Challenges to Understanding and Compliance Among Surgical Patients in Low-Income Urban Teaching Hospitals

Financial and educational barriers significantly impact low socioeconomic status racial and ethnic minority groups in their pursuit of health care, though less is known about the interplay of these factors in the pursuit of surgical care. This study was designed to uncover the challenges to patient understanding and compliance with pre- and postsurgical clinical advice in low-income urban environments. The data for this study were collected in spoken survey with eighty patients in 9 surgery clinics at Temple University Hospital in Philadelphia. Survey responses were coded into various groups until categories emerged. Relationships among categories were identified to generate themes and subthemes. Key facilitators of patient understanding and compliance were physician likeability and communication. Eighty (100%) patients reported that the physician always treated them with respect, which was important in their interpretation of their experience with the physician. Eighteen (23%) patients identified a language other than English as their primary language and 57 (71%) patients completed high school or less schooling, which likely influenced their communication with the physician. Eighty (100%) patients expressed that the physician always explained things in a way they could understand, focusing on clarity and thoroughness. Challenges to patient understanding and compliance were finances and social resources. Patients noted difficulty paying for medical care and a lack of support at home. Agency could facilitate use of surgical care while a lack thereof could challenge motivation. Ultimately, these themes showed how patients in this environment interact with surgical care.

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Patient Attitudes Toward Spoken Surveys in a Low-Income Urban Surgical Clinic

The American Surgeon ◽

10.1177/0003134820960054 ◽

2020 ◽

pp. 000313482096005

Author(s):

Montgomry L. Burgoon ◽

Parker A. Miller ◽

Bryson Hoover-Hankerson ◽

Nicolle Strand ◽

Howard Ross

Keyword(s):

Health Care ◽

Low Income ◽

College Education ◽

Urban Setting ◽

University Hospital ◽

Low Literacy ◽

Urban Settings ◽

Advantages And Disadvantages ◽

Interview Format ◽

Survey Responses

Diverse groups in urban settings demonstrate poor participation in health care and low levels of literacy. It is possible the method of health information delivery (eg, spoken vs. written) in these settings could impact health care related communication and understanding, though little is known on this topic. The objective of this study was to uncover the advantages and disadvantages of spoken survey administration in a low-income urban setting. The data for this study were collected via spoken survey with eighty patients in 9 surgery clinics at Temple University Hospital (TUH) in North Philadelphia. Survey responses were coded into various groups until categories and relationships among them emerged to produce themes relevant in demonstrating the advantages and disadvantages of spoken survey. 69% (55) of respondents preferred a spoken survey format. Of the 55 patients who preferred the spoken format, 33% (18) possessed some level of college education and 47% (26) had finished high school. Of the 23 patients who primarily spoke Spanish or another language at home, 78% (18) preferred a spoken interview format. Overall, 53% (42) of patients experienced at least 1 instance of poor understanding throughout the survey. Patients were better able to understand questions in a spoken survey compared to written ones that they had completed in the past due to the opportunity for surveyors to explain questions when needed. It is possible that question explanation is necessary in low-income urban settings due to low-literacy levels or improved feelings of survey intimacy and efficiency.

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Socioeconomic Disparities in Foods/Beverages and Nutrients Consumed by U.S. Adolescents When Snacking: National Health and Nutrition Examination Survey 2005–2018

Nutrients ◽

10.3390/nu13082530 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2530

Author(s):

Navika Gangrade ◽

Janet Figueroa ◽

Tashara M. Leak

Keyword(s):

