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Environmental Research Dec 2023Understanding how environmental and social stressors cluster is critical to explaining and addressing health disparities. It remains unclear how these stressors cluster...
OBJECTIVES
Understanding how environmental and social stressors cluster is critical to explaining and addressing health disparities. It remains unclear how these stressors cluster at fine spatial resolution in low to medium-income, urban households. We explored patterns of environmental and social exposures at the household-level and potential predictors of these joint exposures in two environmental justice communities in the Greater Boston area.
METHODS
We recruited 150 households in Chelsea, MA and the Dorchester neighborhood of Boston, MA, between 2016 and 2019 and collected data on two domains: environmental and social stressor. For each domain, we fit Latent Class Analysis (LCA) models to exposure data to assess intra-domain variability, and cross-classified the resultant classes to identify joint exposure profiles. We compared differences in the distribution of these profiles by participants' demographic and household characteristics using χ2, Fisher's exact, Analysis of Variance, and Kruskal-Wallis tests.
RESULTS
We identified two latent classes in each domain: High environmental (n = 90; 60.4%), Low environmental (n = 59; 39.6%), High Social (n = 31; 20.8%), and Low Social (n = 118; 79.2%). Cross-classification yielded four joint exposure profiles: Both Low (n = 46, 30.9%); Both High (n = 18, 12.1%); High environmental-Low Social (n = 72, 48.3%); and Low environmental-High Social (n = 13, 8.7%). Significant group differences were found by housing type (e.g., single-family vs. multi-family) (Fisher's exact p = 0.0016), housing tenure (p = 0.0007), and study site (p < 0.0001). We also observed differences by race/ethnicity, income, and education: households that were Hispanic/Latinx, below the poverty level, and with lower education were more likely to be in the Both High group.
CONCLUSIONS
Our analyses confirmed that environmental and social stressors cluster in socially disadvantaged households. Housing type, housing tenure, and location of the residence were also strong predictors of cluster membership, with renter and multi-family residents at risk of high exposures to environmental and social stressors.
Topics: Humans; Boston; Housing; Poverty; Family Characteristics; Residence Characteristics; Environmental Exposure
PubMed: 37689339
DOI: 10.1016/j.envres.2023.117104 -
Joint Commission Journal on Quality and... Sep 2018Diversity in hospital leadership is often valued as important for achieving clinical excellence. The American Hospital Association surveyed hospitals about their actions...
BACKGROUND
Diversity in hospital leadership is often valued as important for achieving clinical excellence. The American Hospital Association surveyed hospitals about their actions to identify and address health disparities. The survey asked about the degree of representation of racial and ethnic minorities and women among executives and board members.
METHODS
The survey contained 78 items in four domains: Leadership and Strategic Planning, Workforce, Data Collection, and Reducing Disparities. All items were standardized and pooled within each domain to construct four variables. Logistic regression models were used to assess the difference in domain scores, for each domain, between hospitals with (a) high and low representation of people of color in the C-suite, (b) high and low representation of women in the corporate (C-) suite, (c) high and low representation of people of color on the board, and (d) high and low representation of women on the board.
RESULTS
Hospitals with more diverse boards with respect to race and ethnicity had significantly higher scores for all domains, indicating that these hospitals were pursuing substantially more strategies in all domains. In contrast, more racially and ethnically diverse executive suites were associated only with the Data Collection domain, while hospitals with a higher percentage of women in executive positions had lower scores for all domains except Data Collection.
CONCLUSION
Hospitals with greater representation of racial and ethnic minorities in leadership positions had greater commitments to diversity initiatives. However, hospitals with women-particularly white women-in leadership positions reported fewer diversity initiatives. Future research is needed to examine the mechanisms and causality behind these associations.
