scholarly journals Disparities in ADHD Diagnosis and Treatment by Race/Ethnicity in Youth Receiving Kentucky Medicaid in 2017

2021 ◽  
Vol 31 (1) ◽  
pp. 67-76
Author(s):  
Deborah Winders Davis ◽  
Kahir Jawad ◽  
Yana Feygin ◽  
Liza Creel ◽  
Maiying Kong ◽  
...  
Keyword(s):  
Population Density ◽  
Psychosocial Interventions ◽  
The United States ◽  
Diagnosis And Treatment ◽  
Treatment Modalities ◽  
Adhd Diagnosis ◽  
Stimulant Use ◽  
Treatment Type ◽  
Race Ethnicity ◽  
To Receive

Background: Kentucky has among the highest rate of attention deficit/hyperactivity disorder (ADHD) and stimulant use in the United States. Little is known about this use by race/ethnicity and geography. This article describes patterns of diagnosis of ADHD and receipt of stimulants and psychosocial interventions for children aged 6-17 years receiving Kentucky Medicaid in 2017 and identifies factors associated with diagnosis and treatment.Methods: Using Medicaid claims, children with and without ADHD (ICD-10 codes F90.0, F90.1, F90.2, F90.8, and F90.9) were compared and predictors of diag­nosis and treatment type were examined. Psychosocial interventions were defined as having at least one relevant CPT code. Chi-squared tests and logistic regression models were used for univariate and multivariable analysis, respectively.Results: The rates of ADHD, stimulant use, and psychosocial interventions in our study population exceeded the national aver­age (14% vs 9%; 75% vs 65.5%; and 51% vs 46.5%, respectively). The distributions varied by sex, race/ethnicity, sex among race/ethnicities, and population density. In general, race/ethnicity predicted ADHD diagnosis, stimulant use, and receipt of psy­chosocial interventions with non-Hispanic White children being more likely to receive diagnosis and medication, but less likely to receive psychosocial therapy than other children. Differences were also shown for rural compared with urban residence, sex, and sex within racial/ethnic groups.Conclusions: Diagnosis and treatment modalities differed for children by race/ ethnicity, population density, and sex. More data are needed to better understand whether differences are due to provider bias, child characteristics, or cultural varia­tions impacting the utilization of different treatment options.Ethn Dis. 2021;31(1):67- 76; doi:10.18865/ed.31.1.67

Bipolar Disorders and Their Clinical Management, Part II: Diagnosis, Differential Diagnosis, and Treatment

2019 ◽  
Author(s):  
Bernadette DeMuri-Maletic ◽  
Vladimir Maletic
Keyword(s):  
Quality Of Life ◽  
Bipolar Disorder ◽  
Differential Diagnosis ◽  
Bipolar Disorders ◽  
Psychosocial Interventions ◽  
Diagnosis And Treatment ◽  
Treatment Quality ◽  
Treatment Modalities ◽  
The Impact

Bipolar disorder is a biologically and phenotypically diverse disorder and its diagnosis and treatment provides a significant challenge to even the most seasoned clinician. We provide an update on the diagnosis and differential diagnosis of bipolar disorder, reflecting recent changes in DSM-5. Our review provides a succinct summary of the treatment literature, encompassing pharmacologic and psychosocial interventions for bipolar depression, mania/hypomania, mixed states, and prevention of disease recurrence. We provide a brief critical review of emerging treatment modalities, including those used in treatment resistance. Challenges involved in maintaining adherence are further discussed. Additionally, we review common treatment adverse effects and provide recommendations for proper side effect monitoring. There is evidence of significant functional impairment in patients with bipolar disorder and we conclude with a discussion of the impact of impairment on prognosis and quality of life. This review contains 4 figures, 8 tables, and 45 references. Key Words: bipolar disorders, differential diagnosis, maintenance pharmacotherapy, prognosis, psychosocial interventions, treatment, quality of life

Bipolar Disorders and Their Clinical Management, Part II: Diagnosis, Differential Diagnosis, and Treatment

