RESUMO
BACKGROUND: In Rhode Island, malignant melanoma of skin causes about 30 deaths a year. Early detection has been shown to reduce mortality risk. METHODS: Dermatology volunteers and public health professionals convened 27 free skin cancer screenings at public beaches in 2015-2019 to raise skin cancer awareness and screen patients for malignancy. Participants with suspicious lesions were referred for follow-up and later telephoned to ascertain outcomes. RESULTS: Of 2354 people screened, 597 (25%) were referred. 319 of 597 (53%) were later reached by telephone. 196 of 319 (61%) who had kept appointments by the time of the telephone call reported the following diagnoses: 7 malignant melanomas, 32 keratinocyte carcinomas, and 34 actinic keratoses, yielding 3.0 as number needed to biopsy (NNB), and 18.3 as number needed to screen (NNS). CONCLUSIONS: Our results demonstrate the value of convenient skin cancer screening events, suggesting the desirability of additional interventions of this type.
Assuntos
Melanoma , Neoplasias Cutâneas , Biópsia , Detecção Precoce de Câncer , Humanos , Programas de Rastreamento , Melanoma/diagnóstico , Melanoma/epidemiologia , Rhode Island/epidemiologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologiaRESUMO
INTRODUCTION: Colombia represents a country in transition, from decades of devastating civil war to a post-conflict era of peace building, to the recent management of the influx of thousands of Venezuelan migrants. Brown University, along with Colombian partners, are leading the way in an international, multi-institutional consortium with the goal of emergency medicine capacitation across Colombia. Program Implementations: Through these collaborative efforts, exchange programs for residents and faculty alike have been successfully established. A baseline assessment of emergency medicine education for medical students is underway. By the end of 2019, the Harvard Humanitarian Initiative (HHI) will launch an online tool in multiple languages, including Spanish, to help medical and nursing educators conduct systematic needs assessments of the way in which conflict has impacted medical and nursing schools. CONCLUSIONS: Successful avenues for collaboration and partnership are described between Brown Emergency physicians and Colombian collaborating universities. These programs help to build capacity in Colombia and also provide education and support for residents and faculty at Brown University. Current work will see these programs grow into the future.
Assuntos
Serviços Médicos de Emergência/organização & administração , Medicina de Emergência/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Hospitais Universitários/organização & administração , Médicos/organização & administração , Guerra , Colômbia/epidemiologia , Planejamento em Desastres/organização & administração , Serviços Médicos de Emergência/normas , Medicina de Emergência/normas , Acessibilidade aos Serviços de Saúde/normas , Humanos , Cooperação Internacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Refugiados , Rhode Island/epidemiologiaRESUMO
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
Little is understood regarding medicinal marijuana dispensary users. We sought to characterize socio-demographics and reasons for medicinal marijuana use among medical cannabis dispensary patients in Rhode Island. Participants (n=200) were recruited from one of two Compassion Centers in Rhode Island and asked to participate in a short survey, which included assessment of pain interference using the Brief Pain Inventory (BPI). The majority of participants were male (73%), Caucasian (80%), college educated (68%), and had health insurance (89%). The most common reason for medicinal marijuana use was determined to be chronic pain management. Participants were more likely to have BPI pain interference scores of > 5 if they were older (OR: 1.36, 95% CI: 1.04-1.78) or reported using cannabis as a substitute for prescription medications (OR: 2.47, 95% CI: 1.23-4.95), and were less likely to have interference scores of >5 if they had higher income levels (OR: 0.53, 95% CI: 0.40-0.70) or reported having ever received treatment for an alcohol use disorder. One-fifth of participants had a history of a drug or alcohol use disorder. Most participants report that medicinal cannabis improves their pain symptomology, and are interested in alternative treatment options to opioid-based treatment regimens.
