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Patient pathways and delays to diagnosis and treatment of tuberculosis in an urban setting in Indonesia.

Lancet Reg Health West Pac 2020 Dec 28;5:100059. Epub 2020 Nov 28.

Tuberculosis Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.

Background: Understanding patient pathways can help align patient preferences and tuberculosis (TB) related services. We investigated patient pathways, and diagnostic and treatment delays among TB patients in Indonesia, which has one of the highest proportions of non-notified TB cases globally.

Methods: We conducted a study of TB patients recruited from Community Health Centers (CHCs), public and private hospitals, and private practitioners from 2017 to 2019 in Bandung City, regarding general characteristics and symptoms, and health-seeking, diagnostic and treatment pathways. Read More

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December 2020

The Relationship Between Unemployment and Health Insurance Coverage: Before and After the Affordable Care Act's Coverage Expansions.

Med Care 2021 Jul 26. Epub 2021 Jul 26.

Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY The Hilltop Institute, University of Maryland Baltimore County, Baltimore, MD Division of Health, Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH.

Objective: The objective of this study was to determine whether the Affordable Care Act's (ACA) major coverage expansions mitigated the impact of unemployment on health insurance coverage status.

Data Source: A 2011-2019 versions of the American Community Survey developed by the University of Minnesota Integrated Public Use Microdata Series program.

Research Design: We use difference-in-difference-in-differences (ie, triple difference) regressions to compare changes in the short-run impacts of local unemployment rates before and after the ACA. Read More

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Evaluating Medicaid Expansion Benefits for Patients with Cancer: National Cancer Database Analysis and Systematic Review.

J Cancer Policy 2021 Sep 5;29. Epub 2021 Jun 5.

Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State Street, Suite 3300, Los Angeles, CA, 90033, USA.

Background: Insurance status modifies healthcare access and inequities. The Affordable Care Act expanded Medicaid coverage for people with low incomes in the United States. This study assessed the consequences of this policy change for cancer care after expansion in 2014. Read More

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September 2021

How Does Insurance Status Correlate With Trauma Mechanisms and Outcomes? A Retrospective Study at a Level 1 Trauma Center.

Am Surg 2021 Jul 14:31348211032592. Epub 2021 Jul 14.

Department of Surgery, 12255Tulane University School of Medicine, New Orleans, LA, USA.

Objective: Studies showed that a lack of insurance is associated with worse trauma outcomes. We examine insurance status and trauma mortality in a diverse metropolitan city and hypothesize that the higher risk of mortality in uninsured patients is due to insurance status and other factors.

Methods: A retrospective analysis of patients admitted to a Level 1 Trauma center for emergent surgery in a diverse metropolitan city from Jan 2016-May 2020 was conducted. Read More

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Health insurance enrollment strategies during the Affordable Care Act (ACA): a scoping review on what worked and for whom.

Arch Public Health 2021 Jul 12;79(1):129. Epub 2021 Jul 12.

Institute of Population Health Sciences, Queen Mary University of London, London, UK.

Background: The Affordable Care Act (ACA) provided an opportunity for millions of people in the U.S. to get coverage from the publicly funded Medicaid program or private insurance from the newly established marketplace. Read More

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Treatment and Survival Disparities of Colon Cancer in the Texas-Mexico Border Population: Cancer Disparities in Border Population.

J Surg Res 2021 Jul 4;267:432-442. Epub 2021 Jul 4.

Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address:

Background: Previous studies have reported healthcare disparities in the Texas-Mexico border population. Our aim was to evaluate treatment utilization and oncologic outcomes of colon cancer patients in this vulnerable population.

Methods: Patients with localized and regional colon cancer (CC) were identified in the Texas Cancer Registry (1995-2016). Read More

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The Other US Border: Health Insurance Coverage Among Latino Immigrants In Puerto Rico.

Health Aff (Millwood) 2021 Jul;40(7):1117-1125

Alexander N. Ortega is a professor in the Department of Health Management and Policy, Drexel University Dornsife School of Public Health.

Puerto Rico is a US territory and a popular destination for Latino immigrants in the Caribbean. Even with few language and cultural barriers, however, many Latino immigrants in Puerto Rico are uninsured. Using data from the 2014-19 Puerto Rico Community Survey, we examined inequities in health insurance coverage for non-Puerto Rican Latinos ages 18-64 living in Puerto Rico according to citizenship status and Latino subgroup (Dominican, Cuban, Mexican, and other Latino). Read More

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Factors Associated With Increased Emergency Department Utilization in Patients With Acute Optic Neuritis.

