Film Review: The Business of America

[Excerpt] In the Business of America, the filmakers-at California Newsreel have once again demonstrated their ability to produce lively and substantive documentary on economic issues. In the late 1970s, they produced Controlling Interest, perhaps the most incisive film analysis of multinational corporations ever made. The Business of America turns out to be a worthy sequel

Racial and Ethnic Disparities in Illinois Lung Cancer Incidence, Mortality Stage at Diagnosis, Surgical Treatment, and Screening

This study analyzes the extent of racial and ethnic disparities in lung cancer in Illinois as compared to national trends. Cancer registry data were used to compare lung cancer incidence, mortality and stage at diagnosis rates for non-Hispanic (NH) white, NH Black and Hispanic Illinois residents. Hospital discharge data were used to compare medical and surgical admission and screening rates. Smoking across race and ethnic groups was compared using data from the Illinois Behavioral Risk Factor Surveillance System to determine the extent to which disparities might be related to smoking prevalence. Rate ratios for NH Black and Hispanics compared to NH whites were used to determine the significance of differences and to compare to national data. Despite having a lower prevalence of ever smoking compared to NH whites, NH Blacks had higher lung cancer incidence, mortality, and diagnosis with distant stage disease. NH blacks had more lung cancer medical admissions, but lower surgical admission and screening rates as compared to NH whites. Hispanics had much lower rates of lung cancer incidence and hospital care but had the highest rate of diagnosis at distant stage (61.4% as compared to 50.3% for NH whites). Illinois NH Black versus NH white rate ratios were 1.17 for incidence and 1.24 for mortality as compared to national estimates of only 1.07 and 1.04, respectively. Addressing lung cancer disparities will require a stronger effort to reduce tobacco use in minority communities where smoking is often a response to very high levels of chronic stress. This will require culturally sensitive, community-based messaging and cheaper, more accessible smoking cessation alternatives, plus more equitable access to high-quality preventive health care

Rates of breastfeeding initiation and duration in the United States: data insights from the 2016–2019 Pregnancy Risk Assessment Monitoring System

IntroductionWhile breastfeeding rates in the United States have been increasing, they remain low by international standards with substantial racial, income and education disparities. This study uses recent population-based data to analyze sociodemographic differences in breastfeeding initiation, duration, and exposure to information and education.MethodsWe used the 2016–2019 Pregnancy Risk Assessment Monitoring System (PRAMS) to compare breastfeeding duration among a representative population from 43 states and the District of Columbia. We modeled the likelihood of never initiating breastfeeding by respondent’s age, race and ethnicity, language, marital status, household income, educational attainment, parity and insurance status. We also compared sources of information and education for respondents who never breastfed to those who breastfed up to 6 months.ResultsAmong 142,643 new mother respondents, representing an estimated population of 7,426,725 birthing individuals, 12.6% never breastfed, 60.4% reported breastfeeding at 3 months and 54.7% at 6 months. While 75.8% of college graduates reported breastfeeding at 3 months, this was only 37.8% of respondents with high school or less. Among those with the lowest six-month rates were non-Hispanic Black participants (36.3%) and those age < 20 (25.5%). Respondents with Medicaid coverage for their delivery were 25% more likely to have never breastfed than the privately insured. Respondents reporting household income <$20,000 were 57$85,000. While 64.1% of those breastfeeding at 6 months reported receiving information from “my” doctor’, this was only 13.0% of those who never breastfeed.DiscussionImproved breastfeeding rates could have significant effects on reducing health disparities in the United States. Clinical and public health policy initiatives need to include culturally sensitive breastfeeding education before and after childbirth, with psychological and direct support from obstetrics and primary care providers. Health plans should support home and community-based in-person and telelactation consulting services. Public policies such as paid family and medical leave and workplace accommodations will also be critical. Given the huge implications of breastfeeding rates on the development of infant immune defenses and a healthy microbiome, improving breastfeeding rates should be a much more important public health priority in the United States

Are we providing patient-centered care? Preferences about paracentesis and thoracentesis procedures

Procedures performed at the bedside are as safe and less expensive than Interventional Radiology (IR) procedures. Patient preferences regarding location are rarely taken into account. Therefore, in this study we compared patient satisfaction with bedside and IR paracentesis and thoracentesis procedures, and identified reasons for patient location preferences. We performed a cross-sectional survey of medical inpatients undergoing paracentesis or thoracentesis procedures at a tertiary care academic medical center. The survey had eight domains: overall experience, pain control, expertise, courtesy, bedside manner of the physician, time required, explanation of risks/benefits, comfort and privacy. Patients were also asked about their preference for procedure location. Two hundred and twenty surveys (162 paracentesis and 58 thoracentesis) were completed on 152 patients. Patient satisfaction was similar for bedside and IR procedures across all domains. A location preference was expressed in 151 surveys (68.6%). Thirty-five of 108 responses (32.4%) from patients with a paracentesis expressed a preference for bedside procedures while 73/108 (67.6%) responses expressed a preference for IR. Twenty-eight of 43 responses (65.1%) from patients with a thoracentesis expressed a preference for bedside procedures while 15/43 (34.9%) responses expressed a preference for IR. Comfort was listed as the most common reason for preferring the bedside while specialized equipment and safety were the most common reasons for preferring IR. Patients are equally and highly satisfied with bedside and IR paracentesis and thoracentesis procedures. Because both approaches are safe and effective, clinicians should pursue informed discussions with patients when a choice is available

