J Natl Med Assoc
-
Recently, in the United States, there has been a strong effort to increase representation of members of social groups underrepresented in medicine (URiM). Experiences of discrimination among URiM group members, including women and people of color, have negative effects on their health and well-being and drive further underrepresentation. Here we report results of a qualitative research study designed to characterize Black female physicians' experiences of discrimination related to their identities both as women and people of color, in medical education and the practice of medicine. ⋯ Black female physicians report experiencing damaging discrimination with few effective intervention efforts in tAheir medical training and workplaces. There is need for more research and evaluation of interventions to reduce discrimination at all levels of education and training.
-
Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes (T1D). In established T1D patients, DKA is frequently a result of insulin omission or inadequate insulin administration during illness or stress. Ethnic minorities and patients with lower socioeconomic status are affected disproportionately. We hypothesized that implementation of intensive sick day rules with frequent reinforcement would reduce hospitalizations secondary to DKA in T1D youth irrespective of their demographics. ⋯ Implementation of intensive sick day rules led to a decrease in total number of DKA admissions in our population with T1D youth. However, this intervention did not reduce the health disparity in this population and African-Americans on Medicaid insurance continued to form the disproportionate majority of admissions with DKA. This study highlights the need for further research into interventions that can improve outcomes across racial and socio-economic barriers.
-
The exponential growth in CT utilization in emergency department (ED) until 2008 raised concerns regarding cost and radiation exposure. Head CT was one of the commonest studies. This led to mitigating efforts such as appropriate use guidelines, policy and payment reforms. The impact of these efforts is not fully understood. In addition, disparities in outcomes of acute conditions presenting to the ED is well known however recent trends in imaging utilization patterns and disparities are not well understood. In this study, we describe nationwide trends and disparities associated with head CT in ED settings between 2007 and 2014. ⋯ Previously reported exponential growth of CT use in ED is no longer seen. In particular, there was no significant change in ED head CT use between 2007 and 2017. Headache and Dizziness remain commonly used indications despite limited utility in most clinical scenarios, indicating continued need for appropriate use of imaging. There is significantly lower CT utilization in Non-Hispanic Black, Medicaid patients and those in rural locations, suggesting disparities in diagnostic work-up in marginalized and rural populations. This underscores the need for standardizing care regardless of race, insurance status and location.
-
Structural racism plays a significant role in limited access to higher education, financial resources, employment opportunities, and high-quality healthcare for African Americans. The lack of healthcare equity and infrastructure has directly contributed to overall poor healthcare outcomes for the Black community. Studies have shown that adverse health outcomes such as sexually transmitted diseases (STDs) are more prevalent in African Americans, regardless of their socioeconomic factors and lifestyles. ⋯ Our review showcases the impact of trichomoniasis on the health of the Black community with an emphasis on African American women. A critical examination of the socio-demographic history of Black people in the United States (US) is vital to illustrate the origin of past and current racial health disparities. Further, we expand the complex and nuanced conversation on the intersectionality of racism, health equity, and innovative epidemiological and biomedical research strategies needed to eradicate this global public health threat.
-
Acral lentiginous melanoma (ALM) is an aggressive subtype of cutaneous malignant melanomas that accounts for 50-80% of melanomas in ethnic minorities. Studies on the genetic profile of these tumors largely result from cohorts in Europe, Asia, and Latin America, few inclusive of Black patients. ⋯ Response to targeted and immunologic therapies in ALM patients was overwhelming poor, particularly in BRAF V600E-mutated tumors in contrast to the positive prognosis associated with BRAF V600E mutations in other advanced cutaneous melanoma subtypes.