Cancer mortality in Native Americans in North Carolina.

his paper describes age-adjusted mortality from malignant neoplasms for Native Americans in North Carolina for 1968-72 and 1978-82. Sex-specific standardized mortality ratios were calculated from death certificate data, using the cancer mortality experience of White North Carolinians to obtain the number of expected deaths. For most categories and specific sites of cancer, mortality was at or below the expected level, but higher than expected mortality was found for genitourinary cancers in males (SMR=1.62,95%CI=1.15,2.21)forthe1978-82period;withinthis category, there was a higher than expected level of mortality from prostate cancer (SMR = 2.00; 95% CI = 1.36, 2.83) and cancer of the penis and other male genital organs (SMR = 9.09; 95% CI = 1.10, 32.84). Female Native Americans had an elevated mortality from cervical cancer (SMR = 2.27, 95% CI = 1.09, 4.17) for the 1968-72 period only. Originally published American Journal of Public Health, Vol. 80, No. 8, Aug 199

IT Service Climate: The Validation of an Antecedent Construct for IT Service Quality

Building from organizational climate theory, recent conceptual work has extended the IT service quality research and proposed a new construct, IT Service Climate, as an antecedent of IT service quality (Jia and Reich 2008). This paper reports on an empirical study that validated a 14-item measurement instrument for the IT service climate construct. Consisting of three dimensions, including Service Leadership, Service Vision, and Service Evaluation, the instrument demonstrates satisfactory reliability, convergent validity/unidimensionality, and discriminant validity. Data from a sample of matched pairs of systems and client units also indicate that, service climate scores from systems units explained significant variance in IT service quality as rated by their respective client units, thus demonstrating criterion validity. Contributions to both IT research and practice are discussed

Using Mechanical Turk Data in IS Research: Risks, Rewards, and Recommendations

With the increasing use of crowdsourced data in behavioral research fields, it is important to examine their appropriateness and desirability for IS research. Extending recent work in the IS literature, this tutorial discusses the risks and rewards of using data gathered on Amazon’s Mechanical Turk. We examine the characteristics of MTurk workers and the resulting method biases that may be exacerbated in MTurk data. Based on this analysis, we present a 2x2 matrix to illustrate the categories of IS research questions that are and are not amenable to MTurk data. We suggest that MTurk data is more appropriate for generalizing studies that examine diverse cognition than for contextualizing studies or those involving shared cognition. Finally, we offer a set of practical recommendations for researchers who wish to collect data on MTurk

Impact of Removing Cost Sharing Under the Affordable Care Act (Aca) on Mammography and Pap Test Use

Background The Affordable Care Act (ACA) required private insurers and Medicare to cover recommended preventive services without any cost sharing to improve utilization of these services. This study is an attempt to identify the impact of removing cost sharing on mammography and pap test utilization rates. Methods Counterfactual analysis was used to predict what would have been the screening rates in post-ACA if ACA was not there. This was done by estimating a model that examines determinants of dependent variable for the pre-ACA year (pre-ACA year is 2009). The estimated model was then used to predict the dependent variable for the post-ACA year using individual characteristics and other relevant variables unlikely to be affected by ACA (post-ACA year is 2016). Effect of ACA is defined as the difference between the values of dependent variables in post-ACA and the predicted values of dependent variables in the post-ACA year using counterfactual. Results The counterfactual analysis show that the utilization of mammogram and pap test did not improve following ACA. Conclusion Removal of cost-sharing under the ACA did not improve mammography or pap test rates. Therefore, financial barrier may not be an important factor in affecting utilization of the screening tests and policy makers should focus on other non-financial barriers in order to improve coverage of the tests

Impact of Medicaid Coverage Expansion Under the Affordable Care Act on Mammography and Pap Tests Utilization Among Low-Income Women

Introduction The Affordable Care Act (ACA) expanded the coverage of Medicaid to include entire population with income below 138% of federal poverty line. It remains unclear whether this policy change has improved access to and utilization of health care, particularly use of mammography and Pap tests among poor women. Methods We used a difference-in-difference (DID) design to estimate the impact of Medicaid expansion on mammography and Pap tests utilization among low-income women. Expansion states are the treatment group and non-expansion states are the control group. The years 2012–13 are the pre-expansion period and 2015–16 are the post-expansion period for the purpose of estimating the DID parameters. Results The difference-in-difference estimate show that likelihood of utilizing mammograms did not change significantly among low-income women after the implementation of Medicaid expansion (DID coefficient -0.0476 with t-statistics at -1.26), Pap test decreased (coefficient -0.0615, t-statistics -2.76), and Medicaid enrollment has increased significantly among low-income women living in expansion states (coefficient 0.0889 with t-value of 3.68). Conclusion Expansion of Medicaid was associated with increased Medicaid enrollment but did not yield near-term improvement in use of mammography and Pap tests among low-income women. Factors beyond health insurance coverage may be important in determining the likelihood of obtaining these screenings. Policy makers should try to identify other barriers to cancer screenings among low-income women in the USA

Who doesn't receive carotid endarterectomy when appropriate?

