Representation of Racial/ Ethnic Minority Individuals in the Leadership of Major Medical Journals

Medical journals play an important role in achieving health equity by diversifying their leadership, but there is a dearth of published data on how they are faring. The objective of this study was to assess the proportions of the underrepresented in medicine (UIM) racial/ ethnic minorities in medical journal leadership. We pre-selected 6 prominent general medicine journals, 9 prominent specialty journals, and 5 “control” journals (covering public health, health equity, and bench research), assembled names of all editors/ editorial board members listed on the website-based journal mastheads and used major public internet search engines to obtain information about sex, race, and ethnicity. We searched the journal databases for all articles published on racial/ethnic disparities or health equity by each journal between January 2015 to October 2020.Among general medicine journals, there were no UIM Editors-in-Chief or Deputy Editors; 1 (2%) Black and 3 (5%) Hispanic among Associate Editors (n=65); and 8 (6%) Black, and 2 (2%) Hispanic among Editorial Board Members (n=136). Among specialty journals, there were no UIM Editors-in-Chief; 3 (7%) Black and 0 (0%) Hispanic Deputy or Associate Editors (n=43); 6 (6%) Black and 5 (5%) Hispanic Editorial Board Members (n=105). Among “control” journals, there were Black Editors-in-Chief, but no Hispanic Editors-in-chief; 7 (8%) Black and 1(1%) Hispanic Deputy and Associate editors (n=86); 43 (47%) Black and 3 (3%) Hispanic Editorial Board Members (n=92). There is considerable room for improvement to enhance the involvement of UIM racial/ethnic minority individuals in leadership of prominent general and specialty medical journals

Child-mediated health communication: A conceptual framework for increasing stroke literacy in hard to reach populations

Effectively engaging economically-disadvantaged ethnic minority communities for promoting health has proved to be challenging for a variety of reasons, including factors related to healthcare access, literacy, inadequate or ineffective cultural appropriateness of materials, and the relatively low priority for health due to competing demands related to economic hardship. We have developed a framework of Child-Mediated Health Communication (CMHC), which focuses on children as channels for carrying out health promotion interventions to parents and other caregivers. CMHC is an innovative, alternative strategy for engaging this underserved population, where traditional methods of health promotion have not been successful. We discuss the theoretical foundation, development, and effectiveness of a CMHC framework in our stroke preparedness communication intervention, Hip Hop Stroke

Health seeking behaviour in management of erectile dysfunction among men in an urban African population

Background: Erectile dysfunction (ED) is consistent inability to achieve/maintain penile erection sufficiently enough for satisfactory sexual intercourse. It is a major sexual disorder causing significant distress in men with associated poor quality of life. Despite it being a common sexual disorder, many of the affected people do not seek medical care. The study sought to investigate health seeking behaviour in management of ED among urban dwelling African men.Methods: A cross-sectional descriptive survey method was adopted. The study population comprised of men drawn from an urban setting in Nigeria using a multi-stage sampling technique. Three hypotheses were formulated which were cultural beliefs, financial status and medical access/perception on quality of care will not significantly influence health seeking behaviour for management of ED. Researchers’ designed questionnaire validated by three experts drawn from the relevant fields with reliability co-efficient of 0.77 obtained through split half method by Pearson product moment correlation was used for data collection. The three postulated hypotheses were tested using Person product moment correlation.Results: All the three hypotheses were rejected at 0.05 alpha level of significance because their calculated r-values were greater than their critical values.Conclusions: It was concluded that cultural beliefs, financial status and access to medical facilities/perception of quality of care from such medical facilities influence the health seeking behaviour of men in the management of ED.

Effect of birthplace on cardiometabolic risk among blacks in the Metabolic Syndrome Outcome Study (MetSO)

BACKGROUND: Metabolic syndrome poses an increased global burden of disease and causes immense financial burden, warranting heightened public health attention. The present study assessed the prevalence and severity of cardiometabolic risk among foreign-born versus US-born blacks, while exploring potential gender-based effects. METHODS: A total of 1035 patients from the Metabolic Syndrome Outcome Study (Trial registration: NCT01946659) provided sociodemographic, medical history, and clinical data. General Linear Model (GLM) was used to assess the effects of birthplace and gender on cardiometabolic parameters, adjusting for age differences in the sample. RESULTS: Of the sample, 61.6 % were foreign-born blacks (FBB) and 38.4 % were US-born blacks (USB). FBB had significantly lower BMI compared with USB (32.76 ± 0.35 vs. 35.41 ± 0.44, F = 22.57), but had significantly higher systolic blood pressure (136.70 ± 0.77 vs. 132.83 ± 0.98; F = 9.60) and fasting glucose levels than did USB (146.46 ± 3.37 vs. 135.02 ± 4.27; F = 4.40). Men had higher diastolic BP (76.67 ± 0.65 vs. 75.05 ± 0.45; F = 4.20), glucose (146.53 ± 4.48 vs. 134.95 ± 3.07; F = 4.55) and triglyceride levels (148.10 ± 4.51 vs. 130.60 ± 3.09; F = 10.25) compared with women, but women had higher LDL-cholesterol (109.24 ± 1.49 vs. 98.49 ± 2.18; F = 16.60) and HDL-cholesterol levels (50.71 ± 0.66 vs. 42.77 ± 0.97; F = 46.01) than did men. CONCLUSIONS: Results showed that birthplace has a significant influence on cardiometabolic profiles of blacks with metabolic syndrome. Patients’ gender also had an independent influence on cardiometabolic profile