National Health ◽

Low Socioeconomic Status ◽

Low Income ◽

High Income ◽

Future Research ◽

Nutrition Examination Survey ◽

Middle Income ◽

Low Socioeconomic ◽

Health And Nutrition ◽

Income Ratio

Snacking contributes a significant portion of adolescents’ daily energy intake and is associated with poor overall diet and increased body mass index. Adolescents from low socioeconomic status (SES) households have poorer snacking behaviors than their higher-SES counterparts. However, it is unclear if the types of food/beverages and nutrients consumed during snacking differ by SES among adolescents. Therefore, this study examines SES disparities in the aforementioned snacking characteristics by analyzing the data of 7132 adolescents (12–19 years) from the National Health and Nutrition Examination Survey 2005–2018. Results reveal that adolescents from low-income households (poverty-to-income ratio (PIR) ≤ 1.3) have lower odds of consuming the food/beverage categories “Milk and Dairy” (aOR: 0.74; 95% CI: 0.58-0.95; p = 0.007) and “Fruits” (aOR: 0.62, 95% CI: 0.50–0.78; p = 0.001) as snacks and higher odds of consuming “Beverages” (aOR: 1.45; 95% CI: 1.19-1.76; p = 0.001) compared to those from high-income households (PIR > 3.5). Additionally, adolescents from low- and middle-income (PIR > 1.3–3.5) households consume more added sugar (7.98 and 7.78 g vs. 6.66 g; p = 0.012, p = 0.026) and less fiber (0.78 and 0.77 g vs. 0.84 g; p = 0.044, p = 0.019) from snacks compared to their high-income counterparts. Future research is necessary to understand factors that influence snacking among adolescents, and interventions are needed, especially for adolescents from low-SES communities.

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Causes of death and comorbidities in hospitalized patients with COVID-19

Scientific Reports ◽

10.1038/s41598-021-82862-5 ◽

2021 ◽

Vol 11 (1) ◽

Cited By ~ 3

Author(s):

Sefer Elezkurtaj ◽

Selina Greuel ◽

Jana Ihlow ◽

Edward Georg Michaelis ◽

Philip Bischoff ◽

...

Keyword(s):

Cause Of Death ◽

Causes Of Death ◽

Pulmonary Infection ◽

Diffuse Alveolar Damage ◽

University Hospital ◽

Health Conditions ◽

Teaching Hospitals ◽

Increased Risk ◽

Clinical Records ◽

Full Body

AbstractInfection by the new corona virus strain SARS-CoV-2 and its related syndrome COVID-19 has been associated with more than two million deaths worldwide. Patients of higher age and with preexisting chronic health conditions are at an increased risk of fatal disease outcome. However, detailed information on causes of death and the contribution of pre-existing health conditions to death yet is missing, which can be reliably established by autopsy only. We performed full body autopsies on 26 patients that had died after SARS-CoV-2 infection and COVID-19 at the Charité University Hospital Berlin, Germany, or at associated teaching hospitals. We systematically evaluated causes of death and pre-existing health conditions. Additionally, clinical records and death certificates were evaluated. We report findings on causes of death and comorbidities of 26 decedents that had clinically presented with severe COVID-19. We found that septic shock and multi organ failure was the most common immediate cause of death, often due to suppurative pulmonary infection. Respiratory failure due to diffuse alveolar damage presented as immediate cause of death in fewer cases. Several comorbidities, such as hypertension, ischemic heart disease, and obesity were present in the vast majority of patients. Our findings reveal that causes of death were directly related to COVID-19 in the majority of decedents, while they appear not to be an immediate result of preexisting health conditions and comorbidities. We therefore suggest that the majority of patients had died of COVID-19 with only contributory implications of preexisting health conditions to the mechanism of death.

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Low socioeconomic status is associated with self-reported HIV positive status among young MSM in Brazil and Peru

BMC Infectious Diseases ◽

10.1186/s12879-021-06455-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Thiago S. Torres ◽

Lara E. Coelho ◽

Kelika A. Konda ◽

E. Hamid Vega-Ramirez ◽

Oliver A. Elorreaga ◽

...

Keyword(s):

