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Journal of Foot and Ankle Research Jul 2022Ongoing colonisation produces inequity in healthcare delivery and inequality in healthcare outcomes for Aboriginal and Torres Strait Islander Peoples. As a consequence,... (Review)
Review
BACKGROUND
Ongoing colonisation produces inequity in healthcare delivery and inequality in healthcare outcomes for Aboriginal and Torres Strait Islander Peoples. As a consequence, within the domain of lower limb health, foot disease has severe impacts for First Nations Peoples. Central to developing culturally safe healthcare and driving positive foot health change for First Nations Peoples, is the need for health professionals to develop understanding of First Nations perspectives of foot health. The aim of this systematic review was to evaluate studies investigating Aboriginal and Torres Strait Islander Peoples' perceptions of foot and lower limb health.
METHODS
PubMeD, Ovid (Embase, Emcare, Medline), CINAHL, Informit Indigenous collection, and grey literature sources were searched to 23 July 2021. We included any published reports or studies that examined Aboriginal and Torres Strait Islander Peoples' perceptions of foot and lower limb health, or meanings of, or attitudes to, foot and lower limb health.
RESULTS
Four studies with a total of 1515 participants were included. Studies found that Aboriginal and Torres Strait Islander people self-assessed foot health with a demonstrated ability to perceive their feet as healthy relative to Western clinical measures of peripheral blood supply and neurological function. Footwear, including ill-fitting or lack of footwear was considered a contributing factor to reduced foot and lower limb health. Foot pain affected up to 60% of participants with up to 70% of foot pain untreated. Lack of access to culturally safe health care delivered by culturally capable health professionals was perceived to contribute to worse foot and lower limb health outcomes.
CONCLUSIONS
Aboriginal and Torres Strait Islander Peoples' perceptions of foot and lower limb health are influenced by multiple complex interrelated factors. The limited number of studies in this area indicates ongoing failings to consult First Nations Peoples regarding their own lower limb and foot health. It is therefore essential that healthcare service and cultural capability implementation is led by Aboriginal and Torres Strait Islander Peoples in co-design. Urgent need for further research that exemplifies design and delivery of culturally safe care is required.
Topics: Delivery of Health Care; Foot; Health Status; Humans; Lower Extremity; Native Hawaiian or Other Pacific Islander; Pain
PubMed: 35869536
DOI: 10.1186/s13047-022-00557-0 -
American Journal of Public Health Aug 2015We conducted a systematic review of published studies on stroke epidemiology in American Indians and Alaska Natives (AI/ANs). We used MeSH terms and strict inclusion... (Review)
Review
We conducted a systematic review of published studies on stroke epidemiology in American Indians and Alaska Natives (AI/ANs). We used MeSH terms and strict inclusion criteria to search PubMed, identifying a relevant sample of 57 refereed publications. We report a consensus view in which prevalent stroke is more common, and estimates of cerebrovascular risk factors are higher, among AI/ANs than among other US populations. Like other minority groups, AI/ANs suffer stroke at younger ages than do non-Hispanic Whites. However, data on AI/AN stroke mortality are significantly compromised by racial misclassification and nonrepresentative sampling. Studies correcting for these problems have found that stroke mortality rates among AI/ANs are among the highest of all US racial and ethnic groups. As with Black and non-Hispanic White stroke mortality, AI/AN stroke mortality varies by geographic region, with the highest rates in Alaska and the Northwest and the lowest in the Southwest. Our results underscore the need for a concerted national effort to collect accurate cross-sectional and longitudinal data on stroke in AI/ANs.
Topics: Alaska; Canada; Female; Humans; Incidence; Indians, North American; Male; Prevalence; Risk Factors; Stroke; United States
PubMed: 26066955
DOI: 10.2105/AJPH.2015.302698 -
Journal of Forensic and Legal Medicine Nov 2017Age estimation from dental developmental stages is considered comparatively more accurate, reliable and precise than other methods used in forensic sciences. Willems... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Age estimation from dental developmental stages is considered comparatively more accurate, reliable and precise than other methods used in forensic sciences. Willems method is the revised version of Demirjian method, based on modified dental maturity scores to estimate age of children in years for both the sexes.