2019 ◽  
Author(s):  
Bernadette DeMuri-Maletic ◽  
Vladimir Maletic
Keyword(s):  
Quality Of Life ◽  
Bipolar Disorder ◽  
Differential Diagnosis ◽  
Bipolar Disorders ◽  
Psychosocial Interventions ◽  
Diagnosis And Treatment ◽  
Treatment Quality ◽  
Treatment Modalities ◽  
The Impact

Bipolar disorder is a biologically and phenotypically diverse disorder and its diagnosis and treatment provides a significant challenge to even the most seasoned clinician. We provide an update on the diagnosis and differential diagnosis of bipolar disorder, reflecting recent changes in DSM-5. Our review provides a succinct summary of the treatment literature, encompassing pharmacologic and psychosocial interventions for bipolar depression, mania/hypomania, mixed states, and prevention of disease recurrence. We provide a brief critical review of emerging treatment modalities, including those used in treatment resistance. Challenges involved in maintaining adherence are further discussed. Additionally, we review common treatment adverse effects and provide recommendations for proper side effect monitoring. There is evidence of significant functional impairment in patients with bipolar disorder and we conclude with a discussion of the impact of impairment on prognosis and quality of life. This review contains 7 tables and 45 references. Key Words: bipolar disorders, differential diagnosis, maintenance pharmacotherapy, prognosis, psychosocial interventions, treatment, quality of life

scholarly journals The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

2021 ◽  
Vol 18 (4) ◽  
pp. 1384
Author(s):  
Whitney E. Zahnd ◽  
Cathryn Murphy ◽  
Marie Knoll ◽  
Gabriel A. Benavidez ◽  
Kelsey R. Day ◽  
...  
Keyword(s):  
Access To Care ◽  
Ethnic Minority ◽  
Data Access ◽  
The United States ◽  
Cancer Disparities ◽  
Treatment Modalities ◽  
Minority Populations ◽  
Race Ethnicity ◽  
Ethnic Minority Populations ◽  
Racial Ethnic

One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.

Bipolar Disorders and Their Clinical Management, Part II: Diagnosis, Differential Diagnosis, and Treatment

2019 ◽  
Author(s):  
Bernadette DeMuri-Maletic ◽  
Vladimir Maletic
Keyword(s):  
Quality Of Life ◽  
Bipolar Disorder ◽  
Differential Diagnosis ◽  
Bipolar Disorders ◽  
Psychosocial Interventions ◽  
Diagnosis And Treatment ◽  
Treatment Quality ◽  
Treatment Modalities ◽  
The Impact

Bipolar disorder is a biologically and phenotypically diverse disorder and its diagnosis and treatment provides a significant challenge to even the most seasoned clinician. We provide an update on the diagnosis and differential diagnosis of bipolar disorder, reflecting recent changes in DSM-5. Our review provides a succinct summary of the treatment literature, encompassing pharmacologic and psychosocial interventions for bipolar depression, mania/hypomania, mixed states, and prevention of disease recurrence. We provide a brief critical review of emerging treatment modalities, including those used in treatment resistance. Challenges involved in maintaining adherence are further discussed. Additionally, we review common treatment adverse effects and provide recommendations for proper side effect monitoring. There is evidence of significant functional impairment in patients with bipolar disorder and we conclude with a discussion of the impact of impairment on prognosis and quality of life. This review contains 4 figures, 7 tables, and 45 references. Key Words: bipolar disorders, differential diagnosis, maintenance pharmacotherapy, prognosis, psychosocial interventions, treatment, quality of life

