Racial differences in performance-based function and potential explanatory factors among individuals with knee osteoarthritis.
Female; Humans; Male; Aged; Middle Aged; Socioeconomic Factors; Pain Measurement; African Americans; Body Mass Index; European Continental Ancestry Group; Exercise Test; Knee Joint/physiopathology; Osteoarthritis Knee/physiopathology; Physical Functional Performance
Objective: In individuals with knee osteoarthritis (OA), self-reported physical function is poorer in African Americans than in whites, but whether this difference holds true for objective assessments is unclear. The purpose of this study was to examine racial differences in performance-based physical function as well as potential underlying factors contributing to these racial differences.; Methods: Participants with knee OA from a randomized controlled trial completed the 2-minute step test (2MST), timed-up-and-go (TUG), and 30-second chair stand (30s-CST) at baseline. Race differences in performance-based function were assessed by logistic regression. Separate models were adjusted for sets of demographic, socioeconomic, psychological health, and physical health variables.; Results: In individuals with knee OA (n = 322; 72% women, 22% African American, mean ± SD age 66 ± 11 years, mean ± SD body mass index 31 ± 8 kg/m 2 ), African Americans (versus whites) had greater unadjusted odds of poorer function (30s-CST odds ratio [OR] 2.79 [95% confidence interval (95% CI) 1.65-4.72], 2MST OR 2.37 [95% CI 1.40-4.03], and TUG OR 3.71 [95% CI 2.16-6.36]). Relationships were maintained when adjusted for demographic and psychological health covariates, but they were either partially attenuated or nonsignificant when adjusted for physical health and socioeconomic covariates.; Conclusion: African American adults with knee OA had poorer unadjusted performance-based function than whites. Physical health and socioeconomic characteristics diminished these differences, emphasizing the fact that these factors may be important to consider in mitigating racial disparities in function. (© 2019, American College of Rheumatology.)
Flowers PPE;Schwartz TA;Arbeeva L;Golightly YM;Pathak A;Cooke J;Gupta JJ;Callahan LF;Goode AP;Corsi M;Huffman KM;Allen KD
Arthritis Care & Research
2020
2020-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1002/acr.24018" target="_blank" rel="noreferrer noopener">10.1002/acr.24018</a>
Evolving Roles of Health Care Organizations in Community Development.
COMMUNITY health services; MEDICAL care; SELF-efficacy; SOCIOECONOMIC factors; SERIAL publications; HEALTH promotion; COMMUNITIES; HEALTH facilities
The article aims to increase awareness of and dialogue about the achievable benefits and existing challenges of health care organizations' engagement in community development as to continue national efforts which aimed at achieving social, economic, and health equity.
Hilt Austin J
Ama Journal Of Ethics
2019
2019-03
Journal Article
<a href="http://doi.org/10.1001/amajethics.2019.201" target="_blank" rel="noreferrer noopener">10.1001/amajethics.2019.201</a>
Exploring comorbid depression and physical health trajectories: A case-based computational modelling approach.
Adult; Female; Humans; Male; Middle Aged; Socioeconomic Factors; Aged; Chronic Disease; *Computer Simulation; Longitudinal Studies; Comorbidity; *Health Status; Artificial Intelligence; cluster analysis; Life Change Events; primary care; Artificial Intelligence; case-based modelling; comorbid depression and physical health; complexity theory; differential equations; longitudinal analysis; nonlinear dynamics; Systems Analysis; Adult Survivors of Child Abuse/statistics & numerical data; Depression/*epidemiology/*physiopathology; Health Services Research/*methods; Intimate Partner Violence/statistics & numerical data; Primary Health Care/organization & administration
While comorbid depression/physical health is a major clinical concern, the conventional methods of medicine make it difficult to model the complexities of this relationship. Such challenges include cataloguing multiple trends, developing multiple complex aetiological explanations, and modelling the collective large-scale dynamics of these trends. Using a case-based complexity approach, this study engaged in a richly described case study to demonstrate the utility of computational modelling for primary care research. N = 259 people were subsampled from the Diamond database, one of the largest primary care depression cohort studies worldwide. A global measure of depressive symptoms (PHQ-9) and physical health (PCS-12) were assessed at 3, 6, 9, and 12 months and then annually for a total of 7 years. Eleven trajectories and 2 large-scale collective dynamics were identified, revealing that while depression is comorbid with poor physical health, chronic illness is often low dynamic and not always linked to depression. Also, some of the cases in the unhealthy and oscillator trends remain ill without much chance of improvement. Finally, childhood abuse, partner violence, and negative life events are greater amongst unhealthy trends. Computational modelling offers a major advance for health researchers to account for the diversity of primary care patients and for developing better prognostic models for team-based interdisciplinary care.
