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  • 1
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    Posttraumatic Stress Disorder and Adherence to Medications in Survivors of Strokes and Transient Ischemic Attacks
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. 8 ( 2012-08), p. 2192-2197
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. 8 ( 2012-08), p. 2192-2197
    Abstract: Posttraumatic stress disorder (PTSD) can be triggered by life-threatening medical events such as strokes and transient ischemic attacks (TIAs). Little is known regarding how PTSD triggered by medical events affects patients' adherence to medications. Methods— We surveyed 535 participants, age ≥40 years old, who had at least 1 stroke or TIA in the previous 5 years. PTSD was assessed using the PTSD Checklist-Specific for stroke; a score ≥50 on this scale is highly specific for PTSD diagnosis. Medication adherence was measured using the 8-item Morisky scale. Logistic regression was used to test whether PTSD after stroke/TIA was associated with increased risk of medication nonadherence. Covariates for adjusted analyses included sociodemographics, Charlson comorbidity index, modified Rankin Scale score, years since last stroke/TIA, and depression. Results— Eighteen percent of participants had likely PTSD (PTSD Checklist-Specific for stroke ≥50), and 41% were nonadherent to medications according to the Morisky scale. A greater proportion of participants with likely PTSD were nonadherent to medications than other participants (67% versus 35%, P 〈 0.001). In the adjusted model, participants with likely PTSD were nearly 3 times more likely (relative risk, 2.7; 95% CI, 1.7–4.2) to be nonadherent compared with participants without PTSD (PTSD Checklist-Specific for stroke 〈 25) even after controlling for depression, and there was a graded association between PTSD severity and medication nonadherence. Conclusion— PTSD is common after stroke/TIA. Patients who have PTSD after stroke or TIA are at increased risk for medication nonadherence.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.112.655209
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Race and social status related to different health behaviors in breast cancer patients.
    American Society of Clinical Oncology (ASCO) ; 2018
    In:  Journal of Clinical Oncology Vol. 36, No. 15_suppl ( 2018-05-20), p. e12528-e12528
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 36, No. 15_suppl ( 2018-05-20), p. e12528-e12528
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2018.36.15_suppl.e12528
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2018
    detail.hit.zdb_id: 2005181-5
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  • 3
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    Racial and insurance disparities in multiple myeloma management in a referral center.
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 15_suppl ( 2019-05-20), p. e18140-e18140
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 15_suppl ( 2019-05-20), p. e18140-e18140
    Abstract: e18140 Background: Multiple Myeloma (MM) management has significantly improved disease-free and overall (OS) survival but disparities among racial groups still exist. After the Affordable Care Act, the extent to which induction, autologous stem cell transplant (ASCT), and maintenance therapies are used are uncertain. We sought to describe underuse of induction, ASCT and maintenance in a large referral center. Methods: Between 2010 and 2014, 3101 patients were diagnosed with MM via ICD-9 code from the Data Warehouse and certified hospital tumor registry. NCCN 2014 and CMS guidelines were used to define the categories of treatment underuse, and define transplant eligibility. Demographics including insurance, Charlson Comorbidity Index and treatments received were determined via chart abstraction. To date, 393 confirmed MM from 697 charts were abstracted. Comparison by groups used Chi-square for categorical variables, t-test and ANOVA for continuous variables. Multivariate logistic regression models were applied to predict underuse of induction, harvest, ASCT, and maintenance. Results: Patients were 62 ±11.3 years-old, with no racial differences in age and insurance coverage. More minorities had Medicaid (Black [B] 13%, White [W] 7%, Hispanic [H] 25%; p = 0.001). Almost all patients (97%) received induction (B 99%, W 96%, H 100%; p = 0.3), with no difference by insurance. Among transplant eligible patients, 93% underwent harvest, 87% underwent ASCT, with no racial differences. Patients with Medicare or self-pay were less likely to undergo harvest compared to patients with Medicaid or private insurance (p = 0.01). No difference in ASCT rates by insurance were noted. B patients were less likely to receive maintenance than non-B (73% vs 86%; p = 0.03), with no difference by insurance. OS was 73%, with no racial differences. In multivariate model, older age predicted induction underuse (aOR = 1.15, 95% CI: 1.06-1.25) (c = 0.9, p = 0.005), and B patients experienced more maintenance underuse (aOR = 2.22, 95% CI: 1.09-4.54) (c = 0.61, p = 0.1), controlling for age and comorbidity. Conclusions: While there were no racial or insurance differences in access to induction therapy, fewer Black patients received maintenance therapy. Interviews are underway to understand reasons for observed differences.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2019.37.15_suppl.e18140
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
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  • 4
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    Which social measures relate to cancer screening & healthy behaviors?