Topics: Cultural Diversity; Ethnicity; Health Equity; Hospital Administrators; Hospital Bed Capacity; Humans; Leadership; Ownership; Racial Groups; Residence Characteristics; Sex Distribution
PubMed: 30166038
DOI: 10.1016/j.jcjq.2018.03.008 -
The Senior Care Pharmacist Dec 2022Patient Priorities Care (PPC) aims to identify and integrate patient goals and preferences into health care decision-making to provide more personalized care for... (Observational Study)
Observational Study
Patient Priorities Care (PPC) aims to identify and integrate patient goals and preferences into health care decision-making to provide more personalized care for multimorbid older individuals. Home-based primary care (HBPC) is a model of care delivery that supports aging in place. HBPC-integrated pharmacists can identify patient priorities and communicate with the team to ensure care is aligned with what matters most. Evaluate patients' perceptions of having priorities identification conversations with the pharmacist; identify the value domains represented by patients' health outcome goals. HBPC program at a large family medicine practice where pharmacists are core members of the interdisciplinary team. Pharmacists led priorities identification conversations for patients newly enrolled in HBPC. Care preferences and health outcome goals were documented in the medical record and communicated during HBPC team meetings. This was a prospective, observational study of HBPC enrollees. After the priorities identification conversation, a three-question survey was administered to identify patients' perceptions of the conversation and interaction with the pharmacist. Health outcome goals and care preference statements were reviewed to determine with which value domain(s) they most aligned. Descriptive statistics were used for results analysis. Pharmacists led conversations with 30 participants. Average overall satisfaction with the conversation was 4.6 on a 5-point Likert scale (1 = least, 5 = most satisfied). Ninety-three percent of patients felt it was appropriate to have a pharmacist lead these conversations. Ninety-seven percent believed it was important/very important to discuss their values and goals with their health care team. The predominant value domains represented were Managing Health (43%) and Functioning (40%). Patients were mostly satisfied with having PPC conversations and felt it was appropriate for a pharmacist to lead these conversations. Managing health conditions and preserving function were the most frequent value domains associated with patients' goals and care preferences.
Topics: Humans; Aged; Pharmacists; Prospective Studies; Independent Living; Communication; Primary Health Care
PubMed: 36461137
DOI: 10.4140/TCP.n.2022.631 -
BMC Public Health May 2022Micro-level statistics on child undernutrition are highly prioritized by stakeholders for measuring and monitoring progress on the sustainable development goals. In this...
Micro-level statistics on child undernutrition are highly prioritized by stakeholders for measuring and monitoring progress on the sustainable development goals. In this regard district-representative data were collected in the Bangladesh Multiple Indicator Cluster Survey 2019 for identifying localised disparities. However, district-level estimates of undernutrition indicators - stunting, wasting and underweight - remain largely unexplored. This study aims to estimate district-level prevalence of these indicators as well as to explore their disparities at sub-national (division) and district level spatio-demographic domains cross-classified by children sex, age-groups, and place of residence. Bayesian multilevel models are developed at the sex-age-residence-district level, accounting for cross-sectional, spatial and spatio-demographic variations. The detailed domain-level predictions are aggregated to higher aggregation levels, which results in numerically consistent and reasonable estimates when compared to the design-based direct estimates. Spatio-demographic distributions of undernutrition indicators indicate south-western districts have lower vulnerability to undernutrition than north-eastern districts, and indicate significant inequalities within and between administrative hierarchies, attributable to child age and place of residence. These disparities in undernutrition at both aggregated and disaggregated spatio-demographic domains can aid policymakers in the social inclusion of the most vulnerable to meet the sustainable development goals by 2030.
Topics: Bangladesh; Bayes Theorem; Child; Child Nutrition Disorders; Cross-Sectional Studies; Growth Disorders; Humans; Infant; Malnutrition; Prevalence; Thinness
PubMed: 35585516
DOI: 10.1186/s12889-022-13170-4 -
Assessment Dec 2022Identifying disability score differences in people with schizophrenia according to sociodemographic and clinical variables can help design better rehabilitation or care...
Identifying disability score differences in people with schizophrenia according to sociodemographic and clinical variables can help design better rehabilitation or care programs, but in order to compare the scores, it is necessary to confirm the measurement invariance. This study analyses differential item functioning (DIF) in the WHODAS 2.0 (WHO Disability Assessment Schedule) by applying two procedures based on Rasch trees (TREE-PCM and PCM-IFT). A total of 352 patients with schizophrenia spectrum disorder aged between 18 and 55 years took part. Sociodemographic (gender, age, marital status, and education) and clinical (depressive symptomatology, and presence of positive and negative symptoms) covariates were analysed in each of the WHODAS 2.0 domains. The TREE-PCM did not detect DIF, while with PCM-IFT an item with DIF was detected for the age variable. Although the findings suggest that only one item presents DIF, this refers to important issues when assessing functioning in patients with schizophrenia and should be reviewed.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Schizophrenia; Disabled Persons; Demography; Disability Evaluation; Psychometrics
PubMed: 34340588
DOI: 10.1177/10731911211036746 -
Psychological Bulletin Nov 2020Over a century of research has focused on the relationship between student characteristics and academic dishonesty. Here we conduct a meta-analysis of this extensive... (Meta-Analysis)
Meta-Analysis
Over a century of research has focused on the relationship between student characteristics and academic dishonesty. Here we conduct a meta-analysis of this extensive literature across three broad domains: personality, academic attitudes, and historical information including demographic and prior accomplishments. After analyzing correlations from over 27,000 participants across 75 samples, several relationships stand out. Although measures of conscientiousness (ρ¯ = -.25) and agreeableness (ρ¯ = -.13) from the popular five-factor model demonstrate important relationships with dishonesty, equal or greater effects were found for specific personality scales including impulsivity (ρ¯ = .39) and psychopathy (ρ¯ = .40). Both morality (ρ¯ = -.24) and academic self-efficacy (ρ¯ = -.28) were related to less dishonest behavior but demonstrated substantially smaller effects than measures of neutralization (ρ¯ = .43), a tendency to justify and deflect immoral behavior as reasonable given the circumstances. Hypotheses were developed and results are framed by two competing models of academic dishonesty. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Topics: Adult; Antisocial Personality Disorder; Attitude; Deception; Demography; Female; Humans; Impulsive Behavior; Male; Morals; Personality; Self Efficacy; Students; Young Adult
PubMed: 32897087
DOI: 10.1037/bul0000300 -
Experimental Gerontology Oct 2022We aimed to clarify the factors that contribute to the improvement or progression of frailty in rural Japanese community-dwelling older adults.