Socioeconomic Status ◽

Latin American ◽

Low Socioeconomic Status ◽

Low Income ◽

Sexual Attraction ◽

Hiv Positive ◽

Sociodemographic Characteristics ◽

Hiv Status ◽

Hiv Test ◽

Young Msm

Abstract Background Despite efforts to stop HIV epidemic in Latin America, new HIV cases continue to increase in the region especially among young MSM (YMSM). This study aims to assess if sociodemographic characteristics are associated with self-reported HIV positive status among YMSM from three Latin American countries. Methods Cross-sectional web-based survey advertised on dating apps (Grindr and Hornet) and Facebook in Brazil, Mexico and Peru. For this analysis, we included YMSM aged 18–24 years who self-reported their HIV status. We used multivariable logistic regression models for each country separately to verify if sociodemographic characteristics (race, education and income) were associated with HIV self-reported status after adjusting for behavior characteristics (sexual attraction and steady partner). Results Among 43,687 MSM who initiated the questionnaire, 27,318 (62.5%) reported their HIV status; 7001 (25.6%) of whom were YMSM. Most YMSM (83.4%) reported an HIV test in the past year, and 15.7% reported an HIV positive status in Peru, 8.4% in Mexico and 7.7% in Brazil. In adjusted models, low-income was associated with higher odds of self-reported HIV positive status in Brazil (aOR = 1.33, 95%CI: 1.01–1.75) and Peru (aOR = 1.56, 95%CI: 1.02–2.40), but not in Mexico. Lower education was associated with higher odds of self-reported HIV positive status only in Brazil (aOR = 1.35, 95%CI: 1.05–1.75). Conclusions In this large, cross-country study, self-reported HIV positive status among YMSM was high. Lower socioeconomic status was associated with higher odds of self-reported HIV positive status in Brazil and Peru. There is an urgent need for HIV prevention interventions targeting YMSM, and efforts to address low-income YMSM are especially needed in Peru and Brazil.

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Lack of fit with the neighbourhood social environment as a risk factor for psychosis – a national cohort study

Psychological Medicine ◽

10.1017/s0033291721002233 ◽

2021 ◽

pp. 1-9

Author(s):

Peter Schofield ◽

Jayati Das-Munshi ◽

Roger T. Webb ◽

Henriette Thisted Horsdal ◽

Carsten B. Pedersen ◽

...

Keyword(s):

Low Income ◽

Minority Groups ◽

Density Effect ◽

Ethnic Minority Groups ◽

Ethnic Density ◽

Affective Psychosis ◽

Lack Of Fit ◽

National Cohort ◽

Group Density ◽

Manual Occupation

Abstract Background Many studies report an ethnic density effect whereby psychosis incidence among ethnic minority groups is higher in low co-ethnic density areas. It is unclear whether an equivalent density effect applies with other types of socioeconomic disadvantages. Methods We followed a population cohort of 2 million native Danes comprising all those born on 1st January 1965, or later, living in Denmark on their 15th birthday. Socioeconomic disadvantage, based on parents' circumstances at age 15 (low income, manual occupation, single parent and unemployed), was measured alongside neighbourhood prevalence of these indices. Results Each indicator was associated with a higher incidence of non-affective psychosis which remained the same, or was slightly reduced, if neighbourhood levels of disadvantage were lower. For example, for individuals from a low-income background there was no difference in incidence for those living in areas where a low-income was least common [incidence rate ratio (IRR) 1.01; 95% confidence interval (CI) 0.93–1.10 v. those in the quintile where a low income was most common. Typically, differences associated with area-level disadvantage were the same whether or not cohort members had a disadvantaged background; for instance, for those from a manual occupation background, incidence was lower in the quintile where this was least v. most common (IRR 0.83; 95% CI 0.71–0.97), as it was for those from a non-manual background (IRR 0.77; 95% CI 0.67–0.87). Conclusion We found little evidence for group density effects in contrast to previous ethnic density studies. Further research is needed with equivalent investigations in other countries to see if similar patterns are observed.

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Predictors of Unmet Dental Health Needs in US Adults in 2018: A Cross-Sectional Analysis

JDR Clinical & Translational Research ◽

10.1177/23800844211035669 ◽

2021 ◽

pp. 238008442110356

Author(s):

D.J. Gaskin ◽

H. Zare ◽

R. McCleary ◽

O. Kanwar ◽

A.L. Davis

Keyword(s):