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 15_suppl ( 2019-05-20), p. e18142-e18142
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 15_suppl ( 2019-05-20), p. e18142-e18142
    Abstract: e18142 Background: Much of cancer health services research relies on administrative data, yet, there have been calls for more granular racial & social disparities data. Subjective SES (sSES) is associated with health status & behaviors, independent of objective SES (oSES) measures like income, education and race. We assessed the relationship between breast cancer patients’ oSES and sSES with their cancer screening and health behaviors. Methods: Data are part of a large prospective study evaluating the role of insulin resistance in women with newly diagnosed breast cancer. Patients were asked to place where they stand in their communities on the MacArthur Scale of Subjective Social Status ladder (sSES). oSES measures include race, income & education. We assessed diet, activity, breast & pap screening. Group comparisons used chi-square and t-tests as appropriate. We ran logistic multivariate models with age, race, insurance, comorbidity & income. Results: Of 1035 breast cancer patients with an average age of 58±12 yrs, 81% were White and 19% Black, 63% graduated college, 47%W & 16%B women reported an income of 〉 $100,000/yr. The median sSES = 8; 20% had high sSES ( 〉 8). There were no racial differences observed in sSES (high sSES: 22% B vs 20% W; p = 0.7). More patients with high sSES graduated college (76% vs 61%, p = 0.0002) & had income 〉 $100K/yr (62% vs 36%, p 〈 .0001) than patients with lower sSES. Of the oSES, women with higher income were more likely to undergo both cancer screenings as compared to patients with lower income. College education did not impact cancer screenings. Black women were less likely to get pap smears. Patients with high as compared to low sSES had higher cancer screening rates and healthy behaviors. Conclusions: Income and sSES are positively associated with cancer screening and health behaviors; education & race are associated with activity & diet. Race is associated with pap screening.[Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2019.37.15_suppl.e18142
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
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  • 5
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    Effect of organizational approaches on safety-net hospitals’ cancer care quality.
    American Society of Clinical Oncology (ASCO) ; 2015
    In:  Journal of Clinical Oncology Vol. 33, No. 15_suppl ( 2015-05-20), p. 6511-6511
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 15_suppl ( 2015-05-20), p. 6511-6511
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2015.33.15_suppl.6511
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2015
    detail.hit.zdb_id: 2005181-5
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  • 6
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    Can a web-based tracking and feedback tool improve breast cancer care at safety-net hospitals?
    American Society of Clinical Oncology (ASCO) ; 2017
    In:  Journal of Clinical Oncology Vol. 35, No. 8_suppl ( 2017-03-10), p. 107-107
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 35, No. 8_suppl ( 2017-03-10), p. 107-107
    Abstract: 107 Background: System failures, a cause of underuse in which doctors order care, patients don’t refuse but care doesn’t ensue, tend to happen more at safety net hospitals (SNH). Tracking & follow-up approaches that close referral loops in SNHs may reduce underuse. In a randomized trial, we tested a Tracking & Feedback (T & F) tool to reduce underuse of adjuvant breast cancer treatment. Methods: We recruited 5 community & 5 municipal SNHs that serve a large proportion of minorities in the NYC metropolitan area. We implemented rapid case ascertainment, a T & F tool and trained point persons at each site to determine if women with newly operated stage 1-3 breast cancer, connected with the oncologist since such connections are associated with getting treated. The tool created a daily “to do” reminder for point persons to ascertain if patients were seen by the oncologist. Point persons then relayed this information to surgeons to follow through as they deemed necessary. Underuse includes: no RT after lumpectomy or mastectomy with 〉 4 positive nodes; no chemo for HR- and no hormonal therapy for HR+ tumors 〉 1cm; no trastuzumab for Her2+ tumors. We interviewed key informants about tool usefulness. We conducted intention to treat and pre-post analyses to assess tool and implementation effectiveness, respectively. Results: Pre-intervention, despite randomizing hospitals, intervention (INT) hospitals had fewer whites (4% vs 14%; p = 0.0005), poorer follow-up approaches (0.68 vs 0.80; p = 0.07), less Medicaid & uninsured patients (36% vs 62%; p 〈 .0001) and more underuse (28% vs 15%; p = 0.002) compared to control (CNTL) hospitals; comorbidities and stage were similar. The RCT found no difference in underuse rates (9% at INT & 11% at CNTL hospitals; p = 0.8). Because randomization did not result in equivalent distributions, we modeled pre- (N = 403) and post (N = 191) populations controlling for time period and clustering & found that hospitals with better follow-up (OR = 0.82; 95% CI: 0.71-0.96) had less underuse. In settings with poor follow-up & tracking approaches, key informants found the tool useful. Conclusions: While the RCT findings were negative, they suggest a T & F tool may help reduce underuse in SNHs with poor follow-up capabilities. Clinical trial information: NCT01544374.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2017.35.8_suppl.107