OBJECTIVES
We aimed to clarify the factors that contribute to the improvement or progression of frailty in rural Japanese community-dwelling older adults.
METHODS
Of the 840 participants in the cohort study of independent older adults aged 65 years and older living in the Tamba-Sasayama area of Hyogo Prefecture (FESTA study) from September 2016 to December 2017, 551 participated in the 2-year follow-up survey from September 2018 to December 2019.
METHODS
We evaluated clinical background, physical and cognitive function, total physical activity, daily protein intake, quality of life (QOL) using the WHOQOL-BREF (WHOQOL-26), and frailty status diagnosed using the Japanese version of the Cardiovascular Health Study. We compared the frailty status at the initial and follow-up examinations and classified the participants into three groups: improvement, unchanged, and worsening. Each parameter was compared among the three groups and the factors contributing to the improvement or worsening of frailty status were analyzed using a modified Poisson regression analysis.
RESULTS
The median age at the first survey was 72 years (range: 68-76); 190 men and 361 women were enrolled. The improvement group consisted of individuals with a change in status from frail to prefrail/robust and from prefrail to robust (n = 114); the worsening group consisted of individuals with a change in status from robust to prefrail/frail and from prefrail to frail (n = 92). The physical domain of QOL was significantly associated with an improvement in frailty status independent of the frailty status at baseline. Contrastingly, any domains of QOL were not significantly associated with a worsening frailty status.
CONCLUSIONS
This study demonstrated for the first time that QOL has a significant impact on the future improvement and progression of frailty status and that QOL conditions and frailty status affect older adults bidirectionally.
Topics: Aged; Cohort Studies; Dietary Proteins; Female; Frail Elderly; Frailty; Geriatric Assessment; Humans; Independent Living; Japan; Male; Quality of Life
PubMed: 35987474
DOI: 10.1016/j.exger.2022.111930 -
The Journal of Frailty & Aging 2022Antiretroviral therapy (ART) usage among people living with HIV (PLWH) has led to significant mortality declines and increasing lifespan. However, high incidence and...
BACKGROUND
Antiretroviral therapy (ART) usage among people living with HIV (PLWH) has led to significant mortality declines and increasing lifespan. However, high incidence and early onset of aging-related conditions such as frailty, pose as a new threat to this population.
OBJECTIVES
We aimed to characterize frailty by comparing health domains consisting of psychosocial, functional and physical deficits between frail PLWH and matched uninfected controls; identify associated risk factors and the impact on negative health outcomes including mortality risk score, quality of life, healthcare utilization, functional disability and history of falls among virally suppressed PLWH.
DESIGN
Cross-sectional study.
SETTING
Infectious disease clinic in a tertiary institution.
PARTICIPANTS
Individuals aged >25 years, on ART >12 months, not pregnant and without acute illness; multi-ethnic, Asian.
MEASUREMENTS
Frailty instruments included Frailty phenotype (FP), FRAIL scale (FS) and Frailty index (FI). FI health deficits were categorized into health domains (psychosocial, functional and physical) and used as standard comparator to characterize frailty. Health domains of frail PLWH were compared with frail matched, uninfected controls. Regression analyses were applied to explore associated risk factors and health-related frailty outcomes.
RESULTS
We recruited 336 PLWH. Majority were male (83%), Chinese (71%) with CD4+ count 561 (397-738) cells/µl. Frailty prevalence among PLWH were 7% (FP); 16% (FS) and 22% (FI). Proportions of psychosocial, functional, and physical domains were similarly distributed among frail PLWH measured by different frailty instruments. When compared with matched controls, psychosocial dominance was significant among the PLWH, but not in functional and physical domains. Identified frailty risk factors included poor nutritional status, higher CD4+ count nadir, depression, metabolic syndrome, higher highly sensitive C-reactive protein (hsCRP) and history of AIDS-defining illness (ADI). Frailty influenced the risk for negative health outcomes including increased mortality risk scores, poor quality of life (QOL), frequent healthcare utilization and increased functional disability (p<0.05).
