Disparities in Access to Cranial Remodeling Orthosis for Deformational Plagiocephaly

2021 ◽  
pp. 105566562110698
Author(s):  
Alexandra Junn ◽  
Jacob Dinis ◽  
Aaron Long ◽  
Sacha Hauc ◽  
Sarah Phillips ◽  
...  

Objective Moderate to severe cases of deformational plagiocephaly (DP) may be treated with cranial remolding orthoses (CRO). This study investigated the socioeconomic disparities in access to care for CRO for DP correction. Design This was a retrospective review of medical records from a single CRO company in Connecticut from 2014 to 2020. Methods Demographic variables were collected from all patients. Univariable logistic regressions were used to identify differences for presenting age at consultation, whether CRO was pursued, and length of CRO treatment by insurance payor and household income quartile. Results Of the 5620 patients identified, 4100 (73.0%) received CRO, with 674 (12.0%) receiving a second helmet. Of those receiving CRO, 1536 (37.5%) had Medicaid insurance while 2558 (62.4%) were commercially insured. Patients on Medicaid were 1.30 times more likely to have delayed presentation ( P  =  .017), while patients from the lowest income quartile were 1.26 1.50 ( P < .001) and 1.58 ( P < .001) times more likely to have a delayed presentation relative to those in the highest and second-highest income quartiles, respectively. Patients in the highest and second-highest income quartiles were also 1.55 ( P < .001) and 1.45 ( P < .001) more likely, respectively, to receive CRO after consultation than those from the lowest income quartile. Conclusions Lower income and Medicaid-insured patients had delayed presentation for CRO consultation. Those from the lowest income quartile were more likely to never receive CRO than those from wealthier backgrounds. Low socioeconomic status and Medicaid insurance, which can have more restrictive coverage policies for CRO, may result in the delayed treatment of DP.

2018 ◽  
Vol 62 (2) ◽  
pp. 193-209 ◽  
Author(s):  
Carol A. Carman ◽  
Christine A. P. Walther ◽  
Robert A. Bartsch

The nonverbal battery of the Cognitive Abilities Test (CogAT) is one of the two most common nonverbal measures used in gifted identification, yet the relationships between demographic variables and CogAT7 performance has not yet been fully examined. Additionally, the effect of using the CogAT7 nonverbal battery on the identification of diverse demographic groups based on various norming, cutoff, and modifier plans has only just begun to be explored. In this study, we analyzed the CogAT7 nonverbal battery scores of kindergartners from a very large urban school district with a high minority, low socioeconomic status, and high English language learner population to determine the relationships between demographic variables and CogAT performance. The results suggest relationships between CogAT scores and multiple demographic variables, similar to other nonverbal instruments. We also examined the effects of various norming practices, including school-level and group-specific norming, on identification using the CogAT7 nonverbal battery.


2013 ◽  
Vol 29 (3) ◽  
pp. 485-495 ◽  
Author(s):  
André Salem Szklo ◽  
James F. Thrasher ◽  
Cristina Perez ◽  
Valeska Carvalho Figueiredo ◽  
Geoffrey Fong ◽  
...  

Increasing the effectiveness of smoking cessation policies requires greater consideration of the cultural and socioeconomic complexities of smoking. The purpose of this paper is to explore the association between socioeconomic status and "selected midpoints" linked to smoking cessation in Brazil. Data was collected from a representative sample of urban adult smokers as part of the ITC-Brazil Survey (2009, N = 1,215). After controlling for age and gender, there were no statistically significant differences quit attempts in the last six months between individuals with different socioeconomic status. However, smokers with high socioeconomic status visited a doctor 1.54 times more often than those with low socioeconomic status (p-value = 0.017), and were also 1.65 times more likely to receive advice to quit smoking (p-value = 0.025). Our results demonstrate that disparities in health and socioeconomic status are still a major challenge for policymakers to increase the population impact of tabacco control actions worldwide.