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2017
    detail.hit.zdb_id: 2005181-5
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  • 7
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    Abstract 3257: Prevalence and Correlates of PTSD After Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background Stroke survivors may be at increased risk for post-traumatic stress disorder (PTSD), yet detailed data on prevalence and contributing factors are lacking. Harlem residents and local researchers, alarmed by high rates of stroke in their community and frustrated by the difficulty of engaging stroke survivors in prevention programs, aimed to determine the prevalence and correlates of PTSD in a cohort of survivors of stroke and transient ischemic attack (TIA). Methods Harlem residents and researchers employed community-based participatory research to develop a recurrent stroke prevention intervention. English and Spanish speaking adults over 40 were eligible for inclusion if they reported a stroke or TIA within the past five years. Baseline assessments included blood pressure, direct LDL cholesterol and validated self-report scales for demographics, stroke impact (modified Rankin scale), medical co-morbidities (Charlson co-morbidity index), and the widely-used 17-item PTSD Checklist Specific for stroke (PCL-S). A PCL-S score of 25 connotes a positive screening test, while a score greater than 50 is highly specific for PTSD. We recruited participants from community and clinical sites. To create a model of correlates for PTSD (PCL-S score 〉 50), we used logistic regression. Results The 379 enrollees had a mean age of 64 years, 62% were women, 79% were Black or Latino, 28% never completed high school, and more than half earned under $15,000 yearly. Most (75%) had PCL-S scores greater than 25, including 69 (18%) who scored above 50. Using logistic regression, and controlling for gender, race, education, and income (c-statistic of 0.835, p 〈 0.0001), PTSD was associated with younger age (odds ratio 0.94, 95% CI 0.91-0.97), increased disability post-stroke (OR 1.93, 95% CI 1.49-2.51), and greater burden of medical co-morbidities (OR 2.17, 95% CI 1.09-4.31). In addition, participants with PTSD were more likely to smoke (30% vs. 13%, p=0.0003) and have elevated LDL cholesterol 〉 100 mg/ dl (59% vs. 39%, p=0.003), both major risk factors for recurrent stroke. There was no significant difference in blood pressure control between the patients with and without PTSD. Conclusion PTSD is common after stroke, especially in younger people with more disability and more co-morbidity. We recommend that clinicians screen patients for PTSD after stroke and offer supportive therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A3257
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1467823-8
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  • 8
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    Abstract 142: Latino Stroke Survivors More Likely to Experience Depression
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background: Literature suggests that White Americans experience more depression in general, and post-stroke depression than non-White Americans, but depression disparities have not been well-explored. We aimed to characterize this association by applying a novel ‘Rank and Match’ secondary analytic method, based on the Institute of Medicine’s disparity framework to a multi-racial/ethnic stroke cohort. Methods: We recruited a cohort of community-dwelling adults who had a stroke in the past 5 years, from Harlem and the South Bronx in New York City, to a recurrent stroke prevention intervention. At baseline, we measured depression using the PHQ-8 scale and patients’ health status, demographics, comorbidities and socioeconomic status (SES), including income and education. We used multivariate logistic regression to evaluate the impact of race/ethnicity, after adjusting for health status and SES, on having depression (using a score ≥ 10 as depressed). Then based on the IOM’s disparity framework, we used our "Rank and Match" method to assess racial/ethnic differences in depression after matching Latinos and non-Latinos by their health status rank. Results: The cohort included 600 participants, with a mean of 1.9 years after stroke, mean age of 63 years, 42% were Black, 39% Latino, 60% female, 56% lived below poverty, 29% had Medicaid and 31% had less than a high school degree. Participants with depression (n=178; 30%) were more likely young (p=0.002), Latino (p 〈 0.0001), receiving Medicaid (p 〈 0.001), and had more comorbidities (p=0.004) than non-depressed participants. The adjusted odds of depression for Latinos was 3.45 (95% CI: 1.48 - 8.07) times higher than for Whites and 2.22 (95% CI: 1.45 - 3.38) times higher than for Blacks. After applying the “Rank and Match” method, the difference between Latinos and Whites became stronger (OR=4.65; 95% CI: 1.91 - 11.30), and the difference between Latinos and Blacks sustained (OR=2.19; 95% CI: 1.41 - 3.40). Conclusion: This study newly reveals a high depression burden among Latino stroke survivors, particularly in comparison with non-Latinos. Future research is needed to further study this disparity, and to address depression in this population.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.A142
