J Natl Med Assoc
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The African American (AA) community in Washington DC is at an elevated risk for hepatocellular carcinoma (HCC) that has a dismal prognosis. The recent rapid increase in the incidence and diagnosis of HCC and liver metastases (LM) in DC prompted us to evaluate the past six decades of this incidence and some of its underlying causes using a single institutional cohort in a hospital located in the center of the city. Electronic medical and pathology records of 454 liver cancer patients from 1959 to 2013 at Howard University Hospital (HUH) were reviewed. ⋯ Cases of liver metastases clinically diagnosed and confirmed by biopsies increased 96.4% from 1959 to 1968 to 2009-2013. This study confirms that HCC incidence has been increasing (initially driven by HCV, and NAFLD in the latter decades) more rapidly in DC than previously believed, highlighting the impact of case definitions especially regarding NAFLD in the context of changing diagnostic approaches including the revised ICD10. The rising burden, disproportionate population distribution, and low survival rate among AAs emphasize the importance of prevention and early detection as a public health imperative.
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The association between the behavioral affect of black men and law enforcement officers' physical abuse of those men is not well-understood. This analysis measures the association between self-reported negative affect behavior (anger or depression) by the men and physical abuse by law enforcement officers, controlling for demographic and behavioral attributes. ⋯ Cohort studies are needed to determine if a black man's negative coping style, history of incarceration or exposure to racism is causally related to his history of physical abuse by a law enforcement officer.
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The value of including race as part of the patient identifier in care and medical education has been a topic of debate among clinicians, medical educators, and sociologists.1,2,6,7,8 The perceived benefit of using racial identifiers is that it may allow physicians to predict the risk of disease and inform drug therapy.9 This association is thought to be useful to medical students and trainees as they form their clinical knowledge base. However, there is a larger body of evidence that the use of race leads to bias and stereotyping by physicians. In many cases, patients are assigned to racial categorizations that are inconsistent with their self-reported identities.1,15 It is unclear which medical schools have a policy that explicitly detail their stance on this topic. In this article, we propose a frame of thinking to guide medical educators as they develop policies on race as patient identifiers.
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Minority groups continue to suffer disproportionately from COVID-19's impact, with Blacks and Hispanics three times more likely to die from the disease than their White counterparts. The COVID-19 vaccine roll out has the potential to provide relief to these most adversely impacted communities. However, historic mistrust within racial minority communities threatens to derail the effective implementation of a vaccination program. ⋯ Current day experience with structural racism and research abuses like Tuskegee Study collectively influence our perception of biased healthcare system. We outline issues and propose solutions that must be addressed to achieve a successful vaccination agenda. Mishandling of public expectations at any point may lead to an avalanche of vaccine opposition which might be unrecoverable.
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Public perceptions and disparities in access to telehealth orthopaedic services in the COVID-19 era.
We used online crowdsourcing to explore public perceptions and attitudes towards virtual orthopaedic care, and to identify factors associated with perceived difficulty navigating telehealth services during the COVID-19 pandemic. ⋯ The majority of the public appears receptive to telehealth for orthopaedic care for both new patient visits and follow-up appointments. The finding that people with multiple chronic conditions and psychosocial needs struggle to engage with telehealth suggests that those who arguably stand to benefit the most from continued care are the ones being unintentionally left out of this digitization boom.