Investigation of an ethnic predisposition to developing brain metastases (BM) in Asian patients with colorectal cancer (CRC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15023-e15023
Author(s):  
Kerri McGovern ◽  
Teresa Rodriguez ◽  
Melissa H Smith ◽  
Antonia Maloney ◽  
Wasif M. Saif
Keyword(s):  
Overall Survival ◽  
Molecular Markers ◽  
Ethnic Disparities ◽  
The United States ◽  
Treatment Modalities ◽  
Increased Risk ◽  
Incidence And Mortality ◽  
Race Ethnicity ◽  
The Impact ◽  
Hispanic White

e15023 Background: CRC, the third most common cancer in the United States, carries racial/ethnic disparities in both incidence and mortality. With availability of effective systemic therapies, the life of CRC patients can be prolonged which thereby increases the risk of metastases at uncommon sites, such as the brain. We report our investigation into the impact of race/ethnicity on the incidence of BM in CRC patients using retrospective data (2010 – 2018) at a single institution. Methods: We retrospectively reviewed patients diagnosed with CRC and collected data on age, race/ethnicity, stage, treatment modalities, metastatic sites, and survival. Race and ethnicity were defined in accordance with federal standards set by the U.S. Census. Following this, race/ethnicity was self-declared and/or based on the primary language declared and categorized as non-Hispanic White, Hispanic White, non–Hispanic Black, Asian, or Unknown/Other. CRC location was classified as right-sided, left-sided or rectal. Results: We identified 264 CRC patients (median age: 61; range: 38 - 99). Among them 123 identified as non-Hispanic white, 28 non-Hispanic black, 26 Hispanic white, and 9 declared Other. There were 76 (29%) who identified as Asian. Of those 76 patients, 5 (7%) developed BM. All 5 patients were male and stage IV at initial diagnosis. BM was a late stage phenomenon with rectal primary and lung metastases seemly associated with an increased risk in the specific cohort. Molecular markers such as KRAS were available in 3 patients without clear association. Median time to development of BM was 29 months (range: 26 - 33). Median overall survival after BM diagnosis was 5.5 months (range: 4 - 11). Overall survival was longest for the patient who had both radiation and surgery. Conclusions: Our study showed an incidence of BM of 7% in the Asian sub-population compared to the historical control of 0.6 – 3.2% in the overall population. These results at the least warrant further investigation in a larger patient population of BM in CRC patients with emphasis on molecular markers. Recognition of BM in CRC patients is clinically relevant secondary to multiple lines of therapy as mentioned earlier and its grave impact on outcome.

scholarly journals Pharmacotherapy treatment of stimulant use disorder

2021 ◽  
Vol 11 (6) ◽  
pp. 347-357
Author(s):  
Mei T. Liu
Keyword(s):  
Public Health ◽  
Behavioral Therapy ◽  
Contingency Management ◽  
Public Health Problem ◽  
Psychosocial Interventions ◽  
The United States ◽  
Stimulant Use ◽  
Methamphetamine Use ◽  
Methamphetamine Use Disorder ◽  
Selection Of

Abstract Stimulant use disorder (SUD) is a public health problem in the United States that is associated with increased morbidity and mortality. Psychosocial interventions, such as cognitive behavioral therapy and contingency management, are the main treatment modality for SUDs and no pharmacotherapy is currently FDA approved for this indication. Although some medications show promising data for the treatment of SUD, the evidence remains inconsistent, and the clinical application is limited due to the heterogenicity of the population and the lack of studies in patients with various comorbidities. Selection of pharmacotherapy treatment for methamphetamine intoxication, persistent methamphetamine-associated psychosis with methamphetamine use disorder, and cocaine use disorder in patients with co-occurring OUD are discussed in 3 patient cases.

scholarly journals Racial and Ethnic Disparities in the Refusal of Surgical Treatment in Women 40 Years and Older With Breast Cancer in the United States Between 2010 and 2017

2022 ◽  
Author(s):  
Pierre Fwelo ◽  
Zenab Yusuf ◽  
Abigail Adjei ◽  
Gabriel Huynh ◽  
Xianglin Du
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Surgical Treatment ◽  
Black Women ◽  
Ethnic Disparities ◽  
Breast Conserving Surgery ◽  
The United States ◽  
Recommended Treatment ◽  
Race Ethnicity ◽  
To Receive