AIMS
To test the applicability and accuracy level of Willems method of dental age estimation in diverse population samples by quantifying the variations between the chronological and estimated ages of an individual.
METHODOLOGY
A systematic search of online databases (Pubmed, Scopus, Embase, Medline, Trip and Web of Science) was performed for identifying the articles utilizing Willems dental maturity scaling method for age estimation in children. All the research articles published in peer-reviewed English language journals between 2001 and January 2017 were included for present systematic review and meta-analysis.
RESULTS
Out of the total 973 selected articles; thirty one studies were recruited for qualitative analysis and out of them, 15 studies were selected/identified for quantitative and meta-analysis. It was found that Willems method overestimates the age of children to a comparatively lesser extent (-0.04 and -0.02 years) than the Demirjian method (around six months).
CONCLUSION
Willems method of dental age estimation gives comparatively lesser overestimations of age than other methods reported in the available literature and is thus, accurate and reliable enough to be utilized for forensic purposes.
Topics: Age Determination by Teeth; Child; Ethnicity; Humans; Models, Statistical; Racial Groups; Radiography, Panoramic; Sex Characteristics
PubMed: 28918371
DOI: 10.1016/j.jflm.2017.08.017 -
EClinicalMedicine May 2023We estimate the effects of alcohol taxation, minimum unit pricing (MUP), and restricted temporal availability on overall alcohol consumption and review their... (Review)
Review
UNLABELLED
We estimate the effects of alcohol taxation, minimum unit pricing (MUP), and restricted temporal availability on overall alcohol consumption and review their differential impact across sociodemographic groups. Web of Science, Medline, PsycInfo, Embase, and EconLit were searched on 08/12/2022 and 09/26/2022 for studies on newly introduced or changed alcohol policies published between 2000 and 2022 (Prospero registration: CRD42022339791). We combined data using random-effects meta-analyses. Risk of bias was assessed using the Newcastle-Ottawa Scale. Of 1887 reports, 36 were eligible. Doubling alcohol taxes or introducing MUP (Int$ 0.90/10 g of pure alcohol) reduced consumption by 10% (for taxation: 95% prediction intervals [PI]: -18.5%, -1.2%; for MUP: 95% PI: -28.2%, 5.8%), restricting alcohol sales by one day a week reduced consumption by 3.6% (95% PI: -7.2%, -0.1%). Substantial between-study heterogeneity contributes to high levels of uncertainty and must be considered in interpretation. Pricing policies resulted in greater consumption changes among low-income alcohol users, while results were inconclusive for other socioeconomic indicators, gender, and racial and ethnic groups. Research is needed on the differential impact of alcohol policies, particularly for groups bearing a disproportionate alcohol-attributable health burden.
FUNDING
Research reported in this publication was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Award Number R01AA028009.
PubMed: 37256096
DOI: 10.1016/j.eclinm.2023.101996 -
BMC Public Health Aug 2022Leave events are a public health concern resulting in poorer health outcomes. In Australia, leave events disproportionally impact Aboriginal and Torres Strait Islander...
BACKGROUND
Leave events are a public health concern resulting in poorer health outcomes. In Australia, leave events disproportionally impact Aboriginal and Torres Strait Islander people. A systematic review was conducted to explore the causes of leave events among Aboriginal and Torres Strait Islander people and strategies to reduce them.
METHODS
A systematic review was conducted using Medline, Web of Science, Embase and Informit, a database with a strong focus on relevant Australian content. Additionally, we examined the references of the records included, and performed a manual search using Google, Google scholar and the Australia's National Institute for Aboriginal and Torres Strait Islander Health Research. Two independent reviewers screened the records. One author extracted the data and a second author reviewed it. To appraise the quality of the studies the Mixed Methods Appraisal Tool was used as well as the Aboriginal and Torres Strait Islander Quality Appraisal Tool. A narrative synthesis was used to report quantitative findings and an inductive thematic analysis for qualitative studies and reports.