Assuntos
Maconha Medicinal/uso terapêutico , Dor , Adulto , Centros Comunitários de Saúde/estatística & dados numéricos , Estudos Transversais , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/tratamento farmacológico , Dor/epidemiologia , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Medição da Dor/métodos , Rhode Island/epidemiologia , Autorrelato , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
OBJECTIVE: To determine whether early pulmonary hypertension (PH) at 10-14 days of life in preterm infants is associated with bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age (PMA). STUDY DESIGN: This was a prospective observational cohort study of infants <28 weeks' gestation. Exclusion criteria were any major anomaly, genetic syndrome, or death before the initial echocardiogram. Echocardiograms were performed between 10 and 14 days of life and at 36 weeks' PMA to assess PH. BPD and its severity were determined at 36 weeks PMA by the National Institutes of Health workshop definition. RESULTS: From March 2011 to April 2013, of 146 consecutively admitted infants <28 weeks, 120 were enrolled. One infant was excluded, 17 did not consent, and 8 died before undergoing a study echocardiogram. At 10-14 days of life, 10 infants had early PH (8%). Male sex (56% vs 40%), gestational age (26(+2) ± 1(+2) vs 25(+6) ± 1(+4) weeks), birth weight (837 ± 205 g vs 763 ± 182 g), and small for gestational age (14% vs 20%) were not significantly different among infants with no PH and early PH, respectively. Infants with early PH required >0.3 fraction of inspired oxygen by day 10 of life (70% vs 27%, P < .01). Moderate/severe BPD or death was greater among infants with early PH (90%) compared with no PH (47%, relative risk 1.9, 95% CI 1.43-2.53). CONCLUSION: In this prospective, single-center cohort, early PH was associated with moderate/severe BPD or death at 36 weeks' PMA.
Assuntos
Displasia Broncopulmonar/epidemiologia , Hipertensão Pulmonar/epidemiologia , Recém-Nascido Prematuro , Estudos de Coortes , Ecocardiografia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Prevalência , Estudos Prospectivos , Rhode Island/epidemiologiaRESUMO
BACKGROUND: Significant disparities in emergency department (ED) rates exist for Latinos; however, few studies have investigated the factors that may account for these disparities. OBJECTIVES: To examine individual/family and health system factors among Latino and non-Latino white (NLW) children with asthma to explain disparities in ED rates. METHODS: The study was carried out in Puerto Rico (PR) and Rhode Island (RI) with the same design: a cross-sectional, observational approach with repeated measurements of selected variables. RESULTS: The sample was composed of 804 children ages 7 to 15 years, with 405 from PR and 399 from RI. Latino children from both sites had significantly higher rates of ED use as compared with NLWs from RI. Regression analyses showed site, asthma control, parental reported severity of asthma and public insurance to be significantly associated with ED use. CONCLUSION: Latino ethnicity and public insurance were among the most important factors related to frequent ED use. Revisions of the policies driving public insurance to assure better access to specialists, preventive education, and evidence-based treatment are needed. The results also suggest the need for the development of interventions in the ED that are geared toward educating families on how best to use emergency services.
Assuntos
Asma/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Disparidades em Assistência à Saúde , Hispânico ou Latino , Adolescente , Asma/fisiopatologia , Criança , Atenção à Saúde , Progressão da Doença , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Educação de Pacientes como Assunto , Porto Rico/etnologia , Rhode Island/epidemiologiaRESUMO
BACKGROUND: The lifetime prevalence of self-reported asthma among Puerto Ricans is very high, with increased asthma hospitalizations, emergency department visits, and mortality rates. Differences in asthma severity between the mainland and island, however, remain largely unknown. OBJECTIVE: We sought to characterize differences in asthma severity and control among 4 groups: (1) Island Puerto Ricans, (2) Rhode Island (RI) Puerto Ricans, (3) RI Dominicans, and (4) RI whites. METHODS: Eight hundred five children aged 7 to 15 years completed a diagnostic clinic session, including a formal interview, physical examination, spirometry, and allergy testing. Using a visual grid adapted from the Global Initiative for Asthma, asthma specialists practicing in each site determined an asthma severity rating. A corresponding level of asthma control was determined by using a computer algorithm. RESULTS: Island Puerto Ricans had significantly milder asthma severity compared with RI Puerto Ricans, Dominicans, and whites (P < .001). Island Puerto Ricans were not significantly different from RI whites in asthma control. RI Puerto Ricans showed a trend toward less control compared with island Puerto Ricans (P = .061). RI Dominicans had the lowest rate of controlled asthma. Paradoxically, island Puerto Ricans had more emergency department visits in the past 12 months (P < .001) compared with the 3 RI groups. CONCLUSIONS: Potential explanations for the paradoxic finding of milder asthma in island Puerto Ricans in the face of high health care use are discussed. Difficulties in determining guideline-based composite ratings for severity versus control are explored in the context of disparate groups.