1998 ◽  
Vol 82 (3_suppl) ◽  
pp. 1287-1292 ◽  
Author(s):  
Arnold R. Bruhn

Spirrison, Schneider, Hartwell, Carmack, and D'Reaux (1997) argued that onset prior to age 4 of reported first memory is linked to maladjustment based on a study of 60 undergraduates; however, the literature suggests that sex, age, socioeconomic status, and Verbal IQ are likely to affect age of first recall. Responses of three previously unanalyzed samples were then reviewed for age of first recall. The first two samples yielded a 3-year earlier age of first recall for the female university student sample (3.2 vs 3.5 yr. for men); however, Spirrison, et at.'s prediction of maladjustment is probably better explained by various personal and demographic variables. A third sample—incarcerated male prisoners—was handpicked for specific demographic measures to test the notion that late age of first recall is linked with somatic complaints. Their average age of first recall was 6.2 yr. or “late onset.” Spirrison, et al.'s results would predict “somatic concerns”—extremely unlikely for this group. First recall at a later age is likely linked to a variety of psychological and demographic variables, including but not limited to low Verbal IQ, low education, low socioeconomic status, male, and a criminal background. Similarly, early age of first recall is probably linked to a high Verbal IQ, high education, middle-class socioeconomic status or higher, female, and an interest in reflection, among other variables. More research is needed on what affects age of first recall to avoid questionable attributions of pathology.


2019 ◽  
Vol 29 (3) ◽  
pp. 230-238
Author(s):  
Gloria Chen ◽  
Cynthia S. Bell ◽  
Penelope Loughhead ◽  
Bashar Ibeche ◽  
John S. Bynon ◽  
...  

Introduction: The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a psychometric instrument designed to assess patient risk for transplant. We investigated the association between SIPAT scores and demographic data with psychosocial and medical outcomes within a diverse kidney/kidney–pancreas transplant population. Design: The SIPAT was administered to all pretransplant candidates. A retrospective review of transplanted patients who had at least 6 months of follow-up was completed. Results: The sample included 136 patients: male (n = 77 [57%]) with a mean age of 47 years old. Thirty-eight percent were black (n = 51), 55% had less than a high school education (n = 74), and 65% had low socioeconomic status (n = 89). Statistical difference was found among SIPAT scores and substance use and support system instability ( P = .035, P = .012). Females ( P = .012) and patients with a history of psychopathology ( P = .002) developed or had a relapse of psychopathology following transplant. Patients with more than a high school education ( P = .025) and who were less than 30 years ( P = .026) had higher rejection incidence rates. Risk factors for rehospitalizations included Hispanic race, diabetes, and low socioeconomic status ( P = .036, P = .038, P = .014). African American/Black and male patients had higher incidence of infection events ( P = .032, P = .049). Mortality and treatment nonadherence were not significantly associated with SIPAT scores or demographic variables. Conclusion: The SIPAT was associated with posttransplant substance use and support system instability, while demographic variables were associated with the development and/or relapse of psychopathology, graft loss, rejection, infection events, and medical rehospitalizations. Revision of the SIPAT to include additional demographic components may lend to improved prediction of transplant outcomes.


1995 ◽  
Vol 114 (3) ◽  
pp. 465-473 ◽  
Author(s):  
O. Paltiel ◽  
J. D. Kark ◽  
M. Leinonen ◽  
P. Saikku

SUMMARYThe prevalence of antibodies toChlamydia pneumoniaewas examined in a stratified random sample of 581 Jerusalem adult residents between August 1987 and March 1989. IgG and IgA titres were measured by microimmunofluorescence, and associations with smoking and socio-demographic variables were assessed. IgG antibodies were found in 84·5% (95% confidence interval (CI): 80·4–87·9) of men and 68·7% (95% CI: 61·6–75·0) of women (P < 0·0001 for sex difference), indicating a very high rate of exposure in this population. IgA antibodies, postulated to represent persistent infection, were present in 45·1% (95% CI: 40·1–50·2) of men and 23% (95% CI: 17·4–29·7) of women (P < 0.0001 for sex difference). Factors associated with IgG seropositivity included family size, education and social class. On the other hand, age (in men) and smoking were associated with IgA seropositivity. These findings support the hypothesis that low socioeconomic status and household crowding may be predictive of exposure to or infection with this organism (IgG seropositivity), whereas they do not explain persistence of the infection putatively expressed as IgA seropositivity.


