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PloS One 2022Racial disparity in academia is a widely acknowledged problem. The quantitative understanding of racial-based systemic inequalities is an important step towards a more...
Racial disparity in academia is a widely acknowledged problem. The quantitative understanding of racial-based systemic inequalities is an important step towards a more equitable research system. However, because of the lack of robust information on authors' race, few large-scale analyses have been performed on this topic. Algorithmic approaches offer one solution, using known information about authors, such as their names, to infer their perceived race. As with any other algorithm, the process of racial inference can generate biases if it is not carefully considered. The goal of this article is to assess the extent to which algorithmic bias is introduced using different approaches for name-based racial inference. We use information from the U.S. Census and mortgage applications to infer the race of U.S. affiliated authors in the Web of Science. We estimate the effects of using given and family names, thresholds or continuous distributions, and imputation. Our results demonstrate that the validity of name-based inference varies by race/ethnicity and that threshold approaches underestimate Black authors and overestimate White authors. We conclude with recommendations to avoid potential biases. This article lays the foundation for more systematic and less-biased investigations into racial disparities in science.
Topics: Bias; Censuses; Ethnicity; Humans; Names; United States
PubMed: 35231059
DOI: 10.1371/journal.pone.0264270 -
BMC Health Services Research Nov 2022The implementation of person-centred care (PCC) is advocated worldwide. Stakeholders in charge of implementing PCC as a broad-scale change across the health care sector...
BACKGROUND
The implementation of person-centred care (PCC) is advocated worldwide. Stakeholders in charge of implementing PCC as a broad-scale change across the health care sector face two intertwined and complex challenges. First, making sense of PCC as an intervention with complex innovation characteristics and second, staging implementation of PCC by choosing appropriate implementation strategies. We aimed to explore one of these challenges by tracking, naming, specifying, and comparing which strategies and how strategies were enacted to support the implementation of more PCC in a real-world setting represented by one health care region in Sweden.
METHODS
A case study with seven embedded units at two organisational levels within a health care region was conducted from 2016 to 2019. Data were collected from three sources: activity logs, interviews, and written documents. Strategies were identified from all sources and triangulated deductively by name, definition, and cluster in line with the taxonomy Expert Recommendations for Implementing Change (ERIC) and specified according to recommendations by Proctor and colleagues as actor, action, action target, temporality, dose, outcome, and justification.
RESULTS
Four hundred thirteen activities were reported in logs, representing 43 discrete strategies identified in ERIC (n = 38), elsewhere (n = 1), or as emerging strategies (n = 4). The highest reported frequencies of discrete strategies were identified as belonging to two clusters: Train and educate stakeholders (40%) and Develop stakeholder interrelationships (38%). We identified a limited number of strategies belonging to the cluster Use evaluative and iterative strategies (4.6%) and an even smaller number of strategies targeting information to patients about the change initiative (0.8%). Most of the total dose of 11,076 person-hours in the 7 units was spent on strategies targeting health care professionals who provide PCC (81.5%) while the dose of strategies targeting support functions was 18.5%.
CONCLUSIONS
Our findings show both challenges and merits when strategies for implementation of PCC are conducted in a real-world setting. The results can be used to support and guide both scientists and practitioners in future implementation initiatives.
Topics: Humans; Self Care; Delivery of Health Care; Health Personnel; Patient-Centered Care; Sweden
PubMed: 36424611
DOI: 10.1186/s12913-022-08846-x -
North Carolina Medical Journal 2022Transgender youth face health disparities in suicidality, which have been exacerbated by the COVID-19 pandemic. Health care providers should advocate for upstream...
Transgender youth face health disparities in suicidality, which have been exacerbated by the COVID-19 pandemic. Health care providers should advocate for upstream interventions to reduce suicide disparities, including Medicaid expansion, family acceptance therapy, improved access to name and gender marker changes, continuation of telehealth, and creation of trauma-informed schools.
