RESUMO
In this case study, we aim to understand how health departments in 5 US jurisdictions addressed health inequities and implemented strategies to reach populations disproportionately affected by COVID-19 during the initial Omicron variant period. We used qualitative methods to examine health department experiences during the initial Omicron surge, from November 2021 to April 2022, assessing successful interventions, barriers, and lessons learned from efforts to promote health equity. Our findings indicate that government leadership supported prioritizing health equity from the beginning of the pandemic, seeing it as a need and vital part of the response framework. All jurisdictions acknowledged the historical trauma and distrust of the government. Health departments found that collaborating and communicating with trusted community leaders helped mitigate public distrust. Having partnerships, resources, and infrastructure in place before the pandemic facilitated the establishment of equity-focused COVID-19 response activities. Finally, misinformation about COVID-19 was a challenge for all jurisdictions. Addressing the needs of diverse populations involves community-informed decisionmaking, diversity of thought, and delivery measures that are tailored to the community. It is imperative to expand efforts to reduce and eliminate health inequities to ensure that individuals and communities recover equitably from the effects of COVID-19.
Assuntos
COVID-19 , Equidade em Saúde , Humanos , Porto Rico , New Jersey , Cidade de Nova Iorque , SARS-CoV-2 , Ilhas Virgens Americanas , Promoção da SaúdeRESUMO
Racial and ethnic disparities in genetic awareness (GA) can diminish the impact of personalized cancer treatment and risk assessment. We assessed factors predictive of GA in a diverse population-based sample to inform awareness strategies and reduce disparities in genetic testing. METHODS: A cross-sectional study was conducted from July 2019 to August 2019, with the survey e-mailed to 7,575 adult residents in southeastern Pennsylvania and New Jersey. Constructs from National Cancer Institute Health Information and National Trends Survey assessed cancer attitudes or beliefs, health literacy, and numeracy. Characteristics were summarized with mean ± standard deviation for numeric variables and frequency counts and percentages for categorical variables. Comparison of factors by race or ethnicity (non-Hispanic White and non-Hispanic Black) and sex was conducted by t-tests, chi-square, or Fisher's exact tests. Multivariate logistic regression models were conducted to identify factors independently predictive of GA. RESULTS: Of 1,557 respondents, data from 940 respondents (the mean age was 45 ± 16.2 years, 35.5% males, and 23% non-Hispanic Blacks) were analyzed. Factors associated with higher GA included female gender (P < .001), non-Hispanic White (P < .001), college education (P < .001), middle-higher income (P < .001), stronger belief in genetic basis of cancer (P < .001), lower cancer fatalism (P = .004), motivation for cancer information (P < .001), and higher numeracy (P = .002). On multivariate analysis, college education (odds ratio [OR] 1.79; 95% CI, 1.22 to 2.63), higher motivation for cancer information (OR 1.56; 95% CI, 1.17 to 2.09), stronger belief in genetics of cancer (OR 2.21; 95% CI, 1.48 to 3.30), and higher medical literacy (OR 2.21; 95% CI, 1.34 to 3.65) predicted greater GA. CONCLUSION: This population-based study conducted in the precision medicine era identified novel modifiable factors, importantly perceptions of cancer genetics and medical literacy, as predictive of GA, which informs strategies to promote equitable engagement in genetically based cancer care.
Assuntos
Testes Genéticos/métodos , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde/métodos , Disparidades nos Níveis de Saúde , Adulto , Estudos Transversais , Detecção Precoce de Câncer/psicologia , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Testes Genéticos/estatística & dados numéricos , Letramento em Saúde/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Pessoa de Meia-Idade , New Jersey/etnologia , Pennsylvania/etnologia , Medicina de Precisão/tendências , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Our aim was to examine differences in clinical outcomes between Hispanic subgroups who underwent emergency general surgery (EGS). METHODS: Retrospective cohort study of the HCUP State Inpatient Database from New Jersey (2009-2014), including Hispanic and non-Hispanic White (NHW) adult patients who underwent EGS. Multivariable analyses were performed on outcomes including 7-day readmission and length of stay (LOS). RESULTS: 125,874 patients underwent EGS operations. 22,971 were Hispanic (15,488 with subgroup defined: 7,331 - Central/South American; 4,254 - Puerto Rican; 3,170 - Mexican; 733 - Cuban). On multivariable analysis, patients in the Central/South American subgroup were more likely to be readmitted compared to the Mexican subgroup (OR 2.02; p < 0.001, respectively). Puerto Rican and Central/South American subgroups had significantly shorter LOS than Mexican patients (Puerto Rico -0.58 days; p < 0.001; Central/South American -0.30 days; p = 0.016). CONCLUSIONS: There are significant differences in EGS outcomes between Hispanic subgroups. These differences could be missed when data are aggregated at Hispanic ethnicity.