J Neuroophthalmol 2021 Jul 1. Epub 2021 Jul 1.

Saint Louis University School of Medicine (EM-F), St. Louis, Missouri; Department of Ophthalmology, Department of Neurology & Neurological Sciences at Stanford University (HM), Palo Alto, California; and Department of Neurology and Neurological Sciences (HM), Palo Alto, California.

Background: Symptoms of acute vision loss and eye pain may lead patients with optic neuritis to seek care in the emergency department (ED). Given the availability of lower cost alternatives for providing medical care for optic neuritis, this study aimed to identify factors associated with higher ED utilization.

Methods: Subjects with acute optic neuritis were identified through a chart review of adults with International Classification of Diseases-9 (ICD-9) or ICD-10 codes for optic neuritis with corresponding gadolinium contrast enhancement of the optic nerve on MRI in the medical record research repository of a tertiary care institution. Read More

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Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States.

Int J Environ Res Public Health 2021 06 4;18(11). Epub 2021 Jun 4.

Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, USA.

Palliative care improves quality-of-life and extends survival, however, is underutilized among gynecological cancer patients in the United States (U.S.). Read More

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Health Insurance Disruptions and Care Access and Affordability in the U.S.

Am J Prev Med 2021 Jul 24;61(1):3-12. Epub 2021 May 24.

Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia.

Introduction: Health insurance is associated with better care in the U.S., but little is known about the associations of coverage disruptions (i. Read More

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Increased Mortality in Underinsured Penetrating Trauma Patients.

Am Surg 2021 Jun 15:31348211024974. Epub 2021 Jun 15.

Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA.

Introduction: It remains unclear whether an increased mortality risk in uninsured patients exists across Injury Severity Score (ISS) classifications. We hypothesized that penetrating trauma self-pay patients would have a similarly increased mortality risk across all ISS categories.

Methods: The National Trauma Data Bank (2013-2015) was queried for patients presenting with penetrating firearm, explosive, or stab wound injuries. Read More

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Where are US outpatient mental health facilities that serve children with autism spectrum disorder? A national snapshot of geographic disparities.

Autism 2021 Jun 12:13623613211024046. Epub 2021 Jun 12.

Harvard Medical School, USA.

Lay Abstract: There has been a rise in the observed prevalence of autism spectrum disorder among children. Existing studies show the share of counties with a treatment facility that offers care for children with autism spectrum disorder. However, no estimates exist of the share of US outpatient mental health treatment facilities that provide services for children with autism spectrum disorder. Read More

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HPV Vaccination Trends and Disparities in the United States - Who Is Getting Left Behind?

Sex Transm Dis 2021 Mar 12. Epub 2021 Mar 12.

1California Pacific/Palo Alto Medical Foundation Research Institute 2Palo Alto Medical Foundation Research Institute 3California Pacific Medical Center Research Institute 4University of California, San Francisco School of Medicine 5Department of Radiation Oncology, Stanford University School of Medicine.

Background: US guidelines recommend human papillomavirus (HPV) vaccination for males and females up to 26, with more recent extended coverage for those 27-45 years based on discussion with patients' clinician. This study seeks to assess trends and disparities of vaccination in the United States based on demographic characteristics.

Methods: Data was obtained from the National Health and Nutrition Examination Survey between 2007 and 2016. Read More

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Demographic Factors Associated With Non-Guideline-Based Treatment of Kidney Cancer in the United States.

JAMA Netw Open 2021 Jun 1;4(6):e2112813. Epub 2021 Jun 1.

Department of Urology, University of Texas Southwestern Medical Center, Dallas.

Importance: Significant demographic disparities have been found to exist in the delivery of health care. Demographic factors associated with clinical decision-making in kidney cancer have not been thoroughly studied.

Objective: To determine whether demographic factors, including sex and race/ethnicity, are associated with receipt of non-guideline-based treatment for kidney cancer. Read More

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Disparities in Medical Debt Among U.S. Adults with Serious Psychological Distress.

Health Equity 2020 30;4(1):549-555. Epub 2020 Dec 30.

Department of Health Professions, Hofstra University, Hempstead, New York, USA.