Socioeconomic Status ◽

Oral Health ◽

Low Socioeconomic Status ◽

Low Income ◽

The United States ◽

Permanent Teeth ◽

Dental Visit ◽

Low Socioeconomic ◽

The Past ◽

Dental Needs

Objective: To identify predictors of unmet dental needs for adults 18 y of age or older in the United States. Method: Using the Aday and Andersen framework and data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we ran logistic regression to estimate predictors for adults of not having a dental visit within 5 y and having lost any teeth using a national sample of 155,060 survey respondents. Results: Results showed that predisposing factors (age, race/ethnicity, gender, and educational attainment) and enabling factors (income and health insurance status) are important predictors for losing teeth due to decay or gum disease. Men, the elderly, and less educated and low-income residents were less likely to have seen a dentist within the past 5 y and more likely to have lost their permanent teeth. Compared to non-Hispanic White adults, Hispanics adults were more likely to have had a dental visit within the past 5 y. Unmet dental needs varied across states. People living in states with extensive Medicaid dental care benefit coverage were less likely to lose their teeth and more likely to have had a dental visit within the past 5 y. Conclusion: Efforts to improve oral health should address unmet dental needs of men and adults with low socioeconomic status. Studying the variation between state oral health care programs could further our understanding of how public policy can improve population oral health. Knowledge Transfer Statement: Men, non-Hispanic Blacks, mixed and other race minorities, and low socioeconomic status adults are most at risk of unmet dental needs. States can address these needs by expanding Medicaid coverage for adults.

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Will 'Deaths of Despair' among Whites Change How We Talk about Racial/Ethnic Health Disparities?

Ethnicity & Disease ◽

10.18865/ed.28.2.123 ◽

2018 ◽

Vol 28 (2) ◽

pp. 123 ◽

Cited By ~ 6

Author(s):

Lauren Brown ◽

Reginald Tucker-Seeley

Keyword(s):

Health Disparities ◽

Population Health ◽

Low Socioeconomic Status ◽

Urban Areas ◽

Minority Groups ◽

Premature Death ◽

Popular Literature ◽

The United States ◽

Deaths Of Despair ◽

Racial Ethnic

The recent trend of premature death among Whites in the United States has garnered attention in both the popular and academic literature. This attention has focused on the plight of low socioeconomic status Whites in non-urban areas. The population health literature in general and the health disparities literature more specifically has struggled to describe differences in health when White groups present worse health outcomes or worsening trends compared with racial/ ethnic minority groups. There remain many open questions as population health/health disparities research attempts to explain the increasing mortality rates for low socioeconomic status Whites in non-urban areas in relationship to other racial/ethnic groups. As the conversation in the academic and popular literature continues to unfold, a key question for population health research and practice is how will the ‘deaths of despair’ phenomenon among Whites influence our measuring of, and reporting and intervening on, race/ethnic health disparities? Ethn Dis. 2018;28(2):123-128; doi:10.18865/ ed.28.2.123.

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P147: International scope of emergency ultrasound: barriers to utilizing ultrasound to guide central venous catheter placement by providers in Kenya

CJEM ◽

10.1017/cem.2016.321 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S127-S127

Author(s):

F. Zaver ◽

K. Boniface ◽

H. Shokoohi ◽

B. Wachira ◽

G. Wanjiku

Keyword(s):