2020 ◽  
Vol 13 ◽  
pp. 285-289
Author(s):  
Samuel Wilcox ◽  
Hayrettin Okut ◽  
Robert Badgett ◽  
Stephanie Hassouneh ◽  
Elizabeth Ablah

Introduction: Diabetes mellitus (DM) disproportionately affects people with low socioeconomic-status (SES). Student-run free clinics (SRFC) aim to care for low SES populations and experience high clinician turnover. Flow sheets have been used to improve care for those with diabetes, yet no research has assessed the use of such a flow sheet in a SRFC. The aim of this project was to determine if use of a flow sheet improved care for people with DM in an SRFC.   Methods: Charts from all patients receiving care for DM at one SRFC in the year before (n=53) and after (n=56) implementation of the flow sheet were reviewed. Pre and post group comparisons and post subgroup comparisons were made for glycosylated-hemoglobin (HgbA1c), microalbumin, and foot and eye exams.   Results: During a one-year period, a larger proportion of patients who received care post flow sheet introduction received at least two HgbA1c tests (53%), a microalbumin test (46%), and a foot-exam (46%) compared to those receiving care before the flow sheet (28%, 2%, and 25%, respectively). There was no difference in proportions of patients undergoing eye exams. In post subgroup analysis, flow sheets were used for 50% of patients, and patients who received care with the flow sheet were more likely to receive at least two HgbA1c tests and a foot exam per year. Conclusions: Our study suggests that flow sheets can improve the process of care for patients with diabetes in a SRFC. A systematic integration of the flow sheet is being implemented in the SRFC now.


Author(s):  
Jens Agerström ◽  
Magnus Carlsson ◽  
Anders Bremer ◽  
Johan Herlitz ◽  
Johan Israelsson ◽  
...  

Abstract Aims  Individuals with low socioeconomic status (SES) face widespread prejudice in society. Whether SES disparities exist in treatment and survival following in-hospital cardiac arrest (IHCA) is unclear. The aim of the current retrospective registry study was to examine SES disparities in IHCA treatment and survival, assessing SES at the patient level, and adjusting for major demographic, clinical, and contextual factors. Methods and results  In total, 24 217 IHCAs from the Swedish Register of Cardiopulmonary Resuscitation were analysed. Education and income constituted SES proxies. Controlling for age, gender, ethnicity, comorbidity, heart rhythm, aetiology, hospital, and year, primary analyses showed that high (vs. low) SES patients were significantly less likely to receive delayed cardiopulmonary resuscitation (CPR) (highly educated: OR = 0.89, and high income: OR = 0.98). Furthermore, patients with high SES were significantly more likely to survive CPR (high income: OR = 1.02), to survive to hospital discharge with good neurological outcome (highly educated: OR = 1.27; high income: OR = 1.06), and to survive to 30 days (highly educated: OR = 1.21; and high income: OR = 1.05). Secondary analyses showed that patients with high SES were also significantly more likely to receive prophylactic heart rhythm monitoring (highly educated: OR = 1.16; high income: OR = 1.02), and this seems to partially explain the observed SES differences in CPR delay. Conclusion  There are clear SES differences in IHCA treatment and survival, even when controlling for major sociodemographic, clinical, and contextual factors. This suggests that patients with low SES could be subject to discrimination when suffering IHCA.


Crisis ◽  
2011 ◽  
Vol 32 (1) ◽  
pp. 43-51 ◽  
Author(s):  
Eugene Kinyanda ◽  
Ruth Kizza ◽  
Jonathan Levin ◽  
Sheila Ndyanabangi ◽  
Catherine Abbo

Background: Suicidal behavior in adolescence is a public health concern and has serious consequences for adolescents and their families. There is, however, a paucity of data on this subject from sub-Saharan Africa, hence the need for this study. Aims: A cross-sectional multistage survey to investigate adolescent suicidality among other things was undertaken in rural northeastern Uganda. Methods: A structured protocol administered by trained psychiatric nurses collected information on sociodemographics, mental disorders (DSM-IV criteria), and psychological and psychosocial risk factors for children aged 3–19 years (N = 1492). For the purposes of this paper, an analysis of a subsample of adolescents (aged 10–19 years; n = 897) was undertaken. Results: Lifetime suicidality in this study was 6.1% (95% CI, 4.6%–7.9%). Conclusions: Factors significantly associated with suicidality included mental disorder, the ecological factor district of residence, factors suggestive of low socioeconomic status, and disadvantaged childhood experiences.


Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.


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