RESULTS
We located 421 records. Ten records met eligibility criteria and were included in the systematic review. From those, four were quantitative studies, three were qualitative studies and three reports. Five records studied data from the Northern Territory, two from Western Australia, two from New South Whales and one from Queensland. The quantitative studies focused on the characteristics of the patients and found associations between leave events and male gender, age younger than 45 years and town camp residency. Qualitative findings yielded more in depth causes of leave events evidencing that they are associated with health care quality gaps. There were multiple strategies suggested to reduce leave events through adapting health care service delivery. Aboriginal and Torres Strait Islander representation is needed in a variety of roles within health care provision and during decision-making.
CONCLUSION
This systematic review found that multiple gaps within Australian health care delivery are associated with leave events among Aboriginal and Torres Strait Islander people. The findings suggest that reducing leave events requires better representation of Aboriginal and Torres Strait Islander people within the health workforce. In addition, partnership with Aboriginal and Torres Strait Islander people is needed during the decision-making process in providing health services that meet Aboriginal and Torres Strait Islander cultural needs.
Topics: Health Services, Indigenous; Health Workforce; Humans; Indigenous Peoples; Male; Native Hawaiian or Other Pacific Islander; Northern Territory; Qualitative Research
PubMed: 35927686
DOI: 10.1186/s12889-022-13896-1 -
BMJ (Clinical Research Ed.) Mar 2011To determine whether the ethnicity of UK trained doctors and medical students is related to their academic performance. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine whether the ethnicity of UK trained doctors and medical students is related to their academic performance.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Online databases PubMed, Scopus, and ERIC; Google and Google Scholar; personal knowledge; backwards and forwards citations; specific searches of medical education journals and medical education conference abstracts.
STUDY SELECTION
The included quantitative reports measured the performance of medical students or UK trained doctors from different ethnic groups in undergraduate or postgraduate assessments. Exclusions were non-UK assessments, only non-UK trained candidates, only self reported assessment data, only dropouts or another non-academic variable, obvious sampling bias, or insufficient details of ethnicity or outcomes. Results 23 reports comparing the academic performance of medical students and doctors from different ethnic groups were included. Meta-analyses of effects from 22 reports (n = 23,742) indicated candidates of "non-white" ethnicity underperformed compared with white candidates (Cohen's d = -0.42, 95% confidence interval -0.50 to -0.34; P<0.001). Effects in the same direction and of similar magnitude were found in meta-analyses of undergraduate assessments only, postgraduate assessments only, machine marked written assessments only, practical clinical assessments only, assessments with pass/fail outcomes only, assessments with continuous outcomes only, and in a meta-analysis of white v Asian candidates only. Heterogeneity was present in all meta-analyses.
CONCLUSION
Ethnic differences in academic performance are widespread across different medical schools, different types of exam, and in undergraduates and postgraduates. They have persisted for many years and cannot be dismissed as atypical or local problems. We need to recognise this as an issue that probably affects all of UK medical and higher education. More detailed information to track the problem as well as further research into its causes is required. Such actions are necessary to ensure a fair and just method of training and of assessing current and future doctors.
Topics: Education, Medical, Graduate; Education, Medical, Undergraduate; Educational Measurement; Educational Status; Humans; Prospective Studies; Racial Groups; Retrospective Studies; Students, Medical; United Kingdom
PubMed: 21385802
DOI: 10.1136/bmj.d901 -
Internal Medicine Journal Sep 2012Gout is a growing health problem worldwide especially in affluent countries, such as Australia. Gout and hyperuricaemia are associated with the metabolic syndrome,... (Review)
Review
AIMS
Gout is a growing health problem worldwide especially in affluent countries, such as Australia. Gout and hyperuricaemia are associated with the metabolic syndrome, diabetes mellitus, obesity and hypertension. More importantly, Australia has a growing prevalence of these important health problems. The aim of this study was to systematically review published information regarding the prevalence of gout and hyperuricaemia in Australia.
METHODS
A systematic search was undertaken of the MEDLINE, EMBASE and Web of Science databases, as well as relevant websites for journal articles and reports relating to the prevalence of hyperuricaemia and gout in Australia.
