RESUMO
OBJECTIVE: To determine the association of Spanish as a primary language for a family with the health outcomes of Hispanic infants with very low birth weight (VLBW, <1500g). STUDY DESIGN: Data from the California Perinatal Quality Care Collaborative (CPQCC) linked to hospital discharge records were analyzed. Hispanic infants with VLBW born between 2009 and 2018 with a primary language of English or Spanish were included. Outcomes selected were hypothesized to be sensitive to language barriers. Multivariable logistic regression models and mixed models estimated associations between language and outcomes. RESULTS: Of 18â364 infants meeting inclusion criteria, 27% (n = 4976) were born to families with Spanish as a primary language. In unadjusted analyses, compared with infants of primarily English-speaking families, these infants had higher odds of hospital readmission within 1 year (OR 1.11 [95% CI 1.02-1.21]), higher odds to receive human milk at discharge (OR 1.32 [95% CI 1.23-1.42]), and lower odds of discharge home with oxygen (OR 0.83 [95% CI 0.73-0.94]). In multivariable analyses, odds of readmission and home oxygen remained significant when adjusting for infant but not maternal and hospital characteristics. Higher odds for receipt of any human milk at discharge were significant in all models. Remaining outcomes did not differ between groups. CONCLUSIONS: Significant differences exist between Hispanic infants with VLBW of primarily Spanish-vs English-speaking families. Exploration of strategies to prevent readmissions of infants of families with Spanish as a primary language is warranted.
Assuntos
Recém-Nascido de muito Baixo Peso , Leite Humano , Recém-Nascido , Feminino , Gravidez , Humanos , Lactente , Modelos Logísticos , Hispânico ou Latino , CaliforniaRESUMO
OBJECTIVE: To estimate differences in scheduled and completed specialty referrals by race, ethnicity, language for care, and insurance type. STUDY DESIGN: We studied a retrospective cohort of 38 334 specialty referrals to a large children's hospital between March 2019 and March 2021. We included referrals for patients with primary care clinics within 5 miles of the hospital. We examined whether the odds of and time to scheduled and completed referrals differed by patient sociodemographic characteristics. RESULTS: Of all referrals, 62% were scheduled and 54% were completed. Referral completion rates were lower for patients with Black race (45%), Native Hawaiian/Pacific Islander race (48%), Spanish language (49%), and public insurance (47%). Odds of scheduled and completed referral were lower for Asian (aOR scheduled: 0.94, [95% CI: 0.89, 0.99]; aOR completed: 0.92 [0.87, 0.97]), Black (aOR scheduled: 0.86 [0.79, 0.94]; aOR completed: 0.80 [0.73, 0.87]), and publicly insured patients (aOR scheduled: 0.71 [0.66, 0.75]; aOR completed: 0.70 [0.66, 0.75]). Time to scheduled and completed referral was longer for Black (adjusted hazard ratio [aHR] scheduled: 0.93 [0.88, 0.98]; aHR completed: 0.93 [0.87, 0.99]) and publicly insured patients (aHR scheduled: 0.85 [0.82, 0.88]; aHR completed: 0.84 [0.80, 0.87]) and families with a language other than English (aHR scheduled: 0.66 [0.62, 0.70]; aHR completed: 0.92 [0.86, 0.99]). CONCLUSIONS: Within a geographically homogenous pediatric population, the odds and time to scheduled and completed specialty referrals differed by sociodemographic characteristics, suggesting the effects of discrimination. To improve access equity, health care organizations need clear and consistent referral workflows and more comprehensive metrics for access.