To examine indebtedness for medical care among racial and ethnic minorities and people with serious psychological distress (SPD) using a nationally representative sample in the United States. Using the 2014-2017 Medical Expenditure Panel Survey, we examine medical debt among individuals with SPD. We develop a logistic regression model to estimate the odds of medical debt by SPD status. Read More

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December 2020

A systematic review of dental-related emergency department among Medicaid beneficiaries.

J Public Health Dent 2021 Jun 2. Epub 2021 Jun 2.

CareQuest Institute for Oral Health, Boston, MA, USA.

Objectives: Dental-related emergency department (ED) visits are a growing public health concern. Dental insurance coverage is a strong predictor of dental service access. The objective of this study was to conduct a systematic review to assess the incidence of dental-related ED visits for Medicaid dental enrollees compared to those with other insurances. Read More

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Patients with an increased time to treatment initiation have a poorer overall survival after definitive surgery for localized high-grade soft-tissue sarcoma in the extremity or trunk : report from the National Cancer Database.

Bone Joint J 2021 Jun;103-B(6):1142-1149

Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

Aims: Time to treatment initiation (TTI) is generally defined as the time from the histological diagnosis of malignancy to the initiation of first definitive treatment. There is no consensus on the impact of TTI on the overall survival in patients with a soft-tissue sarcoma. The purpose of this study was to determine if an increased TTI is associated with overall survival in patients with a soft-tissue sarcoma, and to identify the factors associated with a prolonged TTI. Read More

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Health Insurance Payer Type and Ethnicity Are Associated with Cancer Clinical Trial Enrollment Among Adolescents and Young Adults.

J Adolesc Young Adult Oncol 2021 May 19. Epub 2021 May 19.

Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Adolescents and young adults (AYAs) have experienced inferior improvements in cancer survival outcomes. One potential explanation is the low rate of enrollment in cancer clinical trials. While the reasons behind this are multifactual, sociodemographic factors are probably contributory. Read More

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Patient Characteristics Associated With Admission to Low-Safety Inpatient Psychiatric Facilities: Evidence for Racial Inequities.

Morgan C Shields

Psychiatr Serv 2021 May 17:appips202000657. Epub 2021 May 17.

Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.

Objective: The author examined patient demographic, clinical, payment, and geographic factors associated with admission to low-safety inpatient psychiatric facilities.

Methods: Massachusetts all-payer 2017 discharge data (N=39,128 psychiatric patients) were linked to facility-level indicators of safety (N=38 facilities). A composite of safety was created by averaging standardized measures of restraint and seclusion as well as 5-year averages of overall, substantiated, and abuse-related (i. Read More

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County-level demographic, social, economic, and lifestyle correlates of COVID-19 infection and death trajectories during the first wave of the pandemic in the United States.

Sci Total Environ 2021 Sep 3;786:147495. Epub 2021 May 3.

University of Louisville School of Public Health and Information Sciences, Department of Health Management and System Sciences, United States of America.

Background: The US COVID-19 epidemic impacted counties differently across space and time, though large-scale transmission dynamics are unclear. The study's objective was to group counties with similar trajectories of COVID-19 cases and deaths and identify county-level correlates of the distinct trajectory groups.

Methods: Daily COVID-19 cases and deaths were obtained from 3141 US counties from January through June 2020. Read More

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September 2021

Providing comprehensive contraceptive services in primary care at a rural Federally Qualified Health Center in the USA: adapting to patient need in a culturally conservative, rural environment.

Rural Remote Health 2021 05 9;21(2):6308. Epub 2021 May 9.

Workforce, DeBeaumont Foundation, 7501 Wisconsin Avenue, Bethesda, MD 20814, USA

Introduction: In the USA, approximately 45% of pregnancies are unintended. Accessing quality contraceptives can be a barrier for some individuals, especially low-income, uninsured, minority or younger women. These problems are exacerbated in rural areas{1}. Read More

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The effect of expanded insurance coverage under the Affordable Care Act on emergency department utilization in New York.

Am J Emerg Med 2021 Apr 30;48:183-190. Epub 2021 Apr 30.

Population Informatics Lab, Texas A&M University, College Station, TX, USA; Texas A&M University, School of Public Health, Department of Health Policy & Management, College Station, TX, USA.

