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Aim: International child sponsorship programmes comprise a considerable proportion of global aid accessible to the general population. Team Philippines (TP), a health care and welfare initiative run in association with the University of Notre Dame Sydney since 2013, leads a holistic sponsorship programme for 30 children from Calauan, Philippines. To date, empirical research has not been performed into the overall success and impact of the TP child sponsorship programme. As such, this study aims to evaluate its effectiveness in improving paediatric outcomes. Methods: Study cohorts comprised 30 sponsored and 29 age‐ and gender‐matched non‐sponsored children. Data were extracted from the TP Medical Director database and life‐style questionnaires for July–November 2019. Outcome measures included anthropometry, markers of medical health, dental health, exercise, and diet. Statistical analyses were performed in SPSS. Results: Sponsorship resulted in fewer medical diagnoses and prescription medications, superior dental health, and improved diet. Further, sponsored children may show a clinically significant trend towards improved physical health. Sponsorship did not affect growth and development metrics, or levels of physical activity. Conclusions: The TP child sponsorship programme significantly impacts positive paediatric health outcomes in the Calauan community. The strength of the programme lies in its holistic, sustainable, and community‐based model, which is enabled by effective international child sponsorship. This study further supports the relationship between supporting early livelihood and improved health in the paediatric population. [ABSTRACT FROM AUTHOR]

Background: Huntington's disease (HD) is an autosomal dominant neurodegenerative disease that predominantly impacts a Caucasian population, but few efforts have explored racial differences in presentation and progression. Objective: The aim was to assess the presentation and progression of HD across race groups using the Enroll‐HD longitudinal observational study. Methods: We applied propensity score matching for cytosine–adenine–guanine age product score, and age, to identify White, Hispanic, Asian, and Black participants from the Enroll‐HD database. We compared clinical presentations at baseline, and progression over time, using White participants as a control cohort. Results: Black participants were more severe at baseline across all clinical measures. No significant differences in progression were observed between race groups. Conclusions: We consider the factors driving clinical differences at baseline for Black participants. Our data emphasize the necessary improvement in underrepresented minority recruitment for studies of rare diseases. © 2023 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

The article looks at the factors to consider to facilitate participation in headache medicine research among underrepresented groups in the U.S. Topics discussed include the emergence of African Americans as the groups that are less likely to access the medical system for treatment of headache, requirement for clinical trials funded by the National Institutes of Health (NIH) to include participants of diverse race, and role of implicit biases in inadequate access to migraine treatment.

Background: The purpose of this study was to examine the factors associated with disparities in overall survival (OS) by race in pediatric diffuse large B‐cell lymphoma (DLBCL) patients. Methods: We evaluated clinical features and survival among patients ≤21 years of age diagnosed with stage I–IV DLBCL from 2004 to 2014 from the National Cancer Database (NCDB) using a multivariable Cox proportional hazards model. Results: Among 1386 pediatric patients with DLBCL, 1023 patients met eligibility criteria. In unadjusted analysis, Black patients had a significantly higher overall death rate than White patients (HRBlack vs. White 1.51; 95% CI: 1.02–2.23, p = 0.041). The survival disparity did not remain significant in adjusted analysis, though controlling for covariates had little effect on the magnitude of the disparity (HR 1.46; 95% CI 0.93–2.31, p = 0.103). In adjusted models, presence of B symptoms, receipt of chemotherapy, stage of disease, and Other insurance were significantly associated with OS. Specifically, patients with B symptoms and those with Other insurance were more likely to die than those without B symptoms or private insurance, respectively (HR 1.75; 95% CI 1.22–2.50, p = 0.002) and (HR 2.56; 95% CI, 1.39–4.73, p = 0.0027), patients who did not receive chemotherapy were three times more likely to die than those who received chemotherapy (HR 3.10; CI 1.80–5.35, p < 0.001), and patients who presented with earlier stage disease were less likely to die from their disease than those with stage IV disease (stages I–III HR 0.34, CI 0.18–0.64, p < 0.001; HR 0.50, CI 0.30–0.82, p = 0.006, HR 0.72, CI 0.43–1.13, p = 0.152, respectively). Conclusions: Our results suggest that racial disparities in survival may be mediated by clinical and treatment parameters. [ABSTRACT FROM AUTHOR]