RESULTS
Twenty-five journal articles and five reports were included in the review. Data collected in a standardised way show gout increased in prevalence from 0.5% population prevalence to 1.7% population prevalence from 1968 to 1995/1996. There has been a significant rise in the prevalence of gout in the Australian Aboriginal population from 0% in 1965 to 9.7% in men and 2.9% in women in 2002. Consistent with the rise in gout prevalence, serum uric acid in blood donors has increased from 1959 to 1980 (17% in 30- to 40-year-old men).
CONCLUSIONS
The rate of gout and hyperuricaemia in Australia is high in relation to comparable countries and is increasing. The prevalence of gout in elderly male Australians is second only to New Zealand, which has the highest reported rate in the world. Further research on Aboriginal and Torres Strait Islander gout and hyperuricaemia is required as a result of the lack of contemporary data.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Australia; Blood Donors; Child; Europe; Female; Gout; Humans; Hyperuricemia; Male; Middle Aged; Native Hawaiian or Other Pacific Islander; Prevalence; Uric Acid; White People; Young Adult
PubMed: 24020339
DOI: 10.1111/j.1445-5994.2012.02794.x -
JAMA Internal Medicine Nov 2023Recent studies have demonstrated that people of color are more likely to be restrained in emergency department (ED) settings compared with other patients, but many of... (Comparative Study)
Comparative Study Meta-Analysis
IMPORTANCE
Recent studies have demonstrated that people of color are more likely to be restrained in emergency department (ED) settings compared with other patients, but many of these studies are based at a single site or health care system, limiting their generalizability.
OBJECTIVE
To synthesize existing literature on risk of physical restraint use in adult EDs, specifically in reference to patients of different racial and ethnic backgrounds.
DATA SOURCES
A systematic search of PubMed, Embase, Web of Science, and CINAHL was performed from database inception to February 8, 2022.
STUDY SELECTION
Included peer-reviewed studies met 3 criteria: (1) published in English, (2) original human participants research performed in an adult ED, and (3) reported an outcome of physical restraint use by patient race or ethnicity. Studies were excluded if they were conducted outside of the US, or if full text was unavailable.
DATA EXTRACTION AND SYNTHESIS
Four independent reviewers (V.E., M.M., D.D., and A.H.) abstracted data from selected articles following Meta-Analysis of Observational Studies in Epidemiology guidelines. A modified Newcastle-Ottawa scale was used to assess quality. A meta-analysis of restraint outcomes among minoritized racial and ethnic groups was performed using a random-effects model in 2022.
MAIN OUTCOME(S) AND MEASURE(S)
Risk of physical restraint use in adult ED patients by racial and ethnic background.
RESULTS
The search yielded 1597 articles, of which 10 met inclusion criteria (0.63%). These studies represented 2 557 983 patient encounters and 24 030 events of physical restraint (0.94%). In the meta-analysis, Black patients were more likely to be restrained compared with White patients (RR, 1.31; 95% CI, 1.19-1.43) and to all non-Black patients (RR, 1.27; 95% CI, 1.23-1.31). With respect to ethnicity, Hispanic patients were less likely to be restrained compared with non-Hispanic patients (RR, 0.85; 95% CI, 0.81-0.89).
CONCLUSIONS AND RELEVANCE
Physical restraint was uncommon, occurring in less than 1% of encounters, but adult Black patients experienced a significantly higher risk of physical restraint in ED settings compared with other racial groups. Hispanic patients were less likely to be restrained compared with non-Hispanic patients, though this observation may have occurred if Black patients, with a higher risk of restraint, were included in the non-Hispanic group. Further work, including qualitative studies, to explore and address mechanisms of racism at the interpersonal, institutional, and structural levels are needed.