Feasibility of deploying peer coaches to mentor frontline home health aides and promote mobility among individuals recovering from a stroke: pilot test of a randomized controlled trial

Background Each year, approximately 100,000 individuals receive home health services after a stroke. Evidence has shown the benefits of home-based stroke rehabilitation, but little is known about resource-efficient ways to enhance its effectiveness, nor has anyone explored the value of leveraging low-cost home health aides (HHAs) to reinforce repetitive task training, a key component of home-based rehabilitation. We developed and piloted a Stroke Homehealth Aide Recovery Program (SHARP) that deployed specially trained HHAs as “peer coaches” to mentor frontline aides and help individuals recovering from stroke increase their mobility through greater adherence to repetitive exercise regimens. We assessed the feasibility of SHARP and its readiness for a full-scale randomized controlled trial (RCT). Specifically, we examined (1) the practicability of recruitment and randomization procedures, (2) program acceptability, (3) intervention fidelity, and (4) the performance of outcome measures. Methods This was a feasibility study including a pilot RCT. Target enrollment was 60 individuals receiving post-stroke home health services, who were randomized to SHARP + usual home care or usual care only. The protocol specified a 30-day intervention with four planned in-home coach visits, including one joint coach/physical therapist visit. The primary participant outcome was 60-day change in mobility, using the performance-based Timed Up and Go and 4-Meter Walk Gait Speed tests. Interviews with participants, coaches, physical therapists, and frontline aides provided acceptability data. Enrollment figures, visit tracking reports, and audio recordings provided intervention fidelity data. Mixed methods included thematic analysis of qualitative data and quantitative analysis of structured data to examine the intervention feasibility and performance of outcome measures. Results Achieving the 60-participant enrollment target required modifying participant eligibility criteria to accommodate a decline in the receipt of HHA services among individuals receiving home care after a stroke. This modification entailed intervention redesign. Acceptability was high among coaches and participants but lower among therapists and frontline aides. Intervention fidelity was mixed: 87% of intervention participants received all four planned coach visits; however, no joint coach/therapist visits occurred. Sixty-day follow-up retention was 78%. However, baseline and follow-up performance-based primary outcome mobility assessments could be completed for only 55% of participants. Conclusions The trial was not feasible in its current form. Before progressing to a definitive trial, significant program redesign would be required to address issues affecting enrollment, coach/HHA/therapist coordination, and implementation of performance-based outcome measures. Trial registration ClinicalTrials.gov, NCT04840407 . Retrospectively registered on 9 April 202

Application of the Consolidated Framework for Implementation Research to examine nurses’ perception of the task shifting strategy for hypertension control trial in Ghana

Background: The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses’ perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. Methods: Focus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR). Results: Three themes emerged following deductive analysis using CFIR, including: (1) Patient health goal setting- relative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation. Conclusion: Assessing stakeholders’ perception of the TASSH implementation process guided by CFIR is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented. The feedback from the nurses informed barriers and facilitators to implementation of TASSH within the current healthcare system, and suggested system level changes needed prior to scale-up of TASSH to other regions in Ghana with potential for long-term sustainment of the task shifting intervention

Calorie Postings in Chain Restaurants in a Low-Income Urban Neighborhood: Measuring Practical Utility and Policy Compliance

Current strategies for combating obesity include recent federal legislation mandating calorie count postings in chain restaurants. This study describes the current practice of menu board calorie postings in a low-income urban neighborhood, identifies the extent to which current practice complies with existing policy, and evaluates the practical utility of menu boards to consumers. We conclude that although most postings were legally compliant, they did not demonstrate utility. Menu postings for individual servings are easily understood, but complex math skills are needed to interpret meals designed to serve more than one person. In some items, calories doubled depending on flavor and the calorie posting did not give enough information to make healthier selections. We identified specific strategies to improve practical utility and provide recommendations for policy implementation

Study protocol for comparing Screening, Brief Intervention, and Referral to Treatment (SBIRT) to referral as usual for depression in African American churches