Castellani Brian; Griffiths Frances; Rajaram Rajeev; Gunn Jane
Journal of evaluation in clinical practice
2018
2018-12
<a href="http://doi.org/10.1111/jep.13042" target="_blank" rel="noreferrer noopener">10.1111/jep.13042</a>
Inferences from aggregated data.
Socioeconomic Factors; Demography; Data Collection; Data Analysis; Blacks; Statistical; Geographic Factors; Health Resource Utilization; Epidemiological Research; Bias (Research); Residence Characteristics; Emergency Service – Utilization
Jarjoura D
Academic Emergency Medicine
2003
2003-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/aemj.10.8.881" target="_blank" rel="noreferrer noopener">10.1197/aemj.10.8.881</a>
Predictors of nonattendance at the first newborn health supervision visit.
Adult; Female; Ohio; Socioeconomic Factors; Infant; Risk Factors; Sensitivity and Specificity; Age Factors; Outpatients; Hospitals; Patient Compliance; Appointments and Schedules; Confidence Intervals; Mothers; Human; Chi Square Test; Funding Source; Logistic Regression; Newborn; Models; Statistical; Record Review; Telephone; Predictive Research; Relative Risk; Adolescent Mothers; Infant Care; Marital Status; Maternal Age; Parity; Pediatric – Ohio; Ambulatory Care Facilities – Utilization; Child Health Services – Utilization; Physical Examination – In Infancy and Childhood
Specht E M; Bourguet C C
Clinical pediatrics
1994
1994-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/000992289403300504" target="_blank" rel="noreferrer noopener">10.1177/000992289403300504</a>
Aeroallergen sensitization in healthy children: racial and socioeconomic correlates.
Female; Male; Socioeconomic Factors; Incidence; Child; Risk Factors; Sensitivity and Specificity; Odds Ratio; Health Status; Probability; Confidence Intervals; Human; Adolescence; Logistic Regression; Case Control Studies; Immunization; Preschool; Population; Air Pollutants – Immunology; Allergens – Immunology; Hypersensitivity – Diagnosis; Hypersensitivity – Epidemiology; Hypersensitivity – Immunology; Respiratory Hypersensitivity – Diagnosis; Respiratory Hypersensitivity – Ethnology; Respiratory Hypersensitivity – Immunology; Skin Tests – Methods
Objective: Allergic sensitization is very prevalent and often precedes the development of allergic disease. This study examined the association of race with allergic sensitization among healthy children with no family history of atopy.Study Design: Two hundred seventy-five children, predominantly from lower socioeconomic strata, from Cincinnati, Ohio, ages 2 to 18 years without a family or personal history of allergic diseases, underwent skin prick testing to 11 allergen panels. The Pediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) was used to examine the impact of sensitization on quality of life.Results: Thirty-nine percent of healthy children were sensitized to 1 or more allergen panels. Multivariate logistic regression showed increased risk among African-American children for any sensitization (OR, 2.17; [95% CI: 1.23, 3.84]) and sensitization to any outdoor allergen (OR, 2.96 [95% CI: 1.52, 5.74]). Eighty-six percent of children had PADQLQ scores of 1 or less (0 to 6 scale).Conclusions: Allergic sensitization is prevalent even among children who do not have a personal or family history of asthma, allergic rhinitis, or atopic dermatitis and who have no evidence of current, even subtle effects from this sensitization on allergic disease-related quality of life. African-American children are at greater risk for presence of sensitization, especially to outdoor allergens.
Stevenson MD; Sellins S; Grube E; Schroer K; Gupta J; Wang N; Khurana Hershey GK; Stevenson Michelle D; Sellins Stacey; Grube Emilie; Schroer Kathy; Gupta Jayanta; Wang Ning; Khurana Hershey Gurjit K
Journal of Pediatrics
2007
2007-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jpeds.2007.03.001" target="_blank" rel="noreferrer noopener">10.1016/j.jpeds.2007.03.001</a>
The influence of family environment on dissociation in pediatric injury patients.