Background: No prior research studied how to implement patient‐centred care (PCC) for migrant women, who face inequities in health‐care quality. This study explored migrant women's views about what constitutes PCC and how to achieve it. Design: We conducted a qualitative study involving three focus groups with migrant women living in Toronto, Canada, recruited from English language classes at a community settlement agency, used constant comparative technique to inductively analyse transcripts and interpreted themes against a published PCC framework. Participants: Twenty‐three migrant women aged 25‐78 from 10 countries participated. Results: Women articulated 28 physician behaviours important to them across six PCC domains: foster a healing relationship, exchange information, address concerns, manage uncertainty, share decisions and enable self‐care. They emphasized the PCC domain of exchanging information, which included 13 (46.4%) of 28 behaviours: listen to reason for visit, ask questions, provided detailed explanations, communicate clearly, ensure privacy and provide additional information. Women said that instead of practising these behaviours, physicians rushed through discussions, and ignored or dismissed their concerns and questions. As a result, women said that physicians may not fully understand their problem, and they may refrain from stating important details or avoid seeking care. Conclusions: This research characterized the lack of PCC experienced by migrant women and revealed specific physician behaviours to optimize PCC for migrant women. Research is needed to develop and evaluate the impact of strategies targeted at migrant women, physicians and health‐care systems to support PCC for migrant women. [ABSTRACT FROM AUTHOR]

Objectives: Impact of implementing data‐driven performance metric‐tracking across a 10‐dental center infrastructure established by Family Heath Center of Marshfield (FHC‐M) was examined for relative impact on achieving value‐based care delivery in serving a patient population characterized by 88% Medicaid representation. Methods: To track progress toward national benchmarks for preventive care delivery, dental quality analytics dashboard tracking was implemented in real time with sharing of performance metrics across centers. Compliance rate with Uniform Data Systems reporting requirements for sealant placement on permanent first molars in children aged 6‐9 years of age at moderate‐to‐high risk of caries was targeted at FHC‐M dental centers for comparison with those of other community health centers statewide and nationally. Hygienist‐to‐dentist ratio to support robust sealant placement capacity was further examined. Results: Uniform Data Systems data for rate of sealant placement between 2016‐2018 revealed that FHC‐M consistently exceeded rates reported statewide and nationally. For this quality indicator, performance across all dental practices in 27 states reported by Centers for Medicare and Medicaid Services in 2018 achieved 23% in 2017 compared to 73% and 52% placement rates reported by FHC‐M and community health centers, respectively. A 1:1 hygienist‐to‐dentist was documented across FHC‐M dental centers compared to 0.5:1 reported nationally. Conclusions: Implementation of quality metric dashboard and a 1:1 dentist‐to‐hygienist ratio supported realization of value‐based dental care delivery relative to caries prevention in a moderate‐to‐high risk pediatric Medicaid population through achievement of robust sealant placement. Importance of adequate hygienist staffing, "same day" sealant placement and performance feedback supported by technology are highlighted. [ABSTRACT FROM AUTHOR]

Background: Women face challenges when accessing abortion, including varied legislation and reduced access to services in rural and remote settings. There are limited clinical guidelines in Australia and little information regarding the patient journey, particularly the timeframe between referral to abortion procedure. Legislation reform in the Northern Territory (NT) legalised early medical abortion (EMA) in primary health care, providing an opportunity to review service provision of elective surgical abortion prior to and after these changes. Aims: To review the waiting time to access abortion, percentage eligible for EMA based on ultrasound gestation alone, percentage of Indigenous women accessing abortion in the NT and the effects of the legislation change. Materials and Methods: Retrospective audit‐analysed surgical abortion data from 354 patient files who underwent suction curettage of uterus between 2012–2017 in one NT public hospital. Results: Mean wait‐time ranged from 20 to 22 days in 2012–2016 and dropped to 15 days in 2017 following the law reform. Sixty‐two percent of women waited longer than that in the recommended clinical guidelines. Indigenous women represented approximately 25% of patients accessing surgical abortion services. Average gestation at surgical abortion procedure increased following reform. Prior to reform up to 95% of patients accessing surgical abortion would have been eligible for EMA at time of referral. Conclusions: Results demonstrate potential for changes in service provision of abortion in the NT with increased choice, patient‐centred care and reduced waiting times. This audit demonstrated the possibility to move the majority of abortion services into primary health care leading to cost savings. [ABSTRACT FROM AUTHOR]