Abstract Purpose Although surgical resection is the main modality of treatment for breast cancer, some patients elect to refuse the recommended surgery. We assessed racial and ethnic differences in women 40 years and older who received or refused to receive surgical treatment for breast cancer in the United States and whether racial disparities in mortality were affected by their differences in the prevalence of refusal for surgical treatmentMethods We studied 277,127 women with breast cancer using the Surveillance, Epidemiology, and End Results (SEER) data and performed multivariable logistic regressions to investigate the association between surgery status of breast cancer and race/ethnicity. Additionally, we performed Cox logistic regression analyses to determine the predictors of mortality outcomes. Results Of 277,127 patients with breast cancer, 1,468 (0.53%) refused to receive the recommended surgical treatment in our cohort. Non-Hispanic Black women were 112% more likely to refuse recommended surgical treatment for breast cancer compared to their non-Hispanic White counterparts [adjusted odds ratio: 2.12, 95% confidence interval (CI)=1.82-2.47]. Women who underwent breast conserving surgery [hazards ratio (HR): 0.15, 95% CI: 0.13-0.16] and mastectomy (HR:0.21, 95% CI: 0.18-0.23) had lower hazard ratios of mortality as compared to women who refused the recommended treatment after adjusting for covariates. Conclusion Race/ethnicity was associated with refusal for recommended surgery, especially among non-Hispanic Black women. Also, surgery refusal was associated with a higher risk of all-cause and breast cancer-related mortality. These disparities stress the need to tailor interventions aimed at raising awareness of the importance of following physician recommendations among minorities.

Cross-Cohort Evidence of Disparities in Service Receipt for Speech or Language Impairments

2017 ◽  
Vol 84 (1) ◽  
pp. 27-41 ◽  
Author(s):  
Paul L. Morgan ◽  
George Farkas ◽  
Marianne M. Hillemeier ◽  
Hui Li ◽  
Wik Hung Pun ◽  
...  
Keyword(s):  
United States ◽  
Special Education ◽  
The United States ◽  
Language Impairments ◽  
Odds Ratios ◽  
White Children ◽  
English Speaking ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
To Receive

We examined the extent to which disparities in the receipt of special education services for speech or language impairments (SLIs) on the basis of race, ethnicity, or language use by kindergarten—when the delivery of these services might be expected to be most effective—have changed over a 12-year period in the United States. Logistic regression modeling of 2 nationally representative cohorts ( N = 16,800 and 12,080) indicated that children who are Black (covariate-adjusted odds ratios = 0.39 and 0.54) or from non-English-speaking households (covariate-adjusted odds ratios = 0.57 and 0.50) continue to be less likely to receive services for SLIs. Hispanic children are now less likely to receive these services (covariate adjusted odds ratio = 0.54) than otherwise similar non-Hispanic White children. Disparities in special education service receipt for SLIs attributable to race, ethnicity, and language presently occur in the United States and are not explained by many potential confounds.

Abstract P872: Persistent Inequities in Intravenous Thrombolysis for Acute Ischemic Stroke in the United States: Results From the Nationwide Inpatient Sample

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Philip Y Sun ◽  
Ling Zheng ◽  
Michelle P Lin ◽  
Steven Cen ◽  
Nerses Sanossian ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Nationwide Inpatient Sample ◽  
Intravenous Thrombolysis ◽  
The United States ◽  
Stroke Survivors ◽  
Very Elderly ◽  
Pronounced Increase ◽  
Race Ethnicity ◽  
To Receive