Central Venous Catheter ◽

Previous History ◽

Venous Catheter ◽

Standard Of Care ◽

Comfort Level ◽

Perceived Barriers ◽

University Hospital ◽

Central Venous ◽

International Scope ◽

Survey Responses

Introduction: While ultrasound (U/S) use for internal jugular central venous catheter (CVC) placement is standard of care in many institutions in North America, most developing countries have not adopted this practice. Previous surveys of American physicians who are not currently using U/S to place CVCs have identified lack of training and equipment availability as the most important barriers to the use of U/S. We sought to identify Kenyan physicians’ perceived barriers to the use of U/S to guide CVC insertion in a resource-constrained environment. Methods: The study was conducted at the Aga Khan University Hospital in Nairobi, Kenya. Physicians participating in a one-hour course teaching U/S guided CVC placement were asked to complete a survey before beginning training, which was used to assess previous experience with U/S, and evaluate perceived barriers to U/S. Survey responses were analyzed using summary statistics and the Rank-Sum test to compare the difference between participants’ responses based on different specialty, gender and previous history of using U/S. Results: There were 23 physicians who completed the course and the survey. They included 6 internal medicine, 5 critical care, 5 anesthesia, 2 emergency medicine and 5 physicians from other specialties. The mean length of practice was 5 years. 52% (95% CI: 0.30-0.73) had put in >20 CVCs. 21.7% (95% CI: 0.08-0.44) of participants had previous U/S training, but none have received any training on the use of U/S for CVC insertion. The respondents expressed agreement on the ease of the use, improved success rate, and decreased failure rate with U/S guidance. However, less agreement was found regarding the perceived superior convenience and cost effectiveness of U/S CVC placement (see Figure). The lack of training or comfort with the U/S and the availability of U/S and equipment to maintain sterility were reported as the main barriers for use. Neither previous U/S experience nor specialty of the respondent significantly affected responses. Conclusion: Barriers to the use of U/S guidance for the placement of CVCs in Nairobi, Kenya are similar to those found among American physicians. These include training and comfort level with U/S in placement of CVCs, as well as resources required for U/S equipment and to keep the field sterile.

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The medical and surgical care chain in neuro-injured patients: The experience of the Nantes University Hospital from 2004 to 2014

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2015.07.055 ◽

2015 ◽

Vol 58 ◽

pp. e21

Author(s):

C. Lefèvre ◽

F. Bellier Waast ◽

P. Kiény ◽

F. Lejeune ◽

M. Lefort ◽

...

Keyword(s):

Surgical Care ◽

University Hospital ◽

Care Chain ◽

Injured Patients

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Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

10.21203/rs.3.rs-147008/v1 ◽

2021 ◽

Author(s):

Adel Hamed Elbaih ◽

Maged El-Setouhy ◽

Jon Mark Hirshon ◽

Hazem Mohamed El-Hariri ◽

Mohamed El-Shinawi

Keyword(s):

Low Income ◽

Life Support ◽

University Hospital ◽

Low Income Countries ◽

Advanced Trauma Life Support ◽

Trauma Patients ◽

Education Programs ◽

Missed Injuries ◽

Polytrauma Patients ◽

Trauma Education

Abstract IntroductionTrauma deaths account for 8% of all deaths in Egypt. Patients with multiple injuries are at high risk but may be saved with a good triage system and a well-trained trauma team in dedicated institutions. The incidence of missed injuries in the Emergency Department (ED) of Suez Canal University Hospital (SCUH) was found to be 9.0% after applying Advanced Trauma Life Support (ATLS) guidelines. However, this rate is still high compared with many trauma centers.AimImprove the quality of management of polytrauma patients by decreasing the incidence of missed injuries by implementing the Sequential Trauma Education Programs (STEPs) course in the ED at SCUH.MethodsThis interventional training study was conducted in the SCUH ED that adheres to CONSORT guidelines. The study was conducted during the 1-month precourse and for 6 months after the implementation of the STEPs course for ED physicians. Overall, 458 polytrauma patients were randomly selected, of which 45 were found to have missed injuries after applying the inclusion and exclusion criteria. We assessed the clinical relevance of these cases for missed injuries before and after the STEPs course.ResultsOverall, 45 patients were found to have missed injuries, of which 15 (12%) were pre-STEPs and 30 (9%) were post-STEPs course. The STEPs course significantly increased adherence to vital data recording, but the reduction of missed injuries (3.0%) was not statistically significant in relation to demographic and trauma findings. However, the decrease in missed injuries in the post-STEPs course group was an essential clinically significant finding.ConclusionSTEPs course implementation decreased the incidence of missed injuries in polytrauma patients. Thus, the STEPs course can be considered at the same level of other advanced trauma courses as a training skills program or possibly better in dealing with trauma patients. Repetition of this course by physicians should be mandatory to prevent more missed injuries. Therefore, the validation of STEPs course certification should be completed at least every 2 years to help decrease the number of missed injuries, especially in low-income countries and low-resource settings.Trial RegistrationProject manager for the Pan African Clinical Trial Registry (www.pactr.org) database has been accepted with the date of approval:18/11/2020. Current Controlled Trials number for the registry is PACTR202011853914203. Please note that the article state Retrospectively registered that my study adheres to CONSORT guidelines.

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