Dr. David Satcher issued the first Surgeon General Report on oral health in the United States in 2000, drawing attention to a prevailing oral health access crisis. Dr. Satcher's report resonated in Wisconsin where a statewide growing dental access crisis was in progress and inspired grassroots efforts by a Family Health Center to establish a practice-based multi-site dental infrastructure that was integrated into a large regional multi-specialty medical clinic serving a largely rural population. An overview is provided of fundamental elements and relationships that supported establishment of the infrastructure, services, outreach and expanded access offered inclusively to all patients. Further, this community action report presents a blueprint that delineates key dimensions critical to planning and establishing a regionalized infrastructure offering access to all patients. Feasibility of establishing inclusive dental care is documented, and our model is proposed as a potentially replicable prototype for increasing dental access across other federally qualified health centers. Finally, this report is responsive to Dr. Jerome Adam's solicitations for feedback that will inform his plan for issuing a new Surgeon General report that updates status of oral health in America and progress in reversing oral health access disparities. [ABSTRACT FROM AUTHOR]

Aims: To estimate the cost‐effectiveness at population‐level of the OPT‐IN proactive tobacco cessation outreach program for adult smokers enrolled in publicly funded health insurance plans for low‐income persons (e.g. Medicaid). Design Cost‐effectiveness analysis using a state transition model based on data from the Offering Proactive Treatment Intervention (OPT‐IN) randomized control trial. Setting: The trial was conducted in Minnesota, USA, and the economic analysis was conducted from the Medicaid program perspective. Participants: Data were used from 2406 smokers who were randomized into the intervention or comparator groups. Intervention and comparator: The intervention was comprised of proactive outreach (mailed invitation and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive telephone counseling). The comparator was usual care, which comprised access to a primary care physician, insurance coverage of Food and Drug Administration (FDA)‐approved smoking cessation medications and the state's telephone quitline. Measurements: Smoking status, quality of life and health‐care use at varying times, including at baseline and 1 year. Findings The OPT‐IN program cost an average of $84 per participant greater than the comparator. One year after randomization, the population‐level, 6‐month prolonged smoking abstinence rate was 16.5% in the proactive outreach intervention group and 12.1% in the usual care group (P < 0.05). The model projected that the proactive outreach intervention added $78 in life‐time cost and generated 0.005 additional quality‐adjusted life‐years (QALYs), with an expected incremental cost‐effectiveness ratio of $4231 per QALY. Probabilistic sensitivity analysis found that the proactive outreach intervention would be cost‐effective against a willingness‐to‐pay threshold of $50 000/QALY approximately 68% of the time. Conclusions: Population‐level proactive tobacco treatment with personal telephone outreach was effective in achieving higher population‐level quit rates and was cost‐effective at various willingness‐to‐pay thresholds, compared with usual care (i.e. reactive treatment). Taken together with prior research, population‐level proactive tobacco cessation outreach programs are judged to be highly cost‐effective over the long term. [ABSTRACT FROM AUTHOR]

Objective: To explore service providers’ perceptions in order to identify barriers and facilitators to effective coverage of Intimate Partner Violence (IPV) services for immigrant women in Spain, according to the different categories proposed in Tanahashi's model of effective coverage. Methods: A qualitative study based on 29 in‐depth personal interviews and four group interviews with a total of 43 professionals working in public services (social and health‐care services, women's refuges, the police force, the judiciary) and NGOs in Barcelona, Madrid, Valencia and Alicante (Spain) in 2011. Findings: Current IPV services in Spain partially fail in their coverage of abused immigrant women due to barriers of (i) availability, such as the inexistence of culturally appropriate services; (ii) accessibility, as having a residence permit is a prerequisite for women's access to different services and rights; (iii) acceptability, such as women's lack of confidence in the effectiveness of services; and (iv) effectiveness, for example, lack of specific training among professionals on the issues of IPV and immigration. However, interviewees also identified facilitators, such as the enabling environment promoted by the Spanish Law on Gender‐Based Violence (1/2004), and the impetus it has provided for the development of other specific legislative tools to address IPV in immigrant populations in Spain (availability, accessibility and effectiveness). Conclusion: Whilst not dismissing cultural barriers, aspects related to service structure are identified by providers as the main barriers and facilitators to immigrant women use of IPV services. Despite noteworthy achievements, improvements are still required in terms of mainstreaming assistance tailored to immigrant women's needs in IPV policies and services. [ABSTRACT FROM AUTHOR]