Assuntos
Asma/epidemiologia , Hospitalização/estatística & dados numéricos , Adolescente , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Asma/fisiopatologia , Criança , Feminino , Humanos , Masculino , Grupos Populacionais/etnologia , Grupos Populacionais/estatística & dados numéricos , Porto Rico/epidemiologia , Rhode Island/epidemiologia , Índice de Gravidade de Doença , Fatores SocioeconômicosRESUMO
Lead can damage the neurologic, hematologic, and renal systems. Deteriorated leaded paint in older housing remains the most common source of lead exposure for children in the United States; however, other lead sources increasingly are recognized, particularly among certain racial/ethnic populations. In 2003, the Rhode Island Department of Health (RIDOH) recognized litargirio (also known as litharge or lead monoxide), a yellow or peach-colored powder used as an antiperspirant/deodorant and a folk remedy in the Hispanic community, as a potential source of lead exposure for Hispanic children. This report summarizes a case investigation of elevated blood lead levels (BLLs > or =10 microg/dL) associated with litargirio use among two siblings in Rhode Island, the public health action taken, and a survey of parents/guardians in three pediatric clinics in Providence, Rhode Island, to assess litargirio use. Findings underscore the importance of follow-up of elevated BLLs and thorough investigation to identify all lead sources.
Assuntos
Intoxicação por Chumbo/etiologia , Chumbo , Medicina Tradicional , Óxidos , Criança , Pré-Escolar , Doenças em Gêmeos , República Dominicana/etnologia , Feminino , Hispânico ou Latino , Humanos , Lactente , Intoxicação por Chumbo/epidemiologia , Masculino , Rhode Island/epidemiologiaRESUMO
It is unknown whether rates of psychosis differ among depressed patients of various races and ethnic groups. In the present study, we sought to determine whether Hispanic patients with major depression who present for treatment are more likely to report psychotic symptoms than whites, even after controlling for multiple potential confounding factors. Fifteen hundred patients presenting to the Rhode Island Hospital Department of Psychiatry's outpatient practice underwent standardized diagnostic evaluations. Rates of psychosis were compared among Hispanic patients diagnosed with a current major depressive disorder and a white control group closely matched on several key demographic and clinical variables. Comparison rates of psychosis were also made with other ethnic groups. Rates of psychosis were significantly higher in 22 Hispanic patients diagnosed with depression (27.3%) compared with a closely matched white control group (N = 44; 6.8%; chi = 5.2; df = 1; p = .02). Rates of psychosis were also significantly higher in Hispanics than in Portuguese patients, but not blacks, although the former cohort differed in several key demographic and clinical variables. The study suggests that Hispanic patients with major depression who present for treatment may be more likely than whites to report psychotic symptoms. It remains unclear whether these reports represent true psychosis or culturally influenced idioms of distress.
Assuntos
Transtorno Depressivo Maior/epidemiologia , Hispânico ou Latino/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Transtornos Psicóticos/epidemiologia , Adolescente , Adulto , Assistência Ambulatorial , Comorbidade , Comparação Transcultural , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Etnicidade/estatística & dados numéricos , Feminino , Humanos , Masculino , Portugal/etnologia , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Porto Rico/etnologia , Rhode Island/epidemiologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , População Branca/estatística & dados numéricosRESUMO
OBJECTIVE: The purpose of this case-control study was to examine the maternal and neonatal morbidities associated with in vitro fertilization (IVF) in a single large teaching hospital. It was hypothesized that IVF mothers would have more perinatal complications and IVF infants would have higher mortality and morbidity rates than non-IVF control subjects. METHODS: One hundred forty-three gestations resulting from 101 IVF pregnancies, which included singletons (n = 62), twins (n = 72), and triplets (n = 9), were compared with equal numbers of non-IVF control subjects. Each pregnancy was matched by maternal age, race, insurance type, neonatal gender, order of gestation, order in delivery, and date of delivery (+/- 6 months). Among the 143 matched gestations, six IVF and seven control infants died, leaving 137 IVF and 136 control neonates for comparison. RESULTS: The IVF mothers had more pregnancy-induced hypertension (21% vs 4%), premature labor (44% vs 22%), labor induction (25% vs 1%), and preterm delivery (37% vs 21%). The IVF infant survivors had a lower mean (+/- SD) birth weight (2623 +/- 857 gm vs 3006 +/- 797 gm), more frequent occurrence of low birth weight (42% vs 27%), and shorter gestations (37 +/- 4 vs 38 +/- 3 weeks). The IVF infants had longer hospitalizations, more days of oxygen therapy, more days of continuous positive airway pressure, and increased prevalence of respiratory distress syndrome, patent ductus arteriosus, and sepsis. CONCLUSIONS: Couples who undergo IVF appear to be at increased risk of having low birth weight and preterm infants, and multiple gestations account for most of the neonatal morbidities. Both the mothers who conceive multiple gestations by means of IVF and their neonates are at an increased risk of having multiple morbidities.