Female; Male; Ohio; Socioeconomic Factors; Child; Prospective Studies; Income; Self Report; Confidence Intervals; Family; Social Environment; Human; Semi-Structured Interview; Questionnaires; Chi Square Test; Descriptive Research; Descriptive Statistics; Funding Source; Scales; Correlational Studies; Data Analysis Software; Pretest-Posttest Design; Checklists; Adolescence; Pearson's Correlation Coefficient; Retrospective Design; Analysis of Covariance; Child Development; Bivariate Statistics; Severity of Illness Indices; Family Relations; Family Coping; Interview Guides; Parametric Statistics; Parenting Education; Patient-Family Relations; Dissociative Disorders – Risk Factors; Accidents – Adverse Effects; Wounds and Injuries – Complications
Nugent Nicole R; Sledjeski Eve M; Christopher Norman C; Delahanty Douglas L
Clinical Child Psychology & Psychiatry
2011
2011-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/1359104511406487" target="_blank" rel="noreferrer noopener">10.1177/1359104511406487</a>
Behaviors and Characteristics of African American and European American Females That Impact Weight Management.
Female; Socioeconomic Factors; Aged; Body Mass Index; Income; Exercise; Health Status; Dietary Fats; Fruit; Self Report; Demography; Psychosocial; Human; Questionnaires; Descriptive Statistics; Scales; Data Analysis Software; Comparative Studies; Middle Age; Coefficient Alpha; Confidence; Exploratory Research; Blacks; Whites; Support; Physical Activity; Women; Secondary Analysis; Race Factors; Body Weights and Measures; Eating Behavior; Energy Intake; Self-Efficacy; Vegetables; Weight Control; Health Behavior – Ethnology; Obesity – Risk Factors
This report explores the extent to which sociodemographic and psychosocial factors could explain differences in obesity or dietary and exercise behaviors between middle-aged African American (AA) and European American (EA) women seen in primary care. We focus on 'race × predictor' interactions that could explain how AA and EA women differ in ways that affect the prevalence of obesity. This comparative exploratory study uses data from the baseline examination of the Reasonable Eating and Activity to Change Health (REACH) trial, which included 173 AA women and 278 EA women. Inclusion criteria were membership in one of the study family medicine practices, an elevated body mass index (greater than 27 kg/m), age 40 to 69 years, and no contraindications to increased activity and dietary change. Secondary data analyses were employed. There was evidence of race differences in the level of multiple variables related to weight management but there were only three significant 'race × predictor' interactions out of 48 comparisons: (a) race × physical health, with BMI as the dependent variable; (b) race × the percentage of dietary fat, with total dietary kilocalories as the dependent variable; and (c) race × median income, with exercise minutes per week as the dependent variable. The results support the proposition that the weight management experience of AA and EA primary care women is similar after different exposure levels are taken into account. The results contribute to the body of literature that addresses obesity management for AA and EA women in primary care settings. Findings illustrate the need for obesity prevention and management efforts from both multidisciplinary primary care providers and community-wide public health interventions. AA and EA women have different resources, but the same factors generally influence weight management, whether one is AA or EA. This suggests that clinical interventions and public health interventions for AA and EA women can be designed around the same principles while paying attention to relevant cultural issues.
Capers Cynthia Flynn; Baughman Kristin; Logue Everett
Journal of Nursing Scholarship
2011
2011
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1547-5069.2011.01393.x" target="_blank" rel="noreferrer noopener">10.1111/j.1547-5069.2011.01393.x</a>
Stages of change analysis of smokers attending clinics for the medically underserved.