Objective: To examine whether there are individual level factors such as socio‐economic status that may predict disparities in the public's experiences with and expectations of their health‐care providers. Data sources/study setting: Primary data were collected in 2010. The sample comprised of 1211 Israeli citizens above the age of 18. Study design: Participants were randomly approached at one points in time and presented with statements regarding practices they experience and practices that are important to them related to primary care, preventive care and health promotion. We calculated a difference scores for each health‐care area. We measured socio‐economic status (SES) with three separate variables relating to income, education and living location. Data collection/extraction methods: Employees of a professional telephone survey firm conducted the survey. Multiple regression was used with the responsiveness gap in each of three health‐care areas as the dependent variables. Principal findings: We found that level of education is negatively related to the extent of the responsiveness gap in both primary and preventive health care and that income is negatively related to the responsiveness gap in health promotion. Conclusions: Personal characteristics such as SES are related to people's perceptions about the extent of the responsiveness gap. Policy makers can now expend efforts and resources in minimizing such responsiveness gaps among specific populations. [ABSTRACT FROM AUTHOR]

The article presents the research that investigates the racial differences of oncologists and White and African American patients, the attributing factors on the minimal enrollment of minority races during clinical trials, and effectiveness of real-time recruitment studies in the identification of racial disparities on communication.

Objectives/Hypothesis: The objectives of this work were to quantify the involvement of US otolaryngology residency programs in global health endeavors, identify goals and services provided, and determine the participation of residents and fellows. Study Design: Cross-sectional survey of US otolaryngology faculty. Methods: A 10-point online questionnaire was distributed to 103 US otolaryngology residency program directors; all faculty involved in global health volunteerism were invited to participate. Results: Twenty-nine global health initiatives were represented. Most of the 24 residency programs involved (66%) had organized global health offices at their institutions; only 4% actually cooperated with these offices. Most often, only one attending (55%) was involved at each institution. Residents/fellows participated 65% of the time. Abroad, US otolaryngologists worked with freestanding hospitals or clinics (24%), American nongovernmental organizations (17%), academic centers (14%), and remote locations (14%). Most (96%) provided specialty surgical services, but some provided primary care (28%) and general surgical services (14%); 72% trained foreign surgeons. Most respondents (79%) reported that the clinical work done abroad was substantial enough for Accreditation Council for Graduate Medical Education (ACGME) standards. Only one fifth of respondents knew the name of the nearest otolaryngology training institution. Humanitarian aid was the most prevalent goal (100%), followed by resident/fellow exchange (45%) and faculty exchange (21%). Conclusions: At least a quarter of US otolaryngology residency programs engage in global health volunteerism. Most do not utilize institutional global health resources and are unaware of otolaryngology training programs abroad. There may be a role for global health education within the ACGME competency of systems-based practice. Laryngoscope, 2012 [ABSTRACT FROM AUTHOR]

This article provides highlights of a lecture, titled Community-based Participatory Research: A Culturally Focused Case Study, given at the Japan Academy of Nursing Science's 29th annual meeting in Chiba, Japan on 28 November 2009. Community-based participatory research (CBPR) is defined as research that includes both the researcher and the participant group in collaborative, egalitarian, and partnership processes to assess, define, problem-solve, evaluate, and disseminate an issue that is chosen by the stakeholders. A CBPR framework is highlighted and case-study examples from each stage are included. The barriers and facilitators for communities and researchers taking part in CBPR projects are described. Strategies to improve researcher competence in CBPR are listed. Community-based participatory research can be very fulfilling when incorporated into a faculty member's teaching, research, and service to the community. [ABSTRACT FROM AUTHOR]

This study assessed the geographic distribution of dentists in Kentucky, determined socioeconomic correlates of practice location, estimated the future availability of dental providers, and made policy recommendations that could improve access to oral health care in Kentucky and other rural states. Dentists' addresses were mapped using a geographic information system. Poisson regression modeling and geospatial analyses were conducted using SAS v9.1 (SAS Institute, Cary, NC, USA) and ArcGIS v9.2 (Environmental Systems Research Institute Inc., Redlands, CA, USA), respectively. Data on the number of dentists ( n = 2,391) per county ( n = 120) were used for the regression models. Explanatory variables included: per capita income, 2006 intercensal population estimates, percent adults with six or more teeth removed, percent population uninsured, physician-to-population ratios, and region type. A simulation model was used to project dentist-to-population ratios to the year 2016. The dental workforce analysis revealed disparities in the distribution of dentists between rural, urban, and Appalachian Kentucky counties. Dentists were more likely to be found practicing in areas with higher income and higher physician-to-population ratios. Compounding this geographic maldistribution, our projections suggest that the number of dentists per unit population will decrease over time in the near future, likely widening this disparity in rural and underserved areas. These results show present and widening workforce disparities in rural and socioeconomically depressed counties in Kentucky. Understanding the geographic distribution of dentists and the socioeconomic correlates of their practice locations may inform workforce development and reimbursement policies for the goal of improving access to oral health care in these areas. [ABSTRACT FROM AUTHOR]