Topics: Adolescent; COVID-19; Humans; Pandemics; Suicidal Ideation; Transgender Persons; United States; Suicide Prevention
PubMed: 35504715
DOI: 10.18043/ncm.83.3.182 -
BMC Pediatrics Feb 2021Moderately-late preterm (MLP) children (gestational age [GA] 32-36 weeks) are followed-up within community services, which often use developmental milestones as...
BACKGROUND
Moderately-late preterm (MLP) children (gestational age [GA] 32-36 weeks) are followed-up within community services, which often use developmental milestones as indicators of delay. We aimed to examine associations of parental report of smiling-age and walking-age with developmental delay upon school entry for MLP and full-term children.
METHODS
This study regards a community-based cohort study, including 1241 children. Parent-reported smiling-age (n = 514) and walking-age (n = 1210) were recorded in preventive child healthcare. To determine developmental delay at school entry (at age 4) we used the Ages and Stages Questionnaire (ASQ) total and domain scores. We assessed the association of smiling-age and walking-age with dichotomized ASQ-scores, using logistic regression analyses.
RESULTS
For MLP children, each week later corrected smiling-age was associated with a relative increased likelihood of delays of 31, 43, 36 and 35% in the personal-social, problem-solving, gross motor and general developmental functioning, respectively. Each month later corrected walking-age was associated with a relative increased likelihood of delays of 10, 15 and 13% in the personal-social, gross motor and general developmental functioning, respectively. All corrected smiling-ages and walking-ages were within normal full-term ranges. For full-term children, we only found that later walking-age was associated with delays in the personal-social and gross motor domains.
CONCLUSIONS
Smiling-age and walking-age are associated with developmental delay in several domains for MLP and full-term children. Professionals could use these milestones to identify children that may benefit from closer monitoring of their development.
TRIAL REGISTRATION
Clinical Trial Registry name and registration number: controlled-trials.com , ISRCTN80622320 .
Topics: Child; Child Development; Child, Preschool; Cohort Studies; Developmental Disabilities; Humans; Infant; Infant, Newborn; Schools; Smiling; Walking
PubMed: 33596865
DOI: 10.1186/s12887-021-02548-9 -
The Journal of Clinical Endocrinology... Mar 2021As the number of transgender (trans) people (including those who are binary and/or nonbinary identified) seeking gender-affirming hormone therapy rises, endocrinologists... (Review)
Review
CONTEXT
As the number of transgender (trans) people (including those who are binary and/or nonbinary identified) seeking gender-affirming hormone therapy rises, endocrinologists are increasingly asked to assist with interpretation of laboratory tests. Many common laboratory tests such as hemoglobin, iron studies, cardiac troponin, and creatinine are affected by sex steroids or body size. We seek to provide a summary of the impact of feminizing and masculinizing hormone therapy on common laboratory tests and an approach to interpretation.
CASES
Case scenarios discussed include 1) hemoglobin and hematocrit in a nonbinary person undergoing masculinizing hormone therapy; 2) estimation of glomerular filtration rate in a trans woman at risk of contrast-induced nephropathy; 3) prostate-specific antigen (PSA) in a trans woman; and 4) chest pain in a trans man with a cardiac troponin concentration between the reported male and female reference ranges.
CONCLUSIONS
The influence of exogenous gender-affirming hormone therapy on fat and muscle distribution and other physiological changes determines interpretation of laboratory tests that have sex-specific differences. In addition to affirmative practice to ensure a patient's name, gender, and pronoun are used appropriately, we propose that once individuals have commenced gender-affirming hormone therapy, the reference range of the affirmed gender be reported (and specified by treating clinicians) except for PSA or cardiac troponin, which are dependent on organ size. While suggestions may be challenging to implement, they also represent an opportunity to lead best practice to improve the quality of care and experiences of healthcare for all trans people.
Topics: Adult; Aged; Artifacts; Clinical Laboratory Techniques; Diagnosis, Differential; Diagnostic Techniques, Endocrine; Female; Heart Function Tests; Hormone Replacement Therapy; Humans; Kidney Function Tests; Male; Middle Aged; Reference Values; Sex Reassignment Procedures; Transgender Persons; Transsexualism
PubMed: 32810277
DOI: 10.1210/clinem/dgaa546 -
Annals of Family Medicine 2021At age 11, my child Neo told me he was a boy and not a girl, as assigned at birth. Despite my training as a child and adolescent psychiatrist, I struggled to accept his...