A qualitative study of urban hospital transitional care

This study is part of a mixed methods evaluation of a large urban medical center transitional care practice (NMG-TC). The NMG-TC provides integrated physical and behavioral health care for high need patients referred from the hospital emergency department or inpatient units and who lack a usual source of primary care. The study was designed for internal quality improvement and sought to evaluate staff perceptions of successful transitions for their medically and socially complex patients, and alternatively, the obstacles most likely to negatively impact patient outcomes. All 16 NMG-TC patient care staff were interviewed in a collaborative effort to produce empowered testimony that might go beyond expected clinical narratives. The interview schedule included questions on risk stratification, integrated mental health care, provider to provider handoffs, and how staff deal with key social determinates of patients’ health. The constant comparative method was used to deductively derive themes reflecting key domains of transitional care practice. Seven themes emerged: i) the need to quickly assess patient complexity; ii) emphasizing caring for major mental health and substance use issues; iii) obstacles to care for uninsured, often undocumented patients; iv) the intractability of homelessness; v) expertise in advancing patients’ health literacy, engagement and activation; vi) fragmented handoffs from hospital care and vii) to primary care in the community. Respondent stories emphasized methods of nurturing patients’ self-efficacy in a very challenging urban health environment. Findings will be used to conceptualize pragmatic, potentially high-impact transitional care quality improvement initiatives capable of better addressing frequent hospital use

Association of Childhood Psychosocial Environment With 30-Year Cardiovascular Disease Incidence and Mortality in Middle Age

Background Childhood adversity and trauma have been shown to be associated with poorer cardiovascular disease (CVD) outcomes in adulthood. However, longitudinal studies of this association are rare. Methods and Results Our study used the CARDIA (Coronary Artery Risk Development in Young Adults) Study, a longitudinal cohort that has followed participants from recruitment in 1985-1986 through 2018, to determine how childhood psychosocial environment relates to CVD incidence and all-cause mortality in middle age. Participants (n=3646) completed the Childhood Family Environment (CFE) questionnaire at the year 15 (2000-2001) CARDIA examination and were grouped by high, moderate, or low relative CFE adversity scores. We used sequential multivariable regression models to estimate hazard ratios of incident (CVD) and all-cause mortality. Participants were 25.1+/-3.6 years old, 47% black, and 56% female at baseline and 198 participants developed CVD (17.9 per 10 000 person-years) during follow-up. CVD incidence was \u3e 50% higher for those in the high CFE adversity group compared with those in the low CFE adversity group. In fully adjusted models, CVD hazard ratios (95% CI) for participants who reported high and moderate CFE adversity versus those reporting low CFE adversity were 1.40 (0.98-2.11) and 1.25 (0.89-1.75), respectively. The adjusted hazard ratios for all-cause mortality was 1.68 (1.17-2.41) for those with high CFE adversity scores and 1.55 (1.11-2.17) for those with moderate CFE adversity scores. Conclusions Adverse CFE was associated with CVD incidence and all-cause mortality later in life, even after controlling for CVD risk factors in young adulthood

A severity-adjusted statistical model of physicians' impact on hospital resource use: Identifying cost-effective patterns of inpatient medical care.

A severity-adjusted statistical model of physicians' impact on hospital resource use: Identifying cost-effective patterns of inpatient medical care

Gun carrying among freshmen and sophomores in Chicago, New York City and Los Angeles public schools: the Youth Risk Behavior Survey, 2007-2013

Abstract Background This study evaluated trends and risk factors over time for self-reported gun carrying among freshman and sophomore public school students in Chicago, New York City and Los Angeles, chosen as high profile cities with different levels of firearm violence. Methods The study used four biennial waves (2007-2013) of the Youth Risk Behavior Survey (YRBS), an anonymous, voluntary survey of public high school students. Analyses were restricted to freshman and sophomores given significant high school dropout rates among older students. School population weighted results are presented based on the YRBS complex survey design, including comparisons of reported gun carrying across survey waves and cities. A violence index was created from eight survey items that capture students’ perceived threat level. Chi square tests and multivariable Poisson regression analyses were used to test the significance of differences across cities and over time in the likelihood of gun carrying controlling for sociodemographic characteristics, mental health risk factors and behavioral risk factors. Results The study included a total weighted population estimate of 1,137,449 students across the three cities and four survey waves. Mean self-reported gun carrying across all survey waves was 8.89% in Chicago, 4.09% in New York City, and 6.03% in Los Angeles (p < 0.001). There were no significant changes in gun carrying prevalence within each individual city over the survey waves. Multivariable Poisson regression estimates showed increased likelihood for gun carrying among males (IRR 1.41, CI 1.27-1.58), among non-Hispanic Blacks (IRR 1.26, CI 1.07-1.48), and among those who reported a higher violence index. Each additional violence index count increase was associated with a 1.74 times (CI 1.70-1.78) increased likelihood for gun carrying. Conclusions There was a much higher self-reported rate of gun carrying and a higher burden of violence exposure in Chicago as compared to New York City and Los Angeles. Students’ exposure to violence extended to other stressors illuminated by the YRBS including fighting, perceptions of safety, and other high-risk behaviors. Through the violence index we created, we are better able to categorize the most high-risk individuals and describe the magnitude of their increased likelihood to carry a gun