Objective.—Evaluate whether, in a primary care setting, Caucasians (C) and African Americans (AA) with moderately to severely disabling migraines differed in regards to: utilizing the health-care system for migraine care, migraine diagnosis and treatment, level of mistrust in the health-care system, perceived communication with their physician, and perceived migraine triggers. Background.—Research has documented ethnic disparities in pain management. However, almost no research has been published concerning potential disparities in utilization, diagnosis, and/or treatment of migraine. It is also important to consider whether ethnic differences exist for trust and communication between patients and physicians, as these are essential when diagnosing and treating migraine. Methods.—Adult patients with headache (n = 313) were recruited from primary care waiting rooms. Of these, 131 (AA = 77; C = 54) had migraine, moderate to severe headache-related disability, and provided socioeconomic status (SES) data. Participants completed measures of migraine disability (MIDAS), migraine health-care utilization, diagnosis and treatment history, mistrust of the medical community, patient–physician communication (PPC), and migraine triggers. Analysis of covariance (controlling for SES and recruitment site), chi-square, and Pearson product moment correlations were conducted. Results.—African Americans were less likely to utilize the health-care setting for migraine treatment (AA = 46% vs. C = 72%, P < .001), to have been given a headache diagnosis (AA = 47% vs. C = 70%, P < .001), and to have been prescribed acute migraine medication (AA = 14% vs. C = 37%, P < .001). Migraine diagnosis was low for both groups, and <15% of all participants had been prescribed a migraine-specific medication or a migraine preventive medication despite suffering moderate to severe levels of migraine disability. African Americans had less trust in the medical community ( P < .001, η2= 0.26) and less positive PPC ( P < .001, η2= 0.11). Also, the lower the trust and communication, the less likely they were to have ever seen (or currently be seeing) a doctor for migraine care or to have been prescribed medication. Conclusions.—Migraine utilization, diagnosis, and treatment were low for both groups. However, this was especially true for African Americans, who also reported lower levels of trust and communication with doctors relative to Caucasians. The findings highlight the need for improved physician and patient education about migraine diagnosis and treatment, the importance of cultural variation in pain presentation, and the importance of communication when diagnosing and treating migraine. [ABSTRACT FROM AUTHOR]

To examine the extent to which doctors' rational reactions to clinical uncertainty (“statistical discrimination”) can explain racial differences in the diagnosis of depression, hypertension, and diabetes.Main data are from the Medical Outcomes Study (MOS), a 1986 study conducted by RAND Corporation in three U.S. cities. The study compares the processes and outcomes of care for patients in different health care systems. Complementary data from National Health And Examination Survey III (NHANES III) and National Comorbidity Survey (NCS) are also used.Across three systems of care (staff health maintenance organizations, multispecialty groups, and solo practices), the MOS selected 523 health care clinicians. A representative cross-section (21,480) of patients was then chosen from a pool of adults who visited any of these providers during a 9-day period.We analyzed a subsample of the MOS data consisting of patients of white family physicians or internists (11,664 patients). We obtain variables reflecting patients' health conditions and severity, demographics, socioeconomic status, and insurance from the patients' screener interview (administered by MOS staff prior to the patient's encounter with the clinician). We used the reports made by the clinician after the visit to construct indicators of doctors' diagnoses. We obtained prevalence rates from NHANES III and NCS.We find evidence consistent with statistical discrimination for diagnoses of hypertension, diabetes, and depression. In particular, we find that if clinicians act like Bayesians, plausible priors held by the physician about the prevalence of the disease across racial groups could account for racial differences in the diagnosis of hypertension and diabetes. In the case of depression, we find evidence that race affects decisions through differences in communication patterns between doctors and white and minority patients.To contend effectively with inequities in health care, it is necessary to understand the mechanisms behind the problem. Discrimination stemming from prejudice is of a very different character than discrimination stemming from the application of rules of conditional probability as a response to clinical uncertainty. While in the former case, doctors are not acting in the best interests of their patients, in the latter, they are doing the best they can, given the information available. If miscommunication is the culprit, then efforts should be aimed at reducing disparities in the ways in which doctors communicate with patients. [ABSTRACT FROM AUTHOR]