Adult; Humans; Male; Socioeconomic Factors; Surveys and Questionnaires; Prospective Studies; *Health Behavior; *Smoking Cessation/psychology/statistics & numerical data; Counseling; Medically Underserved Area; Models; Theoretical
OBJECTIVE: To determine whether smokers at clinics providing care for the medically underserved can be characterized according to the transtheoretical stages of change model. STUDY DESIGN: Prospective, descriptive study. POPULATION: Smokers in the waiting rooms of clinics providing care for the medically underserved. OUTCOMES MEASURED: Standardized questionnaires that assessed stages of change, processes of change, decisional balance, and self-efficacy and temptation. RESULTS: The smoking rate of subjects interviewed at 4 clinics was 44%. Two hundred current smokers completed the questionnaires. Smokers claiming that they planned to quit within 6 months scored higher on experiential process statements that are consistent with quitting smoking than did smokers who claimed they were not planning to quit within 6 months. They also scored higher on behavioral statements related to quitting. Concerns about the negative aspects of smoking were more important to smokers planning to quit than to smokers not planning to quit, whereas the statements assessing positive aspects of smoking were rated the same. Fifty-five percent of the smokers were smoking a pack or more each day and reported smoking more during negative situations and from habit than did smokers who smoked less than a pack a day. CONCLUSIONS: Smokers planning to quit who still smoke at least a pack a day may benefit from counseling to decrease smoking for specific reasons or from pharmacologic aids. Smokers at the clinics who planned to quit smoking reported experiences and behaviors that were consistent with their stated desire to quit and should be counseled in the same fashion as smokers from more traditional practices.
Gil Karen M; Schrop Susan Labuda; Kline Sarah C; Kimble Emily A; McCord Gary; McCormick Kenelm F; Gilchrist Valerie J
The Journal of Family Practice
2002
2002-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Use of Fine-scale Geospatial Units and Population Data to Evaluate Access to Emergency Care.
Adult; Female; Humans; *Censuses; *Travel; Geographic Information Systems/*instrumentation; Health Services Accessibility/*statistics & numerical data; Male; Middle Aged; Ohio; Regression Analysis; Socioeconomic Factors; Spatial Analysis; Time Factors; Odds Ratio; Confidence Intervals; Human; Surveys; Blacks; Hispanics; Regression; Emergency Service; Hospital/*statistics & numerical data; Census; Geographic Information Systems; Housing; Population Density; Emergency Care – Utilization – Ohio; Emergency Service – Utilization – Ohio
Introduction: Time to facility is a crucial element in emergency medicine (EM). Fine-scale geospatial units such as census block groups (CBG) and publicly available population datasets offer a low-cost and accurate approach to modeling geographic access to and utilization of emergency departments (ED). These methods are relevant to the emergency physician in evaluating patient utilization patterns, emergency medical services protocols, and opportunities for improved patient outcomes and cost utilization. We describe the practical application of geographic information system (GIS) and fine-scale analysis for EM using Ohio ED access as a case study. Methods: Ohio ED locations (n=198), CBGs (n=9,238) and 2015 United States Census five-year American Community Survey (ACS) socioeconomic data were collected July-August 2016. We estimated drive time and distance between population-weighted CBGs and nearest ED using ArcGIS and 2010 CBG shapefiles. We examined drive times vs. ACS characteristics using multinomial regression and mapping. Results: We categorized CBGs by centroid-ED travel time in minutes: \textless10 (73.4%; n=6,774), 10-30 (25.1%; n=2,315), and \textgreater30 (1.5%; n=141). CBGs with increased median age, Hispanic and non-Hispanic Black population, and college graduation rates had significantly decreased travel time. CBGs with increased low-income populations (adjusted odds ratio [AOR] [1.03], 95% confidence interval [CI] [1.01-1.04]) and vacant housing (AOR [1.06], 95% CI [1.05-1.08]) had increased odds of \textgreater30 minute travel time. Conclusion: Use of fine-scale geographic analysis and population data can be used to evaluate geographic accessibility and utilization of EDs. Methods described offer guidance to approaching questions of geographic accessibility and have numerous ED and pre-hospital applications.
Joyce Katherine M; Burke Ryan C; Veldman Thomas J; Beeson Michelle M; Simon Erin L
The western journal of emergency medicine
2018
2018-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.5811/westjem.2018.9.38957" target="_blank" rel="noreferrer noopener">10.5811/westjem.2018.9.38957</a>
Predictors of nonattendance at the first newborn health supervision visit.
*Infant; *Pediatrics; *Primary Prevention; *Treatment Refusal; 100 to 299; Adolescent; Adult; Female; Hospital Bed Capacity; Hospital/*statistics & numerical data; Humans; Mothers/psychology; Newborn; Ohio; Outpatient Clinics; Physical Examination; Risk Factors; Socioeconomic Factors
Failure to attend the first newborn health supervision visit is an important problem for the Continuity Care Clinic of Children's Hospital Medical Center of Akron, Ohio. The goal of this study was to use objective data from the neonatal record to identify newborns at high risk of failure to attend. Clinical and social risk factors of the mother and newborn were abstracted from the neonatal progress notes of 319 infants. The relative risk (RR) of nonattendance was calculated for each factor, and rules for predicting failure to attend were evaluated. The best predictors were multiparous mother (RR = 2.4, P = .01), no telephone in home (RR = 2.6, P = .002), and unmarried teenage mother (RR = 5.8, P = .05). Newborns who had a medical problem and had a adult mother were more likely to attend (RR = 0.4, P = .02). These risk factors were easily identifiable from the medical record at birth. Because interventions may be labor-intensive, it is important to target the families at the highest risk.
