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Background Disparities in breast cancer mortality persist despite improvements in screening and therapeutic options. Understanding the impact of social determinants of health on disparate breast cancer outcomes is challenging due to heterogeneity of prior assessments. We examined the association between social vulnerability and breast cancer stage at diagnosis and mortality using a standardized measure of population risk for external stressors on health. Methods Using institutional cancer registry data, female patients aged 18 or older diagnosed with breast cancer between 2012 and 2019 were assigned a 2018 Social Vulnerability Index (SVI) rank based upon home address census tract. We used multinomial logistic regression and Cox proportional hazards model to examine the relationships between SVI and breast cancer stage at diagnosis and all-cause mortality. Covariates included age and, when assessing mortality, cancer stage, comorbidities, body mass index, insurance type, and treatment regimen. Results A total of 3,499 women with a median age of 59 (IQR 48–69) were included. 60% were White and 31% were Black. Median SVI was 0.36 (IQR 0.14–0.68) and median follow-up was 58 months (IQR 37.3–83.9). On adjusted analyses, each decile increase in SVI resulted in an 11% (OR 1.11, 95% CI 1.06–1.16, p  < .001) and 15% (OR 1.15, 95% CI 1.09–1.21, p  < .001) greater odds of presenting with Stage III or IV breast cancer, respectively, compared to DCIS. For patients who underwent surgery ( N  = 2916), each decile increase in SVI was associated with a 6% increase in all-cause mortality risk (HR 1.06, 95% CI 1.01–1.12, p  = .01). Mortality risk was 1.5 times (HR 1.52, 95% CI 1.02–2.26, p  = .04) greater for those in the most vulnerable quartile compared to the least vulnerable quartile. Conclusions Women living in socially vulnerable communities presented with more advanced breast cancers and suffered worse survival. The SVI can be used to identify patients at risk for delayed cancer presentation and increased mortality. This tool can inform geographically targeted resource allocation and interventions aimed at reducing breast cancer care disparities.

Objective Cochlear implants (CI) are surgical devices used for rehabilitation of sensorineural hearing loss. More individuals are receiving CIs as technology and surgical techniques improve and candidacy guidelines expand. Despite growing public awareness, CI utilization remains low. Understanding sentiment regarding these devices is important. Reddit is a text‐based website wherein posters interact on specialized forums, “subreddits.” R/Cochlearimplants allows for unique CI sentiment analysis. Study Design A search was done from October 2024 to November 2024 on r/Cochlearimplants. Setting Internet. Methods Posts were sorted by highest engagement. Metadata regarding date, comments, and upvotes were collected. Sentiment was analyzed using TextBlob and VADER, Python library Natural Language Processing tools. Results Four hundred and twenty unique posters made 1068 total entries. Entries spanned 2019 to 2024, the majority in 2024 (51%, n = 543). VADER found the majority of entries positive (n = 562, 52.9%) while TextBlob found the majority neutral (n = 928, 87%). Sentiment distribution over time was significantly different (P < .001), with more negative sentiment in 2024 than 2019 to 2023. Negative VADER entries had significantly higher word counts (P < .001). Positive VADER entries had higher upvotes (P < .001). Conclusion Sentiment regarding CI remains more nuanced than can be gleaned from this analysis, including cultural and ethical issues. This study demonstrates that sentiment on r/Cochlearimplants is generally neutral or positive, trending relatively more negative over time. This could suggest negativity towards CIs is growing with increased utilization. Awareness of online sentiment may help providers understand patient perspectives and dispel misinformation.

Background: Emergency department (ED) utilization for non-emergent issues has been a longstanding issue in the United States, especially in service areas with high Medicaid enrollment. The Medical Home and Specialty Care Connection Program (MHSCC) at University of Chicago Medicine (UCM) supports patients recently seen in the ED with follow-up care by assisting patients with follow-up appointments, establishing a medical “home” and providing education on primary care utilization via working with a patient advocate. These types of programs have inconsistent results throughout the literature and a dearth of study periods. We conducted a program evaluation to assess the association of the MHSCC in reducing low-acuity ED utilization for program patients. Methods: This program evaluation used retrospective data from the MHSCC program dataset from 2012–2020 and matched with electronic health records of low-acuity ED visits at UCM ED from 2010–2022 for each patient. Pre- and post-low-acuity ED visit rates were calculated based on the patients first program enrollment and compared using the Wilcoxon signed-rank test. Results: In total 5,482 ED patients enrolled in the program were included in the sample, 537 of whom were enrolled more than once. These patients had 41,530 low-acuity ED visits. The rate of low-acuity ED visits after the program enrollment was significantly lower than before with a mean of 2.5 visits per year before program intervention to 1.38 after, a 45% decrease (P<.0001). This resulted in an estimated 9,487 fewer low acuity ED visits over nine years. Patients with multiple enrollments (up to four) further resulted in a slightly lower ED visit rates. Patients who benefitted the most in both proportion and mean analyses were of low acuity. Conclusion: We found a significant reduction in program patient’s ED visit rates for low-acuity needs. Further evaluation on the outcomes of the program, mechanisms of physician referrals and attributes of the patient population are recommended to understand what drives these findings.