Assuntos
Disparidades em Assistência à Saúde , Pediatria , Encaminhamento e Consulta , Criança , Humanos , Estudos RetrospectivosRESUMO
BACKGROUND: The Center for Disease Control and Prevention (CDC) reports that liver disease is a significant cause of morbidity and mortality in the US, afflicting 4.5 million people in 2018, or approximately 1.7% of the American adult population. OBJECTIVE: To determine the prevalence and risk factors associated with liver disease among older Mexican Americans over 18 years of follow-up. METHODS: Non-institutionalized Mexican Americans aged ≥67 years (N = 1938) from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1995/96-2012/13) were studied. Measures included socio-demographic variables, self-reported liver disease, language of interview, medical conditions, hand-grip strength, physical and cognitive function, depressive symptoms, and body mass index. Generalized estimating equation models were used to estimate the odds ratio and 95% confidence interval (CI) of liver disease over time. RESULTS: The mean age at baseline was 74.9 ± 6.0 years and 58.4% were female. The prevalence of liver disease ranged from 2.4% to 8.4%. Over time, the odds ratio of reporting liver disease was 1.17 (CI = 1.12-1.22). Older age, Spanish interview, arthritis, diabetes, heart failure, cancer, and high scores on the Mini-Mental-State-Examination were factors associated with greater odds of reporting liver disease over time. Married participants reported lower odds of liver disease over time. CONCLUSIONS: The prevalence of liver disease in this population was high, ranging from 2.4% to 8.4%. Diabetes, heart failure, arthritis, and cancer were risk factors for liver disease. Screening for liver function among patients with these morbidities may help prevent liver disease in this population with high rates of diabetes and obesity.
Assuntos
Artrite , Insuficiência Cardíaca , Hepatopatias , Idoso , Feminino , Força da Mão , Humanos , Hepatopatias/epidemiologia , Masculino , Americanos Mexicanos/psicologia , Fatores de RiscoRESUMO
O trabalho apresenta as reflexões iniciais do projeto de pós-doutorado desenvolvido no Programa de Pós-Graduação em Comunicação e Cultura da Universidade Federal do Rio de Janeiro, que pretende ouvir artistas idosos de dois grupos distintos: no primeiro os sujeitos acometidos por patologias que afetam a memória, entre elas o Alzheimer, em suas fases iniciais; e no segundo sujeitos que se constroem e são construídos identitariamente como idosos, com base em seu lugar etário. Por meio de entrevistas, usando metodologicamente uma técnica que cruza os modos de fazer da história oral com os da entrevista clínica, realizaremos encontros com artistas (músicos, atores, artistas plásticos etc.) procurando perceber as vozes desses indivíduos como sujeitos de comunicação afetados pelo tempo (e, em alguns casos, pela doença).
The work presents the initial reflections of the postdoctoral project developed on the Graduate Program in Communication and Culture at Federal University of Rio de Janeiro, which intends to listen to old artists of two different groups: in the first, subjects affected by pathologies that affect the memory, includin Alzheimer's, in its early stages; and in the second subjects who build and are built identically as old based on their age. Based on interviews, using the foundations of psychological clinic and oral history, we will hold meetings with artists (musicians, actors, visual artists, etc.) seeking to perceive the voices of these individuals as subjects of communication affected by time (and often by the disease).
El trabajo presenta las reflexiones iniciales del proyecto posdoctoral desarrollado con el Programa de Posgrado en Comunicación y Cultura de la Universidad Federal de Río de Janeiro, que pretende escuchar a artistas antiguos de dos grupos diferentes: en el primero, los sujetos afectados por patologías que afectan la memoria, incluido el Alzheimer, en sus primeras etapas; y el segundo sujetos que construyen y se construyen de manera idéntica a los ancianos, en función de su su edad. Mediante el uso de entrevistas, utilizando metodológicamente una técnica que cruza las formas de hacer historia oral con las de la entrevista clínica psicológica, mantendremos reuniones con artistas (músicos, actores, artistas visuales etc.) para percibir las voces de estas personas como sujetos de comunicación afectados por el tiempo (y a menudo por la enfermedad).