At age 11, my child Neo told me he was a boy and not a girl, as assigned at birth. Despite my training as a child and adolescent psychiatrist, I struggled to accept his declaration and had to learn how to best support him. He was never a typical girl, but when he decided he was transgender, my husband and I navigated the adjustment to new pronouns, a name change, the transition at school, and telling friends and family. Seeing Neo's sadness and despondency when he was not accepted sparked me to educate myself about medical options for transgender individuals and other ways to be gender affirming. Although I initially felt a sense of loss and hurt about Neo being transgender, these feelings changed to acceptance and pride as I watched Neo change and grow. Neo taught me to challenge societal dichotomies and taught me about how physicians in particular can support families with gender-creative children.
Topics: Adolescent; Child; Female; Friends; Gender Identity; Humans; Infant, Newborn; Male; Parenting; Physicians; Transgender Persons
PubMed: 34750131
DOI: 10.1370/afm.2737 -
Journal of the American Medical... Jan 2022There are over 1 million transgender people living in the United States, and 33% report negative experiences with a healthcare provider, many of which are connected to...
There are over 1 million transgender people living in the United States, and 33% report negative experiences with a healthcare provider, many of which are connected to data representation in electronic health records (EHRs). We present recommendations and common pitfalls involving sex- and gender-related data collection in EHRs. Our recommendations leverage the needs of patients, medical providers, and researchers to optimize both individual patient experiences and the efficacy and reproducibility of EHR population-based studies. We also briefly discuss adequate additions to the EHR considering name and pronoun usage. We add the disclaimer that these questions are more complex than commonly assumed. We conclude that collaborations between local transgender and gender-diverse persons and medical providers as well as open inclusion of transgender and gender-diverse individuals on terminology and standards boards is crucial to shifting the paradigm in transgender and gender-diverse health.
Topics: Data Collection; Electronic Health Records; Gender Identity; Humans; Reproducibility of Results; Transgender Persons; United States
PubMed: 34486655
DOI: 10.1093/jamia/ocab136 -
Cureus Apr 2024Introduction Due to the COVID-19 pandemic, the American Association of Medical Colleges (AAMC) recommended that all interviews for residencies and fellowships be...
Introduction Due to the COVID-19 pandemic, the American Association of Medical Colleges (AAMC) recommended that all interviews for residencies and fellowships be conducted in a virtual format. As of March 2024, the Society of Maternal-Fetal Medicine (SMFM) continues to request that all fellowship interviews occur virtually. Without in-person interviews, prospective Maternal-Fetal Medicine (MFM) fellowship applicants must largely rely on program websites to gain insight into each program's offerings, culture, and application requirements. The purpose of this study was to evaluate the content of American College of Graduate Medical Education (ACGME)-accredited Maternal-Fetal Medicine (MFM) fellowship program websites and assess if regional differences exist among website content. Methods All ACGME-accredited MFM fellowship program websites were assessed for 21 defined criteria as of March 2024 and further compared by geographic regions (Midwest, Northeast, South, and West). Analyses were completed using chi-squared univariate tests, with a p < 0.05. Results Of the 108 accredited MFM fellowship programs, 106 programs had a dedicated website (98.15%). Most MFM programs (over 80%) included contact information (102/106), program director name (98/106), faculty names (95/106), application requirements (92/106), current fellow names (91/106), and the program coordinator name (89/106) on their website. Less programs (less than 30%) included diversity, equity, inclusion (DEI) content (28/106), interview dates (28/106), and current fellow research projects or publications (27/106). Western programs were less likely to include the program coordinator's name (12/18 (67%), p = 0.046), but more likely to include DEI content (10/18 (56%), p = 0.005). Northeastern programs were less likely to include their application requirements (24/32 (75%), p = 0.049) and less likely to include pictures of their current fellows (20/32 (63%), p = 0.045). Southern programs were more likely to include the yearly rotation schedule (19/32 (59%), p = 0.040). Midwestern programs were more likely to include information on fellowship benefits or salary (15/24 (63%), p = 0.046). Conclusion This study demonstrated that the content available on MFM fellowship websites varies greatly between programs and geographic regions. Efforts should be made by MFM training institutions to enhance website DEI content, curriculum information, recent fellow publications, and information on program alumni. A detailed and well-structured website may help applicants compare individual programs more equitably in the age of virtual interviewing.