[This corrects the article DOI: 10.3389/froh.2022.962849.].[This corrects the article DOI: 10.3389/froh.2022.962849.].

Background and Aims Frailty is an age‐related syndrome associated with poor surgical outcomes, but the impact of insurance payer status on frailty is not fully understood. We sought to evaluate the association between insurance payer status and frailty among thoracic surgery patients. Methods This retrospective study included all patients undergoing routine frailty screening in a general thoracic surgery clinic at a single center from December 2020 to December 2022. Insurance payers were collected (Medicare, Medicaid, or private). Frailty was measured using the Fried's Frailty Phenotype (FFP) (0: not frail, 1–2: prefrail, 3–5: frail) and the Modified 5‐Item Frailty Index (mFI‐5) (≥ 2 vs. 0–1). Fisher's Exact and Kruskal–Wallis tests and multivariable logistic regressions were performed. A final sensitivity analysis was conducted to examine the association of insurance and frailty in patients who underwent surgery. Results Of the 430 screened patients, 41% (183) were female, median age was 68 (IQR: 62–74), and 48% (207) were non‐White. Insurance coverage was 63% (271) Medicare, 15% (64) Medicaid, and 22% (95) private insurance. Of the cohort, 44% (189) of patients underwent subsequent surgery. After adjusting for age, sex, BMI, race/ethnicity, income, smoking status, medications, cancer history, and healthcare utilization, patients with Medicare were more likely to be frail than those with private insurance (FFP: Medicare—OR: 3.17, CI: [1.14–9.72], p < 0.05 | mFI‐5: OR: 3.40, CI: [1.45–8.55], p < 0.01). This association was seen in patients with Medicaid by mFI‐5 (OR: 3.35, CI: [1.24–9.51], p < 0.05). Furthermore, these findings were consistent with our sensitivity analysis. Conclusion Publicly insured surgical patients are more likely to be frail than those privately insured. The etiology of this disparity is multifactorial and may be a result of healthcare inaccessibility, limitations of coverage, and lower socioeconomic status. Future policy‐based interventions to address social determinants of health may reduce insurance disparities.

Introduction: Household-level psychosocial stress levels have been linked to child tooth brushing behaviors. Community health worker (CHW) interventions that target psychosocial factors in high-risk communities have been associated with changes in health behaviors.Aim: Observe changes in psychosocial factors over time and an association between psychosocial factors and CHW intervention dose amongst urban Chicago families.Patients and methods: Participants (N = 420 families) were recruited from 10 community clinics and 10 Women, Infants, or Children (WIC) centers in Cook County, Illinois to participate in a clinical trial. Research staff collected participant-reported psychosocial factors (family functioning and caregiver reports of depression, anxiety, support, and social functioning) and characteristics of CHW-led oral health intervention visits (number, content, child engagement) at 0, 6, and 12 months. CHWs recorded field observations after home visits on household environment, social circumstances, stressors, and supports.Results: Participants across the cohort reported levels of psychosocial factors consistent with average levels for the general population for nearly all measures. Psychosocial factors did not vary over time. Social functioning was the only measure reported at low levels [32.0 (6.9); 32.1 (6.7); 32.7 (6.9); mean = 50 (standard deviation)] at 0, 6, and 12 months. We did not observe a meaningful difference in social functioning scores over time by exposure to CHW-led intervention visits (control arm, 0, 1, 2, 3, and 4 visits). Field observations made by CHWs described a range of psychosocial stress related to poverty, language barriers, and immigration status.Conclusion: The unexpectedly average and unchanging psychosocial factors over time, in the context of field observations of stress related to poverty, lack of support, immigration status, and language barriers, suggests that our study did not adequately capture the social determinants of health related to oral health behaviors or that measurement biases precluded accurate assessment. Future studies will assess psychosocial factors using a variety of instruments in an attempt to better measure psychosocial factors including social support, depression, anxiety, functioning, trauma and resilience within our urban population. We will also look at neighborhood-level factors of community distress and resilience to better apply the social ecologic model to child oral health behaviors.