CONCLUSIONS
This study highlighted the importance of psychosocial influence in the development of frailty among treated PLWH in a multi-ethnic, Asian setting.
Topics: Aged; Cross-Sectional Studies; Female; Frail Elderly; Frailty; Geriatric Assessment; HIV Infections; Humans; Male; Pregnancy; Quality of Life
PubMed: 35441197
DOI: 10.14283/jfa.2021.48 -
International Journal of Obesity (2005) Feb 2012The SH3-domain GRB2-like (endophilin)-interacting protein 1 (SGIP1) gene has been shown to be differentially expressed in the hypothalamus of lean versus obese Israeli...
OBJECTIVE
The SH3-domain GRB2-like (endophilin)-interacting protein 1 (SGIP1) gene has been shown to be differentially expressed in the hypothalamus of lean versus obese Israeli sand rats (Psammomys obesus), and is suspected of having a role in regulating food intake. The purpose of this study was to assess the role of genetic variation in SGIP1 in human disease.
SUBJECTS
We performed single-nucleotide polymorphism (SNP) genotyping in a large family pedigree cohort from the island of Mauritius. The Mauritius Family Study (MFS) consists of 400 individuals from 24 Indo-Mauritian families recruited from the genetically homogeneous population of Mauritius. We measured markers of the metabolic syndrome, including diabetes and obesity-related phenotypes such as fasting plasma glucose, waist:hip ratio, body mass index and fat mass.
RESULTS
Statistical genetic analysis revealed associations between SGIP1 polymorphisms and fat mass (in kilograms) as measured by bioimpedance. SNP genotyping identified associations between several genetic variants and fat mass, with the strongest association for rs2146905 (P=4.7 × 10(-5)). A strong allelic effect was noted for several SNPs where fat mass was reduced by up to 9.4% for individuals homozygous for the minor allele.
CONCLUSIONS
Our results show association between genetic variants in SGIP1 and fat mass. We provide evidence that variation in SGIP1 is a potentially important determinant of obesity-related traits in humans.
Topics: Adaptor Proteins, Signal Transducing; Adult; Aged; Aged, 80 and over; Alpha-Ketoglutarate-Dependent Dioxygenase FTO; Animals; Body Composition; Carrier Proteins; Cohort Studies; Diabetes Mellitus, Type 2; Eating; Female; Genetic Predisposition to Disease; Humans; Male; Mauritius; Membrane Proteins; Metabolic Syndrome; Middle Aged; Obesity; Pedigree; Phenotype; Polymorphism, Single Nucleotide; Prevalence; Proteins; Rats; Young Adult; src Homology Domains
PubMed: 21407171
DOI: 10.1038/ijo.2011.67 -
Psychiatry and Clinical Neurosciences Aug 2002The present study investigated whether schizophrenia patients with and without DSM-IV bizarre delusions, categorized as bizarre delusions of Schneiderian first rank...
The present study investigated whether schizophrenia patients with and without DSM-IV bizarre delusions, categorized as bizarre delusions of Schneiderian first rank symptoms (SBD) and as non-Schneiderian bizarre delusions (non-SBD), differed on demographic or clinical features, in view of the weight given to bizarre delusions in the diagnosis of schizophrenia. One hundred and twenty-nine in-patients with schizophrenia were assessed systematically for both types of bizarre delusions on the five domains of psychopathology of the Positive and Negative Syndrome Scale (PANSS; delusions/hallucinations, thought disorder/disorganization, excitement, negative symptoms and depressive symptoms) and for extrapyramidal side-effects. Inter-rater reliabilities for SBD and non-SBD were assessed and were exceptionally high (kappa value 0.85 and 0.92, respectively). Neither SBD nor non-SBD were associated with any demographic or non-PANSS clinical characteristics tested. However, the presence of non-SBD was significantly associated with more severe psychopathology in all five domains of the PANSS, whereas the presence of SBD was significantly associated with more severe psychopathology in three domains only: delusions/hallucinations, thought disorder/disorganization and depressive symptoms. However, patients with only SBD did not differ from patients with only non-SBD on any demographic or clinical variables, including five psychopathological domains. These findings suggest that, despite showing more severe symptoms, patients with DSM-IV bizarre delusions do not constitute a clinically distinguishable subgroup.
Topics: Adult; Delusions; Demography; Depression; Female; Humans; Male; Middle Aged; Schizophrenic Psychology; Severity of Illness Index
PubMed: 12109956
DOI: 10.1046/j.1440-1819.2002.01027.x