AbstractObjectiveThe purpose of this study was to identify clinical and nonclinical factors associated with failure to perform carotid endarterectomy (CEA) in patients with clinically appropriate indications. We analyzed data from a prospective cohort study performed at five Veterans Affairs medical centers. Patients were referred for carotid artery evaluation if they had at least 50% stenosis in one carotid artery, had no history of CEA, and were independently classified preoperatively as appropriate candidates for CEA, according to clinical criteria. The primary outcome was receipt of CEA within 6 months of evaluation. Data were collected by medical record review and interview regarding clinical status, and patient and physician perception of the risks and benefits of CEA.ResultsAmong clinically appropriate candidates for CEA, 66.8% (n = 233) did not undergo the operation. Compared with patients who did undergo CEA, a greater proportion of these patients had no symptoms (68.7% vs 45.7%; P < .001). A twofold greater proportion of patients who did not undergo CEA were in the highest quartile of reported aversion to surgery. Moreover, a fourfold greater proportion were perceived by their physicians to be at less than 5% risk for future stroke without the operation, and more than a twofold greater proportion were believed to experience less than 5% efficacy from the operation by their providers (P < .01). In multivariable analyses, four characteristics were significantly associated with whether an appropriate candidate did not receive CEA: asymptomatic disease, less than 70% stenosis, high expressed aversion to surgery score, and low (<5%) provider-perceived efficacy of the operation.ConclusionAmong patients in the Veterans Affairs health care system who are clinically appropriate candidates for CEA, those who did not receive the operation were less likely to have symptomatic disease or high-grade carotid artery stenosis, but were more likely to report high aversion to surgery and to have a provider who believed CEA would not be efficacious

Changing healthcare professionals' behaviors to eliminate disparities in healthcare: What do we know? How might we proceed?

The patient-healthcare provider communication process--particularly the provider's cultural competency--is increasingly recognized as a key to reducing racial/ethnic disparities in health and healthcare utilization. A working group was formed by the Office of Minority Health, Department of Health and Human Services to identify strategies for improving healthcare providers' cultural competency. This expert panel, one of several working groups called together to explore methods of reducing healthcare disparities, was comprised of individuals from academic medical centers and health professional organizations who were nationally recognized as having expertise in healthcare communication as it relates to diverse populations. During the 2-day conference, the panel identified, from personal experience and knowledge of the literature, key points of intervention and interventions most likely to improve the cross-cultural competency of healthcare providers. Proposed interventions included introduction of cultural competence education before, during, and after clinical training; implementation of certification and accreditation requirements in cross-cultural competence for practicing healthcare providers; use of culturally diverse governing boards for clinical practices; and active promotion of workforce cross-cultural diversity by healthcare organization administrators. For each intervention, methods for implementation were specified. On-going monitoring and evaluation of processes of care using race/ethnicity data were recommended to ensure the programs were functioning

Integrating maternal depression care at primary private clinics in low-income settings in Pakistan: A secondary analysis

IntroductionThe prevalence of depression among women in Pakistan ranges from 28% to 66%. There is a lack of structured mental healthcare provision at private primary care clinics in low-income urban settings in Pakistan. This study investigated the effectiveness and processes of a facility-based maternal depression intervention at private primary care clinics in low-income settings.Materials and methodsA mixed-methods study was conducted using secondary data from the intervention. Mothers were assessed for depression using the Patient Health Questionnaire-9 (PHQ-9). A total of 1,957 mothers (1,037 and 920 in the intervention and control arms, respectively) were retrieved for outcome measurements after 1 year of being registered. This study estimated the effectiveness of the depression intervention through cluster adjusted differences in the change in PHQ-9 scores between the baseline and the endpoint measurements for the intervention and control arms. Implementation was evaluated through emerging themes and codes from the framework analysis of 18 in-depth interview transcriptions of intervention participants.ResultsIntervention mothers had a 3.06-point (95% CI: −3.46 to −2.67) reduction in their PHQ-9 score at the endpoint compared with their control counterparts. The process evaluation revealed that the integration of structured depression care was feasible at primary clinics in poor urban settings. It also revealed gaps in the public–private care linkage system and the need to improve referral systems.ConclusionsIntervening for depression care at primary care clinics can be effective in reducing maternal depression. Clinic assistants can be trained to identify and deliver key depression counseling messages. The study invites policymakers to seize an opportunity to implement a monitoring mechanism toward standard mental health care

Host Abundance Correlates With Gulf War Illness Symptom Persistence via NLRP3-Mediated Neuroinflammation and Decreased Brain-Derived Neurotrophic Factor

Neurological disorders are commonly reported among veterans who returned from the Gulf war. Veterans who suffer from Gulf War illness (GWI) complain of continued symptom persistence that includes neurological disorders, muscle weakness, headaches, and memory loss, that developed during or shortly after the war. Our recent research showed that chemical exposure associated microbial dysbiosis accompanied by a leaky gut connected the pathologies in the intestine, liver, and brain. However, the mechanisms that caused the symptoms to persist even 30 years after the war remained elusive to investigators. In this study, we used a rodent model of GWI to investigate the persistence of microbiome alterations, resultant chronic inflammation, and its effect on neurotrophic and synaptic plasticity marker BDNF. The results showed that exposure to GW chemicals (the pesticide permethrin and prophylactic drug pyridostigmine bromide) resulted in persistent pathology characterized by the low relative abundance of the probiotic bacteria in the gut, which correlated with high circulatory HMGB1 levels, blood-brain barrier dysfunction, neuroinflammation and lowered neurotrophin BDNF levels. Mechanistically, we used mice lacking the NLRP3 gene to investigate this inflammasome\u27s role in observed pathology. These mice had significantly decreased inflammation and a subsequent increase in BDNF in the frontal cortex. This suggests that a persistently low species abundance of and associated chronic inflammation due to inflammasome activation might be playing a significant role in contributing to chronic neurological problems in GWI. A therapeutic approach with various small molecules that can target both the restoration of a healthy microbiome and decreasing inflammasome activation might have better outcomes in treating GWI symptom persistence