Specht E M; Bourguet C C
Clinical pediatrics
1994
1994-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/000992289403300504" target="_blank" rel="noreferrer noopener">10.1177/000992289403300504</a>
Perspective: medical students' perceptions of the poor: what impact can medical education have?
*Attitude of Health Personnel; *Education; *Empathy; *Prejudice; *Social Perception; Attitudes; Graduate; Health Knowledge; Humans; Medical; Medical/*psychology; Poverty/*psychology; Practice; Social Class; Socioeconomic Factors; Students; Undergraduate; United States
There is currently little knowledge or understanding of medical students' knowledge and attitudes toward the poor. Teaching hospitals bring students face-to-face with poor and uninsured patients on a regular basis. However, an overview of the research available suggests that this contact does not result in students' greater understanding and empathy for the plight of the poor and may, in fact, lead to an erosion of positive attitudes toward the poor. A basic understanding of justice suggests that as the poor are disproportionately the subjects of medical training, this population should enjoy a proportionate benefit for this service. Furthermore, medicine's social contract with the public is often thought to include an ideal of service to the underserved and a duty to help educate the general public regarding the health needs of our nation. In their discussion, the authors situate medical students' attitudes toward the poor within larger cultural perspectives, including attitudes toward the poor and attributions for poverty. They provide three suggestions for improving trainees' knowledge of and attitudes toward the poor-namely, increasing the socioeconomic diversity of students, promoting empathy through curricular efforts, and focusing more directly on role modeling. The authors argue that service learning, especially efforts that include gaining detailed knowledge of a particular person or persons, coupled with critical reflection, presents a very promising direction toward achieving these goals. Finally, they posit an agenda for future educational research that might contribute to the increased efficacy of medical education in this important formative domain.
Wear Delese; Kuczewski Mark G
Academic medicine : journal of the Association of American Medical Colleges
2008
2008-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/ACM.0b013e3181782d67" target="_blank" rel="noreferrer noopener">10.1097/ACM.0b013e3181782d67</a>
Associations between Difficulty Paying Medical Bills and Forgone Medical and Prescription Drug Care.
*Fees; *Health Expenditures; *Health Services Accessibility; *Patient Compliance; *Prescription Fees; Adult; Aged; Bisexuals; Cross-Sectional Studies; Debt; Drug; Family Health; Female; Financial; Health Status; Health Surveys; Homeless Persons; Humans; Male; Medical; Middle Aged; Ohio; Population Characteristics; Prescriptions; Socioeconomic Factors; Special Populations; Young Adult
Problems paying medical bills have been reported to be associated with increased stress, bankruptcy, and forgone medical care. Using the Behavioral Model for Vulnerable Populations developed by Gelberg et al as a framework, as well as data from the 2010 Ohio Family Health Survey, this study examined the relationships between difficulty paying medical bills and forgone medical and prescription drug care. Logistic regression was used to examine associations between difficulty paying medical bills and predisposing, enabling, need (health status), and health behaviors (forgoing medical care). Difficulty paying medical bills increased the effect of lack of health insurance in predicting forgone medical care and had a conditional effect on the association between education and forgone prescription drug care. Those who had less than a bachelor's degree were more likely to forgo prescription drug care than those with a bachelor's degree, but only if they had difficulty paying medical bills. Difficulty paying medical bills also accounted for the relationships between several population characteristics (eg, age, income, home ownership, health status) in predicting forgone medical and prescription drug care. Policies to cap out-of-pocket medical expenses may mitigate health disparities by addressing the impact of difficulty paying medical bills on forgone care.
Baughman Kristin R; Burke Ryan C; Hewit Michael S; Sudano Joseph J; Meeker James; Hull Sharon K
Population Health Management
2015
2015-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/pop.2014.0128" target="_blank" rel="noreferrer noopener">10.1089/pop.2014.0128</a>