Assuntos
Humanos , Idoso , Comportamento Social , Barreiras de Comunicação , Doença de Alzheimer , Transtornos da Memória , Arte , Envelhecimento , Estudos de Casos e Controles , Entrevistas como Assunto , Relações Familiares , Características de História de VidaRESUMO
BACKGROUND: Individuals with limited English proficiency (LEP) constitute an increasing share of the patient population in American healthcare settings. Few studies have described the patient's perspective on barriers to medical interpretation and experiences in the clinical setting. METHODS: We conducted focus groups with 22 LEP Spanish-speaking adults. Focus groups were transcribed and analyzed in their original Spanish. RESULTS: LEP patients face significant challenges when accessing health care services due to inadequate or insufficient access to professional interpreters. Predominant themes include: lack of interpreter availability, fear of disclosing limited English skills, and language discordant providers overestimating LEP patients' understanding of English. Many participants felt they had received poorer quality care. CONCLUSIONS: LEP patients face multiple barriers to accessing adequate interpretation leading to a perceived worsening in the quality of care. In order to improve health outcomes for LEP patients, routine provision of adequate interpretation is essential.
Assuntos
Barreiras de Comunicação , Acessibilidade aos Serviços de Saúde , Satisfação do Paciente , Relações Médico-Paciente , Qualidade da Assistência à Saúde , Colômbia/etnologia , República Dominicana/etnologia , Grupos Focais , Guatemala/etnologia , Humanos , Porto Rico/etnologia , Pesquisa Qualitativa , Rhode Island/epidemiologiaRESUMO
Objective: The purpose of this study was to examine retrospective data to determine if disparities existed in physical therapy outcomes for acute rehabilitation patients. Materials and Methods: Patients from different ethnic/language groups were compared and disparities were measured by comparing Functional Independent Measures® (FIM) scores. Results: Records of three thousand one hundred and ninety-seven patients admitted to a large acute rehabilitation center in the United States over a six year period were analyzed. Of the 23 language groups represented, the largest three language groups, English, Spanish, and South East (SE) Asian (Hmong, Khmer, Laotian, and Cambodian) languages were analyzed with a total of2,253 subjects. It was found that the three groups were not significantly different, in terms of their length of stay in the rehabilitation setting (F=2.30, p=.101), age (F=2.52, p=.081), or number of comorbidities (F=2.93, p=.054). However, admission FIM® (F=54.94, p<.001), projected FIM® goal (F=56.67, p<.001) and discharge FIM® (F=44.81, p<.001) were all significantly different, with the non-English speakers scoring lower at all three rating points by therapists. Conclusions: The results of this study demonstrate the importance of the effect of cultural and linguistic barriers on health communication interactions. In addition, this study provides insights to international health professionals on the issues of cross-cultural variations in the presentation of language barriers and their impact on potential research outcomes.
Objetivo: El propósito de este estudio fué el examinar retrospectivamente los datos para determinar si las disparidades existen en los resultados de la Fisioterapia para pacientes en rehabilitación aguda. Materiales y Métodos: Se hizo una comparación entre los pacientes de diferentes grupos étnicos o lingüisticos y las disparidades se midieron a través de un test conocido como Functional Independent Measures® (FIM). Resultados: En este estudio fueron analizados los registros de tres mil ciento noventa y siete pacientes admitidos a un centro de rehabilitación en los Estados Unidos en un periodo de seis años. De los veintitres grupos lingüisticos representados, los grupos más grandes y que se tomaron para el analisis fueron el Inglés, el Español y las lenguas del Sureste Asiatico (Hmong, Khemer, Laotian, y Cambodian) con un total de 2.253 sujetos. Se encontró que los tres grupos no tenian diferencias estadisticas significativas en términos de la duración de su estadia en el centro de rehabilitación (F=2.30, p=.101), edad (F=2.52, p=.081), o número de co-enfermedades (F=2.93, p=.054). Sinembargo el test FIM® de admisión (F=54.94, p<.001), el FIM® proyectado (F=56.67, p<.001) y el test FIM® de salida (F=44.81, p<.001) reportaron diferencias significativas, siendo los de habla Inglesa los que tuvieron puntajes más bajos en los tres puntos de medición de los terapistas. Conclusiones: Los resultados de este estudio demuestran la importancia de las barreras culturales y lingüisticas que afectan las interacciones de la communicación en salud. Además, este estudio provee áreas de reflexión para los profesionales en salud internacional sobre las variaciones interculturales en las barreras lingüisticas y su efecto en los resultados de los estudios.