Rapid implementation of telehealth exacerbated the digital divide, creating uneven distribution in access, use, or impact of communication technologies among distinct groups. Our aim was to identify factors impacting access to telehealth in a pediatric specialty clinic. This retrospective cohort study used survey methods and electronic health record (EHR) data to examine telehealth access during the COVID-19 pandemic in the South Side of Chicago. Of 193 patient encounters reviewed, 127 met inclusion criteria. 42 parent surveys were completed, with 36 completed visits. No shows included a higher proportion of Hispanic and non-English speaking patients from areas with lower median income. Our parent questionnaire showed association of no-show rates with lower caregiver education (p ​= ​0.005), non-English speaking (p ​= ​0.015), difficulty accessing internet (p ​= ​0.011), and only smartphone internet access (p ​= ​0.002). Completion of telehealth visits was impacted by ethnicity, education, and digital access. Future work is needed to address these areas. [Display omitted] •During the COVID-19 pandemic telehealth use increased significantly across the US.•Lower household income was associated with increased rates of no-show appointments.•Limited digital literacy was a significant barrier to completion of appointments.•Reliable access to broadband was a key social determinant for successful appointments.

Public health and social science increasingly use Twitter for behavioral and marketing surveillance. However, few studies provide sufficient detail about Twitter data collection to allow either direct comparisons between studies or to support replication. The three primary application programming interfaces (API) of Twitter data sources are Streaming, Search, and Firehose. To date, no clear guidance exists about the advantages and limitations of each API, or about the comparability of the amount, content, and user accounts of retrieved tweets from each API. Such information is crucial to the validity, interpretation, and replicability of research findings. This study examines whether tweets collected using the same search filters over the same time period, but calling different APIs, would retrieve comparable datasets. We collected tweets about anti-smoking, e-cigarettes, and tobacco using the aforementioned APIs. The retrieved tweets largely overlapped between three APIs, but each also retrieved unique tweets, and the extent of overlap varied over time and by topic, resulting in different trends and potentially supporting diverging inferences. Researchers need to understand how different data sources can influence both the amount, content, and user accounts of data they retrieve from social media, in order to assess the implications of their choice of data source.

Crime victim compensation (CVC) was developed to help individuals and families with expenses following violent injury. Administrative obstacles and potential biases may contribute to disparities in CVC. We explored rates of successful claims, award amounts and time to disbursement in Illinois. We completed a freedom of information act request for CVC data from the Office of the Illinois Attorney General from January 2012 to July 2024. Results were stratified by race, mechanism of victimization and denial characteristics. We identified 42,477 claimants for CVC in Illinois during our study period. Of these claims 16,935 (39.9 ​%) were awarded. Black applicants composed the largest portion of denied claims (N ​= ​9,055, 37.7 ​%) and comprised almost half of all claims denied based on ‘victim misconduct’ (N ​= ​1,924, 42.5 ​%). Mean time to case closure ranged from 345 to 405 days following homicide. Focused advocacy is needed to support survivors in pursuit of this program. [Display omitted] •Crime Victim Compensation in Illinois experiences significant processing delays.•Homicide claims have the highest rates of approval, while the majority of other claims are denied.•Black applicants were more likely to be denied based upon victim misconduct than Whites.•Black applicants experienced significant delays to compensation following homicide.

Identifying risk factors in papillary thyroid carcinoma (PTC) that warrant more aggressive treatment is paramount. Importantly, the prevalence and clinical significance of BRAF p.V600E mutation in PTC remain debatable. This study aims to determine the association of BRAF p.V600E with demographic and clinicopathologic characteristics, including recurrence. Single institution data from consecutive PTC patients with BRAF p.V600E immunohistochemistry and/or molecular testing was collected between 2018 and 2022, including BRAF status, morphologic subtype, TN category, tumor size, nodal disease burden, tumor multifocality, extrathyroidal extension, treatment, follow-up time, loco-regional and distant recurrence, and mortality. This study included 301 patients, 30% male. The majority had BRAF p.V600E mutation (78.7%), and BRAF p.V600E was associated with morphologic subtype ( p  < 0.001), with 88% of classic subtype PTCs, 38% of PTCs with extensive follicular growth, and 100% of tall cell subtype expressing BRAF p.V600E. BRAF p.V600E was not associated with tumor size ( p  = 0.696) or nodal disease burden ( p  = 0.962). On multivariate analysis using Cox proportional hazard model, large volume nodal disease burden (HR 3.37, 95%CI 1.49–7.64, p  = 0.004) and male gender (HR 2.29, 95%CI 1.23–4.26, p  = 0.009) were significantly associated with recurrence. BRAF p.V600E (HR 0.71, 95% CI 0.31–1.65, p  = 0.4) was not significantly associated with recurrence. In conclusion, presence of BRAF p.V600E in the absence of high risk histologic features does not have an impact on PTC recurrence, and thus, its utility in risk stratification is questionable in the setting of other clinicopathologic risk factors.