Assuntos
Tratamento de Emergência/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto , Idoso , América Central/etnologia , Cuba/etnologia , Bases de Dados Factuais , Tratamento de Emergência/mortalidade , Feminino , Cirurgia Geral/estatística & dados numéricos , Hispânico ou Latino/classificação , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , México/etnologia , Pessoa de Meia-Idade , Análise Multivariada , New Jersey , Readmissão do Paciente/estatística & dados numéricos , Porto Rico/etnologia , Estudos Retrospectivos , América do Sul/etnologia , Procedimentos Cirúrgicos Operatórios/mortalidadeRESUMO
OBJECTIVE: To characterize the demographic and clinical features of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) syndromes and identify admission variables predictive of disease severity. STUDY DESIGN: We conducted a multicenter, retrospective, and prospective study of pediatric patients hospitalized with acute SARS-CoV-2 infections and multisystem inflammatory syndrome in children (MIS-C) at 8 sites in New York, New Jersey, and Connecticut. RESULTS: We identified 281 hospitalized patients with SARS-CoV-2 infections and divided them into 3 groups based on clinical features. Overall, 143 (51%) had respiratory disease, 69 (25%) had MIS-C, and 69 (25%) had other manifestations including gastrointestinal illness or fever. Patients with MIS-C were more likely to identify as non-Hispanic black compared with patients with respiratory disease (35% vs 18%, P = .02). Seven patients (2%) died and 114 (41%) were admitted to the intensive care unit. In multivariable analyses, obesity (OR 3.39, 95% CI 1.26-9.10, P = .02) and hypoxia on admission (OR 4.01; 95% CI 1.14-14.15; P = .03) were predictive of severe respiratory disease. Lower absolute lymphocyte count (OR 8.33 per unit decrease in 109 cells/L, 95% CI 2.32-33.33, P = .001) and greater C-reactive protein (OR 1.06 per unit increase in mg/dL, 95% CI 1.01-1.12, P = .017) were predictive of severe MIS-C. Race/ethnicity or socioeconomic status were not predictive of disease severity. CONCLUSIONS: We identified variables at the time of hospitalization that may help predict the development of severe SARS-CoV-2 disease manifestations in children and youth. These variables may have implications for future prognostic tools that inform hospital admission and clinical management.
Assuntos
COVID-19/epidemiologia , Hospitalização , Índice de Gravidade de Doença , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Adolescente , Biomarcadores/análise , Proteína C-Reativa/análise , COVID-19/sangue , Criança , Pré-Escolar , Connecticut/epidemiologia , Feminino , Humanos , Hipóxia/epidemiologia , Lactente , Unidades de Terapia Intensiva , Contagem de Linfócitos , Masculino , Análise Multivariada , New Jersey/epidemiologia , New York/epidemiologia , Obesidade Infantil/epidemiologia , Pró-Calcitonina/sangue , Estudos Prospectivos , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/sangue , Troponina/sangue , Adulto JovemRESUMO
BACKGROUND: Residential histories linked to cancer registry data provide new opportunities to examine cancer outcomes by neighborhood socioeconomic status (SES). We examined differences in regional stage colon cancer survival estimates comparing models using a single neighborhood SES at diagnosis to models using neighborhood SES from residential histories. METHODS: We linked regional stage colon cancers from the New Jersey State Cancer Registry diagnosed from 2006 to 2011 to LexisNexis administrative data to obtain residential histories. We defined neighborhood SES as census tract poverty based on location at diagnosis and across the follow-up period through 31 December 2016 based on residential histories (average, time-weighted average, time-varying). Using Cox proportional hazards regression, we estimated associations between colon cancer and census tract poverty measurements (continuous and categorical), adjusted for age, sex, race/ethnicity, regional substage, and mover status. RESULTS: Sixty-five percent of the sample was nonmovers (one census tract); 35% (movers) changed tract at least once. Cases from tracts with >20% poverty changed residential tracts more often (42%) than cases from tracts with <5% poverty (32%). Hazard ratios (HRs) were generally similar in strength and direction across census tract poverty measurements. In time-varying models, cases in the highest poverty category (>20%) had a 30% higher risk of regional stage colon cancer death than cases in the lowest category (<5%) (95% confidence interval [CI] = 1.04, 1.63). CONCLUSION: Residential changes after regional stage colon cancer diagnosis may be associated with a higher risk of colon cancer death among cases in high-poverty areas. This has important implications for postdiagnostic access to care for treatment and follow-up surveillance. See video abstract: http://links.lww.com/EDE/B705.