Topics: Adult; Humans; Black or African American; Delivery of Health Care; Emergency Service, Hospital; Ethnicity; Hispanic or Latino; Restraint, Physical; White; Healthcare Disparities
PubMed: 37747721
DOI: 10.1001/jamainternmed.2023.4832 -
Cancer Causes & Control : CCC Nov 2019Lung cancer mortality has been shown to vary by race and ethnicity in cancer registries; however, studies often do not account for smoking status. We sought to summarize... (Meta-Analysis)
Meta-Analysis
PURPOSE
Lung cancer mortality has been shown to vary by race and ethnicity in cancer registries; however, studies often do not account for smoking status. We sought to summarize the independent contribution of race and ethnicity to survival in US lung cancer patients, accounting for important variables including smoking status.
METHODS
PubMed was used to identify 1,877 potentially eligible studies of which 27 were included. Studies were excluded if they did not account for age, race and/or ethnicity, and smoking status. Fixed- and random-effects meta-analyses were conducted using the reported adjusted hazard ratios (HR) of Hispanic ethnicity and Asian and African-American race compared to Non-Hispanic whites (NHWs) on overall survival in lung cancer.
RESULTS
Hispanic ethnicity and Asian race were associated with decreased adjusted risk of death (Hispanic: N = 5, N = 108,810, HR = 0.95, 95% CI 0.90-1.00; Asian: N = 6, N = 128,950, HR = 0.86, 95% CI 0.81-0.90). The results were similar when excluding studies of solely never-smokers. There was no significant difference in survival between African-American and white race after adjustment (N = 10, N = 131,378, HR = 0.98, 95% CI 0.96-1.01). Other prognostic factors were female gender (HR = 0.88, 95% CI 0.87-0.89), unmarried status (HR = 1.08, 95% CI 1.04-1.11), ever-smoking status (HR = 1.11, 95% CI 1.08-1.15), having comorbidities (HR = 1.39, 95% CI 1.24-1.56), and treatment receipt (surgery: HR = 0.33, 95% CI 0.32-0.34; radiation: HR = 0.87, 95% CI 0.85-0.88; chemotherapy: HR = 0.64, 95% CI 0.63-0.65).
CONCLUSIONS
Even after adjustment for clinical factors and smoking status, Hispanics and Asians experienced improved survival compared to NHWs. Future studies are needed to elucidate the drivers of these survival disparities.
Topics: Ethnicity; Humans; Lung Neoplasms; Racial Groups; Smoking; United States
PubMed: 31522320
DOI: 10.1007/s10552-019-01229-4 -
The Journal of Surgical Research May 2020The impact of social, racial, and economic inequities on health and surgical outcomes for children is poorly described.
BACKGROUND
The impact of social, racial, and economic inequities on health and surgical outcomes for children is poorly described.
METHODS
A systematic review using search terms related to disparities in care of pediatric appendicitis identified 20 titles and narrowed to 11 full texts. Nine retrospective studies were analyzed, representing 350,408 cases treated across the United States from 1983 to 2010. Outcomes included length of stay (LOS), appendiceal perforation rate (AP), laparoscopic versus open approach, and rate of misdiagnosis.
RESULTS
The most frequently reported outcomes were LOS (six of nine studies) and AP (six of nine studies). AP was higher for young children (48% for <6 versus 25% for >10), those in rural settings (42% versus 26% in urban settings), and patients receiving care at children's hospitals (35% versus 22% at nonchildren's hospitals). Longer LOS was associated with young age in three studies (2-5 d for age <10 y versus 1-3 d for age >11 y), race in four studies (1.5-3 d for African American children versus 1-2 d for other races), and lower family income in two studies (2-4 d versus 1-3 d for highest income). Inequitable use of laparoscopy, time to surgery, and rates of misdiagnosis were also reported to be associated with age and race.
CONCLUSIONS
Although limited, the existing literature suggests that social, racial, and economic inequalities impact management and outcomes in pediatric appendicitis. More studies are needed to better describe and mitigate disparities in the surgical care of children.
Topics: Black or African American; Age Factors; Appendectomy; Appendicitis; Child; Diagnostic Errors; Healthcare Disparities; Hospitals, Pediatric; Humans; Intestinal Perforation; Laparoscopy; Length of Stay; Rural Population; Socioeconomic Factors; Time-to-Treatment
PubMed: 31918329
DOI: 10.1016/j.jss.2019.12.018