Background: Intravenous thrombolysis (IVT) was approved for acute ischemic stroke (AIS) 25 yrs ago, yet few AIS patients receive it, with inequities by race/ethnicity, sex, and geography. With expanding evidence-based programs, we hypothesized increases in IVT utilization and reduction in inequities. Methods: Using the Nationwide Inpatient Sample (NIS), we assessed temporal trends from 2002 to 2015 in IVT for AIS (weighted N=6,694,081) by sex, race/ethnicity, age, insurance, and hospital location/teaching status strata using survey - weighted logistic regression. Covariates included socio-demographics, comorbidities, and hospital characteristics. We calculated odds ratios for IVT by each category in 2002-2008 and 2009-2015. Results: IVT for AIS increased from 1.0% in 2002 to 6.8% in 2015, with an overall adjusted annual relative ratio (AARR) of 1.15 (CI 1.14-1.16). Individuals 18-44 yrs had the highest rate of IVT in 2015. The very elderly (≥85 yrs) had the most pronounced increase in IVT (AARR 1.18, CI 1.17-1.19). The sex disparity in IVT improved, but in 2009-2015, women were still 6% less likely to receive IVT than men (Fig 1). Individuals 18-44 yrs were ~3-fold more likely to receive IVT than the very elderly. IVT inequities for black and Hispanic stroke survivors lessened, but blacks remained ~20% less likely than whites to receive IVT. Government-insured patients were ~25% less likely to receive IVT compared to privately insured. Urban AIS patients were up to 4-fold more likely to receive IVT than rural dwellers. Conclusion: From 2002 through 2015, IVT for AIS in the U.S. increased regardless of race/ethnicity, sex, and age among ≥18 yrs, with the most pronounced increase among the very elderly. Despite encouraging trends, only 1 in 15 AIS patients received IVT and persistent inequities remain for blacks, women, government-insured, and rural stroke survivors, highlighting the need for intensifying stroke literacy and preparedness and enhancing systems of care.

Treatment approaches and survival outcomes of older patients with locally advanced esophageal cancer (LAEC) in Ireland.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23034-e23034
Author(s):  
Petra Martin ◽  
Eamonn o'Leary ◽  
Sandra Deady ◽  
Anne M. Horgan
Keyword(s):  
Clinical Trials ◽  
Adjuvant Treatment ◽  
Older Patients ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Treatment Modalities ◽  
Risk Of Death ◽  
Treatment Type ◽  
Esophagogastric Cancer ◽  
To Receive

e23034 Background: Neo+/- adjuvant treatment data in older patients with cancer is sparse due to exclusion of this population from clinical trials. We evaluated the management of locally advanced esophagogastric cancer (LAEC) in older Irish patients to determine treatment modalities utilized and identify factors associated with survival. Methods: Patients diagnosed with LAEC (stage II or III) over a 5 year period (2007-2011)were identified from the National Cancer Registry of Ireland. Follow-up was till end 2014.Demographic characteristicswere assessed. Treatment was classified as “best supportive care (BSC)”, “surgery only”, “neo/adjuvant treatment” and “chemo/radiation alone” (ie chemo, radiotherapy or chemoradiotherapy alone in the absence of surgery).Survival was estimated by Kaplan-Meier estimates and Cox models. Clinicopathologic factors and treatment type found to be significant in univariate analysis were included in a multivariate analysis (MVA). Results: 46%(n = 580) of the 1,251 patients were ≥70yrs, 62% had stage III disease and 51% had gastric cancer. 11% (n = 134) received BSC, 23% (n = 288) had surgery only, 31%(n = 390) had chemo/radiation alone, 35% (n = 439) had neo/adjuvant treatment. 20% (n = 39) of patients ≥75yrs had neoadjuvant treatment compared to 46% < 75 yrs. No patient ≥80yrs received neo/adjuvant treatment. With increasing age patients were less likely to receive neo/adjuvant treatment (p < 0.001), less likely to receive surgery (p < 0.001) and less likely to receive any treatment (p < 0.001).Median survival(OS) decreased with age (< 70yrs: 23months; 70-74: 19months; 75-79:13months; ≥80 years:10 months). In MVA, older age, smoking, later stage, higher grade were significantly associated with a higher risk of death.Including an interaction between treatment and age, patients receiving adjuvant or neoadjuvant treatment had lower risk of death than any other treatment group regardless of age. Conclusions: Older patients were less likely to receive any treatment for LAEC than younger patients. Patients ≥70 years benefit from neo/adjuvant treatment, however,these patients are often excluded based on age. Prospective clinical trials focusing on elderly patients and incorporating life expectancy, comorbidities and geriatric assessment are needed to best guide treatment.

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