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Neoplasias do Colo , Disparidades nos Níveis de Saúde , Áreas de Pobreza , Características de Residência , Neoplasias do Colo/epidemiologia , Humanos , New Jersey/epidemiologia , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos , Análise de SobrevidaRESUMO
CONTEXT: A key component of the improvement of public health infrastructure in the United States revolves around public health workforce development and training. Workforce challenges faced by the public health system have long been recognized, but there are additional challenges facing any region-wide or cross-jurisdictional effort to accurately assess priority workforce training needs and develop training resources to address those needs. These challenges include structural variability of public health organizations; diverse population health contexts; capturing both topic-specific skill sets and foundational competencies among public health workers; and reaching/representing the target population despite suspicion, disinterest, and/or assessment "fatigue" among employees asked to participate in workforce development surveys. OBJECTIVE: The purpose of this article is to describe the challenges, strategies to meet those challenges, and lessons learned conducting public health workforce training needs assessments by academic and practice partners of the Region 2 Public Health Training Center (R2/PHTC). SETTING AND PARTICIPANTS: The R2/PHTC is hosted by the Mailman School of Public Health at Columbia University and serves New York, New Jersey, Puerto Rico, and the US Virgin Islands within its jurisdiction. RESULTS: Strategies for responding to diverse organizational structures and population health contexts across the region; defining training priorities that address both foundational competencies for public health professionals and content-specific training to address local public health needs; reaching/representing target populations of public health workers; and analysis and report writing to encourage rapid response to identified needs and comprehensive workforce development planning are discussed. Lessons learned are likely instructive to other workforce training needs assessments in complex and ever-changing public health environments.
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Assistência à Saúde Culturalmente Competente/métodos , Avaliação das Necessidades/estatística & dados numéricos , Saúde Pública/educação , Recursos Humanos/tendências , Assistência à Saúde Culturalmente Competente/tendências , Humanos , New Jersey , New York , Saúde Pública/métodos , Saúde Pública/tendências , Porto Rico , Desenvolvimento de Pessoal/métodos , Inquéritos e Questionários , Ilhas Virgens AmericanasRESUMO
Decrease coincides with national trends and public reporting of nurse staffing levels.
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Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Admissão e Escalonamento de Pessoal , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Humanos , New Jersey , Segurança do PacienteAssuntos
Hispânico ou Latino , Melanoma/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Neoplasias Cutâneas/diagnóstico , Mídias Sociais , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Melanoma/secundário , New Jersey , Porto Rico/etnologia , Neoplasias Cutâneas/patologiaRESUMO
Identifying animals as sentinels for humans and other animal species is an excellent method for understanding exposure to environmental contamination at different times and places. Shorebirds are useful sentinels because they have a world-wide distribution, eat a range of prey, and are eaten by a range of other species, including humans. We collected blood from semipalmated sandpipers (Calidris pusilla) wintering in northern (Suriname Nâ¯=â¯71) and northeastern (Brazil Nâ¯=â¯61) South America to examine levels of heavy metals and metalloids (arsenic, selenium), and compare them to blood levels in sandpipers at a heavily used stopover site in New Jersey (Nâ¯=â¯30; Delaware Bay, NJ). Since blood represents relatively recent exposure, it can provide information on where and when the birds were exposed. Levels were highest in Brazil for arsenic and particularly selenium; highest in Suriname for cadmium and lead; and highest in New Jersey for chromium. Samples from Brazil and Suriname presented higher levels of mercury than did those from New Jersey. There were no geographic differences for cobalt. Levels of all metals were generally within an order of magnitude. The significant geographic difference for selenium was interesting because it is regulated in the body. Selenium levels in the NJ sample were directly proportional to levels found in their principle food at this migration stopover site (eggs of horseshoe crab, Limulus polyphemus). Mean selenium level was almost an order of magnitude higher in the semipalmated sandpiper blood samples from Brazil (mean of 27,500⯵g/L= ppb) compared to the other sampling locations (mean > 5330⯵g/L). This is a toxic level and cause for concern and further investigation, alerting us to look for other evidence of excess selenium exposure. Otherwise the levels of other metals are generally not high enough to cause harm to the sandpipers themselves or to predators that eat them. We discuss the implications for these birds and their exposure to contaminants at different stopover sites.