Assuntos
Fertilização in vitro/efeitos adversos , Doenças do Recém-Nascido/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Estudos de Casos e Controles , Feminino , Fertilização in vitro/estatística & dados numéricos , Humanos , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Mortalidade Materna , Complicações do Trabalho de Parto/etiologia , Gravidez , Complicações na Gravidez/etiologia , Gravidez Múltipla , Rhode Island/epidemiologia , Fatores de Risco , Sobreviventes/estatística & dados numéricos , Trigêmeos , GêmeosRESUMO
We hypothesized that gender and intrauterine growth retardation (IUGR) have greater effects than birth order on mortality and morbidity rates of very low birth weight (< 1501 gm) twins. Neonatal data were collected on 44 pairs of twins born alive between January 1984 and December 1987. Birth weight was 1018 +/- 289 gm and gestational age was 28.1 +/- 2.5 weeks. The male/female ratio was 46:42; 24 infants had IUGR, and 64 were appropriate in size for gestational age. Of the 88 infants, 61 (69%) survived. Birth order had no effect on outcome. Female twin pairs had a longer gestation than either male twin pairs or twins with discordant sex (29.2 +/- 2.5 weeks vs 27.4 +/- 2.0 weeks and 27 +/- 3 weeks, respectively; p < 0.002). They also had a lower mortality rate (14% vs 47% and 25%; p < 0.001) and a lower incidence of bronchopulmonary dysplasia (22% vs 57% and 50%; p < 0.02). Infants with IUGR had an increased mortality rate (50% vs 23%; p < 0.02) and an increased sepsis rate (61% vs 25%; p < 0.02) compared with infants with appropriate size for gestational age who were matched for gestational age. Multiple logistic regression analysis to assess the independent effects of gestational age, gender, and IUGR on mortality rate, bronchopulmonary dysplasia, and intraventricular hemorrhage revealed that gestational age was the most significant contributor to all three outcome variables; IUGR contributed to an increased mortality rate, and male gender contributed to the occurrence of bronchopulmonary dysplasia.
Assuntos
Ordem de Nascimento , Retardo do Crescimento Fetal/epidemiologia , Recém-Nascido de Baixo Peso , Resultado da Gravidez/epidemiologia , Gêmeos , Índice de Apgar , Distribuição de Qui-Quadrado , Feminino , Idade Gestacional , Humanos , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Modelos Logísticos , Masculino , Gravidez , Rhode Island/epidemiologia , Fatores de Risco , Fatores Sexuais , Gêmeos/estatística & dados numéricosRESUMO
We hypothesized that high school students who experienced prior maltreatment would be more likely than their peers to report health risk behaviors and suicide attempts. Before the establishment of a high school-based clinic, an anonymous needs assessment survey was completed by 600 adolescents (grades 9 to 12). Sociodemographic information was obtained and questions were asked about physical and sexual abuse, health-related behaviors and habits, and suicide attempts. Thirteen percent of the adolescents had been maltreated: 5.2% reported prior physical abuse, 5.4% sexual abuse, and 2.7% both physical and sexual abuse. Multivariate statistical techniques were used to clarify how previous abuse was related to adolescent risk-taking behaviors and suicide. Students with a history of physical abuse were three times more likely than non-abused peers to drink alcohol and smoke cigarettes, almost twice as likely to use illicit drugs, six times more likely to self-induce vomiting, and five times more likely to attempt suicide. A student with a history of prior sexual abuse had a three and one-half times greater chance of being sexually active and was more than three times more likely to attempt suicide. These data on a nonclinical, nondeviant population of adolescents indicate that physical or sexual abuse in childhood may have a significant impact on adolescent health risk behaviors and suicide attempts.