

Safety Net Hospital ◽

History Of ◽

History Of Cancer

PURPOSE: Although mammography screening is crucial for cancer detection, screening rates have been declining, particularly in patients of low socioeconomic status and minorities. We sought to evaluate and improve the compliance rates at our safety net hospital through a prospective randomized controlled trial of a volunteer-run patient navigation intervention. METHODS: Baseline 90-day institutional mammography compliance rates were evaluated for patients who received a physician order for screening mammograms over a 1-month period. This analysis aided in the creation of a prospective randomized controlled trial of a volunteer-run patient navigation intervention to improve compliance, with 49 total participants. The primary outcome was 14-day mammography compliance rates. Secondary analysis examined the efficacy of the intervention with respect to patient demographics, prior mammography compliance, family history of cancer, beliefs on mammography, and past medical history. RESULTS: Analysis of baseline institutional compliance revealed a 47.87% compliance rate, with the majority of compliance occurring within 14 days of order placement. The patient navigation intervention significantly improved compliance by 34% (42% in the control group, 76% in the intervention group). Additional findings included significantly improved compliance in patients who believed they had a low susceptibility to cancer, those who understood the benefits of mammography and early diagnosis, those who had a prior mammogram, those who were employed, and those with a family history of cancer. CONCLUSION: A system to monitor compliance and intervene using patient navigation significantly improved mammography compliance of patients in a safety net hospital. The relatively straightforward design of this volunteer-based intervention makes it affordable, easily replicable, and perhaps beneficial at other institutions.

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Susceptibility Profile of Drug-Resistant Streptococcus pneumoniae Based on ELR

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v8i1.6571 ◽

2016 ◽

Vol 8 (1) ◽

Author(s):

Avi Raju ◽

Eunice R. Santos ◽

Eric V. Bakota ◽

Biru Yang ◽

Raouf R. Arafat

Keyword(s):

Public Health ◽

Streptococcus Pneumoniae ◽

Public Health Surveillance ◽

Safety Net ◽

Health Surveillance ◽

Demographic Characteristics ◽

Drug Resistant ◽

Safety Net Hospital ◽

History Of ◽

Local Safety

The automated retrieval of antimicrobial susceptibility information via ELR expands public health surveillance without expending additional resources. This study presents the antimicrobial susceptibilities of drug-resistant Streptococcus pneumoniae in a local safety net hospital cohort and compares them with the susceptibilities found by the Centers for Disease Control and Prevention's Active Bacterial Core surveillance (ABCs) program. Demographic characteristics and vaccine history of the patients are also reported. The study found one large difference in percentage susceptibility for one antimicrobial drug (penicillin), suggesting a need to develop regional antimicrobial profiles to better inform clinical decisions.

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How is the moral stance related to the intentional stance and group thinking?

Behavioral and Brain Sciences ◽

10.1017/s0140525x19002413 ◽

2020 ◽

Vol 43 ◽

Author(s):

Hannes Rakoczy

Keyword(s):

Natural History ◽

Social Cognitive ◽

Intentional Stance ◽

Cognitive Capacities ◽

Shared Intentionality ◽

History Of ◽

Group Thinking ◽

Moral Stance

Abstract The natural history of our moral stance told here in this commentary reveals the close nexus of morality and basic social-cognitive capacities. Big mysteries about morality thus transform into smaller and more manageable ones. Here, I raise questions regarding the conceptual, ontogenetic, and evolutionary relations of the moral stance to the intentional and group stances and to shared intentionality.

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