Social disparities among youth and the impact on their health

PURPOSE: Social disparities among youth have been recognized as an important influence on disease risk later in the life cycle. Despite this, social problems are seldom assessed in a clinical setting. The primary objective of our study was to evaluate the impact of social disparities on the health of youth. METHODS: A self-directed, web-based screening system was used to identify social disparities along seven social domains. Participants included youth, aged 15-24 years, recruited from an urban hospital clinic. The main outcome variable, self-rated health, was captured on a 5-point Likert scale. Univariable and multivariable regression models adjusted for sex, age, and race/ethnicity were implemented to assess the association between social problems and self-rated health. Correlation between social disparity problems was estimated using phi coefficient. RESULTS: Among 383 participants, 297 (78%) reported at least one social problem. The correlation among social disparity problems was low. Social disparities had an independent effect on self-rated health, and, in a fully adjusted model, disparities in health care access and food insecurity remained significant. The presence of even one social problem was associated with a decrease in overall health (β=0.68, P<0.01). CONCLUSION: There is a high burden of social disparities among our youth urban hospital population. The presence of even one social problem increases the risk of worsening self-rated health. Evaluating the social disparities among youth in the medical setting can help elucidate factors that negatively affect patients' health

Perils of Diagnosis and Detection of Subungual Squamous Cell Carcinoma

Subungual squamous cell carcinoma often presents with atypical clinical manifestations, which can lead to delays in diagnosis. The presence of a tumor can be masked by the presence of infections or other misleading pathological conditions. The authors report on techniques for adequate biopsy and excision of such tumors. A case of subungual squamous cell carcinoma with invasion into the underlying bone is presented. Clinical histopathological evidence is reviewed along with human papillomavirus typing. Accurate diagnosis requires a high index of suspicion and appropriate tissue sampling

Association between access to social service resources and cardiometabolic risk factors: A machine learning and multilevel modeling analysis

Objectives Interest in linking patients with unmet social needs to area-level resources, such as food pantries and employment centres in one's ZIP code, is growing. However, whether the presence of these resources is associated with better health outcomes is unclear. We sought to determine if area-level resources, defined as organisations that assist individuals with meeting healthrelated social needs, are associated with lower levels of cardiometabolic risk factors. Design Cross-sectional. Setting Data were collected in a primary care network in eastern Massachusetts in 2015. Participants and primary and secondary outcome measures 123 355 participants were included. The primary outcome was body mass index (BMI). The secondary outcomes were systolic blood pressure (SBP), low-density lipoprotein (LDL) cholesterol and haemoglobin A1c (HbA1c). All participants were included in BMI analyses. Participants with hypertension were included in SBP analyses. Participants with an indication for cholesterol lowering were included in LDL analyses and participants with diabetes mellitus were included in HbA1c analyses. We used a random forest-based machine-learning algorithm to identify types of resources associated with study outcomes. We then tested the association of ZIP-level selected resource types (three for BMI, two each for SBP and HbA1c analyses and one for LDL analyses) with these outcomes, using multilevel models to account for individual-level, clinic-level and other area-level factors. Results Resources associated with lower BMI included more food resources (-0.08 kg/m2 per additional resource, 95% CI-0.13 to-0.03 kg/m2), employment resources (-0.05 kg/m2, 95% CI-0.11 to-0.002 kg/m2) and nutrition resources (-0.07 kg/m2, 95% CI-0.13 to-0.01 kg/m2). No area resources were associated with differences in SBP, LDL or HbA1c. Conclusions Access to specific local resources is associated with better BMI. Efforts to link patients to area resources, and to improve the resources landscape within communities, may help reduce BMI and improve population health