Background Depression is a leading cause of disability worldwide. African American adults, compared to White adults, are half as likely to be screened for depression in primary care settings. Disparities in depression screening contribute to poor clinical outcomes, as African Americans with depression are more disabled and sicker longer compared to Whites. African American churches are trusted settings that provide access to supports for depression. Indeed, in the first study of its kind, the investigators found that 20% of adults in African American churches screened positive for depression using the Patient Health Questionnaire-9 (PHQ-9). However, no subjects with a positive screen (PHQ-9 ≥ 10) accepted a treatment referral when offered by research personnel. Community Health Workers, who are trusted paraprofessionals from the target community, may bridge the gap between depression screening and treatment. The investigators have trained and certified 112 Community Health Workers from 45 African American churches in New York City to deliver an evidence-based intervention called Screening, Brief Intervention, and Referral to Treatment (SBIRT). Thus, the aim of the current study is to test the impact of Community Health Worker-delivered depression screening in Black churches on engagement with clinical services. Methods Using a hybrid type 1 effectiveness-implementation design, we propose a 2-arm, mixed-methods cluster randomized controlled trial. Church study sites will be randomized to either SBIRT (intervention arm) or referral as usual (usual care arm). This trial will be conducted with 600 church members across 30 churches (300 intervention; 300 usual care). Our primary outcome is treatment engagement, defined as attending a depression-related clinical visit. Secondary outcomes will be changes in Mental Health-Related Quality of Life and depressive symptoms at 3 and 6 months post-screening. Lastly, we will conduct a concurrent, mixed-methods (qualitative-quantitative) process evaluation to assess contextual facilitators and barriers of screening and referral. Discussion This is the first randomized trial of a church-placed, community health worker-delivered intervention for depression in African American populations. This study may provide a novel and effective approach to increasing depression identification and treatment linkage in economically disadvantaged populations with high depression rates. Trial registration ClinicalTrials.gov NCT04524767 . Registered on 21 August 2020

Cilostazol for Secondary Stroke Prevention: History, Evidence, Limitations, and Possibilities

Cilostazol is a phosphodiesterase III inhibitor with a long track record of safety that is FDA and EMA approved for the treatment of claudication in patients with peripheral arterial disease. In addition, cilostazol has been approved for secondary stroke prevention in several Asian countries based on trials that have demonstrated a reduction in stroke recurrence among patients with non-cardioembolic stroke. The onset of benefit appears after 60–90 days of treatment, which is consistent with cilostazol’s pleiotropic effects on platelet aggregation, vascular remodeling, blood flow, and plasma lipids. Cilostazol appears safe and does not increase the risk of major bleeding when given alone or in combination with aspirin or clopidogrel. Adverse effects such as headache, gastrointestinal symptoms and palpitations, however, contributed to a 6% increase in drug discontinuation among patients randomized to cilostazol in a large secondary stroke prevention trial (CSPS.com). Due to limitations of prior trials, such as open label design, premature trial termination, large loss to follow-up, lack of functional or cognitive outcome data, and exclusive enrollment in Asia, the existing trials have not led to a change in clinical practice or guidelines in Western countries. These limitations could be addressed by a double-blind placebo-controlled randomized trial conducted in a broader population. If positive, it would increase the evidence in support of long-term treatment with cilostazol for secondary prevention in the millions of patients worldwide who have suffered a non-cardioembolic ischemic stroke

The impact of a novel tool for comprehensive assessment of palliative care (MPCAT) on assessment outcome at 6- and 12-Month Follow-Up.

peer-reviewedContext Assessment in palliative care settings should be focused, sensitive, specific, and effective to minimize discomfort to vulnerable and often highly morbid patients. This report describes the development of an admission assessment protocol for a Specialist Palliative Care Inpatient Unit and its implementation into clinical practice. Objectives The aim of this study was to develop and investigate the impact of the implementation of a Specialist Palliative Care admission assessment tool on documentation of key patient needs. Methods The outcome of a systematic literature review was used to develop an admission assessment protocol (the intervention) in a Specialist Palliative Care Inpatient Unit. Mixed methods were used to facilitate a comprehensive evaluation pre- and post-intervention to test the effectiveness, feasibility, and acceptability of the intervention. Results The documented evidence of pain assessment improved from a baseline rate of 71% to 100% post-intervention. This improvement was maintained 12 months post-introduction of the tool (P < 0.001). The documented evidence of screening for spiritual distress increased from a baseline rate of 23% to 70% at 6 months and to 82% at 12 months (P < 0.001). The number of referrals made in the first 24 hours after assessment increased post-intervention (physiotherapy, P = 0.001; occupational therapy, P = 0.001; social work, P = 0.005; pastoral care, P = 0.005); this was maintained at 12 months. Significantly, more clinicians (88%) agreed that palliative care domains were comprehensively assessed post-intervention in comparison with 59% pre-intervention (P = 0.01). Conclusion Introducing the Milford Palliative Care Assessment Tool was associated with significant improvement in assessment of multiple important aspects of patient need.ACCEPTEDpeer-reviewe