Background: One of the proposed benefits of expanding insurance coverage under the Affordable Care Act (ACA) was a reduction in emergency department (ED) utilization for non-urgent visits related to lack of health insurance coverage and access to primary care providers. The objective of this study was to estimate the effect of the 2014 ACA implementation on ED use in New York.

Methods: We used the Healthcare Cost and Utilization Project State Emergency Department and State Inpatient Databases for all outpatient and all inpatient visits for patients admitted through an ED from 2011 to 2016. Read More

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Patterns of cost-related medication underuse among Canadian adults with cancer: a cross-sectional study using survey data.

CMAJ Open 2021 Apr-Jun;9(2):E474-E481. Epub 2021 May 6.

Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alta.

Background: Cost-related medication underuse (CRMU) has been reported within the general population in Canada. In this study, we assessed patterns of CRMU among Canadian adults with cancer.

Methods: This is a cross-sectional study using survey data. Read More

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Financial Toxicity in Patients with Brain and Spine Metastases.

World Neurosurg 2021 Jul 30;151:e630-e651. Epub 2021 Apr 30.

Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California, USA. Electronic address:

Objective: Financial toxicity associated with cancer treatment has a deleterious impact on patient outcomes but has not been well characterized among patients with metastatic cancers. We characterize the extent of financial toxicity among this population and identify factors associated with financial toxicity.

Methods: We prospectively surveyed adult patients with brain and spine metastases who received radiosurgery at a large academic medical center between January 2018 and December 2019. Read More

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Characteristics and overall survival in pediatric versus adult pituitary adenoma: a National Cancer Database analysis.

Pituitary 2021 Apr 30. Epub 2021 Apr 30.

Department of Otolaryngology-Head and Neck Surgery, University of California, 101 The City Drive South, Irvine, Orange, CA, 92868, USA.

Objective: Pituitary adenomas in the pediatric population are extremely rare, resulting in limited information in the literature on these patients. In this study, data from the National Cancer Database (NCDB) to compare pituitary adenoma clinical presentations, treatment management patterns, and overall survival between pediatric and adult patients.

Methods: The NCDB was queried for all cases of histologically confirmed pituitary adenoma treated between 2004 and 2015. Read More

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Plastic and reconstructive surgeons' views of a single payer health care system: Implications for patients and practice.

J Plast Reconstr Aesthet Surg 2021 Mar 24. Epub 2021 Mar 24.

Weill Cornell Medical College/NewYork-Presbyterian Hospital, 1300 York Avenue, New York, NY 10065 USA. Electronic address:

Background: Rising health care costs and the high number of uninsured Americans has led to the increasing popularity of a single payer alternative. While opinions of physicians at large have been studied, we present the first data examining the views of United States (U.S. Read More

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Private Health Insurance in Malaysia: Who Is Left Behind?

Asia Pac J Public Health 2021 Apr 14:10105395211000913. Epub 2021 Apr 14.

Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia.

Despite various efforts introduced, private health insurance coverage is still low in Malaysia. The objective of this article is to find the factors associated with not having a private health insurance in Malaysia. We analyze data involving 19 959 respondents from the 2015 National Health Morbidity Survey. Read More

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Trends in Emergency Department Utilization Among Women With Leiomyomas in the United States.

Obstet Gynecol 2021 05;137(5):897-905

Division of Reproductive Endocrinology and Infertility and the Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, and the Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan.

Objective: To describe trends in emergency department (ED) visits in the United States with a primary diagnosis of leiomyomas, subsequent admissions, and associated charges.

Methods: The Healthcare Cost and Utilization Project Nationwide Emergency Department Sample database was used to retrospectively identify all ED visits from 2006 to 2017 among women aged 18-55 years with a primary diagnosis of leiomyomas as indicated by International Classification of Diseases (ICD) diagnosis codes. Trends in ED visits and subsequent admissions were analyzed and stratified by patient and hospital characteristics. Read More

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Patient Awareness and Clinical Inertia: Obstacles to Hypertension Control in Rural Communities in the Dominican Republic.

Am J Hypertens 2021 Apr 5. Epub 2021 Apr 5.

Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.

Background: Many obstacles exist for adequate hypertension control, including low individual awareness and clinical inertia (CI). In this study, we aimed to determine hypertension prevalence, awareness, treatment and control among community residents of rural areas of Peravia in Dominican Republic, followed by an assessment of CI in their primary care clinics (PCC).

Methods: We interviewed 827 adults from 8 rural communities of Peravia. Read More

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