Comparison of instructor-led versus peer-led debriefing in nursing students

Despite its widespread support, the most effective simulation-based debriefing method has little evidence to support its efficacy. In this study, we compared the effect of peer-led and instructor-led debriefing among nursing students. The study was conducted with a non-equivalent control group using a pretest-post-test design. A convenience sample of third-year nursing students was used for the study, where 65 students enrolled in a 2-week clinical placement rotation were randomly assigned to the instructor-led group or peer-led group. The quality of cardiopulmonary resuscitation skills, satisfaction with simulation, and quality of debriefing in the peer-led group were compared to those in the instructor-led group. Group differences at each testing interval were analyzed using independent t-test. Nursing students in the instructor-led debriefing group showed better subsequent cardiopulmonary resuscitation performance, more satisfaction with simulation experience, and higher debriefing scores compared to the peer-led group. From our study, instructor-led debriefing is an effective method in improving skills performance, inducing favorable satisfaction, and providing better quality of debriefing among nursing students. © 2016 John Wiley & Sons Australia, Ltd

A predictive model for the early identification of patients at risk for a prolonged intensive care unit length of stay

<p>Abstract</p> <p>Background</p> <p>Patients with a prolonged intensive care unit (ICU) length of stay account for a disproportionate amount of resource use. Early identification of patients at risk for a prolonged length of stay can lead to quality enhancements that reduce ICU stay. This study developed and validated a model that identifies patients at risk for a prolonged ICU stay.</p> <p>Methods</p> <p>We performed a retrospective cohort study of 343,555 admissions to 83 ICUs in 31 U.S. hospitals from 2002-2007. We examined the distribution of ICU length of stay to identify a threshold where clinicians might be concerned about a prolonged stay; this resulted in choosing a 5-day cut-point. From patients remaining in the ICU on day 5 we developed a multivariable regression model that predicted remaining ICU stay. Predictor variables included information gathered at admission, day 1, and ICU day 5. Data from 12,640 admissions during 2002-2005 were used to develop the model, and the remaining 12,904 admissions to internally validate the model. Finally, we used data on 11,903 admissions during 2006-2007 to externally validate the model.</p> <p>Results</p> <p>The variables that had the greatest impact on remaining ICU length of stay were those measured on day 5, not at admission or during day 1. Mechanical ventilation, PaO₂: FiO₂ratio, other physiologic components, and sedation on day 5 accounted for 81.6% of the variation in predicted remaining ICU stay. In the external validation set observed ICU stay was 11.99 days and predicted total ICU stay (5 days + day 5 predicted remaining stay) was 11.62 days, a difference of 8.7 hours. For the same patients, the difference between mean observed and mean predicted ICU stay using the APACHE day 1 model was 149.3 hours. The new model's r²was 20.2% across individuals and 44.3% across units.</p> <p>Conclusions</p> <p>A model that uses patient data from ICU days 1 and 5 accurately predicts a prolonged ICU stay. These predictions are more accurate than those based on ICU day 1 data alone. The model can be used to benchmark ICU performance and to alert physicians to explore care alternatives aimed at reducing ICU stay.</p

Ellis Island Nation: Immigration Policy and American Identity in the Twentieth Century

Though debates over immigration have waxed and waned in the course of American history, the importance of immigrants to the nation\u27s identity is imparted in civics classes, political discourse, and television and film. We are told that the United States is a nation of immigrants, built by people who came from many lands to make an even better nation. But this belief was relatively new in the twentieth century, a period that saw the establishment of immigrant quotas that endured until the Immigrant and Nationality Act of 1965. What changed over the course of the century, according to historian Robert L. Fleegler, is the rise of contributionism, the belief that the newcomers from eastern and southern Europe contributed important cultural and economic benefits to American society. Early twentieth-century immigrants from southern and eastern Europe often found themselves criticized for language and customs at odds with their new culture, but initially found greater acceptance through an emphasis on their similarities to native stock Americans. Drawing on sources as diverse as World War II films, records of Senate subcommittee hearings, and anti-Communist propaganda, Ellis Island Nation describes how contributionism eventually shifted the focus of the immigration debate from assimilation to a Cold War celebration of ethnic diversity and its benefits—helping to ease the passage of 1960s immigration laws that expanded the pool of legal immigrants and setting the stage for the identity politics of the 1970s and 1980s. Ellis Island Nation provides a historical perspective on recent discussions of multiculturalism and the exclusion of groups that have arrived since the liberalization of immigrant laws.https://egrove.olemiss.edu/libarts_book/1029/thumbnail.jp