PubMed: 38884023
DOI: 10.7759/cureus.58527 -
Journal of the American Medical... Apr 2020The disjointed healthcare system and the nonexistence of a universal patient identifier across systems necessitates accurate record linkage (RL). We aim to describe the...
OBJECTIVE
The disjointed healthcare system and the nonexistence of a universal patient identifier across systems necessitates accurate record linkage (RL). We aim to describe the implementation and evaluation of a hybrid record linkage method in a statewide surveillance system for congenital heart disease.
MATERIALS AND METHODS
Clear-text personally identifiable information on individuals in the Colorado Congenital Heart Disease surveillance system was obtained from 5 electronic health record and medical claims data sources. Two deterministic methods and 1 probabilistic RL method using first name, last name, social security number, date of birth, and house number were initially implemented independently and then sequentially in a hybrid approach to assess RL performance.
RESULTS
16 480 nonunique individuals with congenital heart disease were ascertained. Deterministic linkage methods, when performed independently, yielded 4505 linked pairs (consisting of 2 records linked together within or across data sources). Probabilistic RL, using 3 initial characters of last name and gender for blocking, yielded 6294 linked pairs when executed independently. Using a hybrid linkage routine resulted in 6451 linkages and an additional 18%-24% correct linked pairs as compared to the independent methods. A hybrid linkage routine resulted in higher recall and F-measure scores compared to probabilistic and deterministic methods performed independently.
DISCUSSION
The hybrid approach resulted in increased linkage accuracy and identified pairs of linked record that would have otherwise been missed when using any independent linkage technique.
CONCLUSION
When performing RL within and across disparate data sources, the hybrid RL routine outperformed independent deterministic and probabilistic methods.
Topics: Adolescent; Adult; Algorithms; Colorado; Electronic Health Records; Heart Defects, Congenital; Humans; Medical Record Linkage; Population Surveillance; Probability
PubMed: 32049329
DOI: 10.1093/jamia/ocz232 -
The Modern Hearing Care Landscape: Toward the Provision of Personalized, Dynamic, and Adaptive Care.Seminars in Hearing Aug 2023New technologies and developments in hearing healthcare are rapidly transforming service models, delivery channels, and available solutions. These advances are reshaping... (Review)
Review
New technologies and developments in hearing healthcare are rapidly transforming service models, delivery channels, and available solutions. These advances are reshaping the ways in which care is provided, leading to greater personalization, service efficiencies, and improved access to care, to name a few benefits. Connected hearing care is one model with the potential to embrace this "customized" hearing experience by forging a hybrid of health-technology connections, as well as traditional face-to-face interactions between clients, providers, and persons integral to the care journey. This article will discuss the many components of connected care, encompassing variations of traditional and teleaudiology-focused services, clinic-based and direct-to-consumer channels, in addition to the varying levels of engagement and readiness defining the touch points for clients to access a continuum of connected hearing care. The emerging hearing healthcare system is one that is dynamic and adaptive, allowing for personalized care, but also shifting the focus to the client's needs and preferences. This shift in the care model, largely driven by innovation and the growing opportunities for clients to engage with hearing technology, brings forth new, exciting, and sometimes uncomfortable discussion points for both the provider and client. The modern hearing care landscape benefits clients to better meet their needs and preferences in a more personalized style, and providers to better support and address those needs and preferences.
PubMed: 37484984
DOI: 10.1055/s-0043-1769621