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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  • 9
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    Concerns about medications mediate the association of posttraumatic stress disorder with adherence to medication in stroke survivors
    Wiley ; 2013
    In:  British Journal of Health Psychology Vol. 18, No. 4 ( 2013-11), p. 799-813
    Details
    In: British Journal of Health Psychology, Wiley, Vol. 18, No. 4 ( 2013-11), p. 799-813
    Abstract: Post‐traumatic stress disorder ( PTSD ) can be a consequence of acute medical events and has been associated with non‐adherence to medications. We tested whether increased concerns about medications could explain the association between PTSD and non‐adherence to medication in stroke survivors. Design We surveyed 535 participants aged 40 years or older who had at least one stroke or transient ischaemic attack in the previous 5 years. Methods We assessed PTSD using the PTSD checklist‐specific for stroke, medication adherence with the Morisky Medication Adherence Questionnaire, and beliefs about medications with the Beliefs about Medicines Questionnaire. We used logistic regression to test whether concerns about medications mediated the association between stroke‐induced PTSD and non‐adherence to medication. Covariates for adjusted analyses included age, sex, race, comorbid medical conditions, stroke‐related disability, years since last stroke/ TIA , and depression. Results Symptoms of PTSD were correlated with greater concerns about medications ( r  =   0.45; p  〈   .001), and both were associated with medication non‐adherence. Adjustment for concerns about medications attenuated the relationship between PTSD and non‐adherence to medication, from an odds ratio [ OR ] of 1.04 (95% confidence interval [ CI ], 1.01–1.06; OR , 1.63 per 1 SD ) to an OR of 1.02 (95% CI , 1.00–1.05; OR , 1.32 per 1 SD ), and increased concerns about medications remained associated with increased odds of non‐adherence to medication ( OR , 1.17; 95% CI , 1.10–1.25; OR , 1.72 per 1 SD ) in this fully adjusted model. A bootstrap mediation test suggested that the indirect effect was statistically significant and explained 38% of the association of PTSD to medication non‐adherence, and the direct effect of PTSD symptoms on medication non‐adherence was no longer significant. Conclusion Increased concerns about medications explain a significant proportion of the association between PTSD symptoms and non‐adherence to medication in stroke survivors. Statement of contribution What is already known on this subject? Posttraumatic stress disorder ( PTSD ) is common after cardiovascular events, including stroke and transient ischemic attack. PTSD due to non‐stroke cardiovascular events is associated with increased risk of cardiovascular disease recurrence and mortality. PTSD due to stroke is associated with increased risk for medication nonadherence in stroke survivors. What does this study add? While PTSD has been associated with medication nonadherence in stroke survivors and acute coronary syndrome survivors, no mechanism for that association has been tested. This is the first study to provide evidence for a mediator of the PTSD ‐nonadherence association, increased concerns about medications, and point to potential interventions to improve adherence in stroke survivors.
    Type of Medium: Online Resource
    ISSN: 1359-107X , 2044-8287
    URL: Issue
    URL: Article
    DOI: 10.1111/bjhp.2013.18.issue-4
    DOI: 10.1111/bjhp.12022
    Language: English
    Publisher: Wiley
    Publication Date: 2013
    detail.hit.zdb_id: 2026500-1
    SSG: 5,2
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  • 10
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    Organizational Factors Affect Safety‐Net Hospitals’ Breast Cancer Treatment Rates
    Wiley ; 2017
    In:  Health Services Research Vol. 52, No. 6 ( 2017-12), p. 2137-2155
    Details
    In: Health Services Research, Wiley, Vol. 52, No. 6 ( 2017-12), p. 2137-2155
    Abstract: To identify key organizational approaches associated with underuse of breast cancer care. Setting Nine New York City area safety‐net hospitals. Study Design Mixed qualitative–quantitative, cross‐sectional cohort. Methods We used qualitative comparative analysis ( QCA ) of key stakeholder interviews, defined organizational “conditions,” calibrated conditions, and identified solution pathways. We defined underuse as no radiation after lumpectomy in women 〈 75 years or mastectomy in women with ≥4 positive nodes, or no systemic therapy in women with tumors ≥1 cm. We used hierarchical models to assess organizational and patient factors’ impact on underuse. Principal Findings Underuse varied by hospital (8–29 percent). QCA found lower underuse sites designated individuals to track and follow‐up no‐shows; shared clinical information during handoffs; had fully integrated electronic medical records enabling transfer of responsibility across specialties; had strong system support; allocated resources to cancer clinics; had a patient‐centered culture paying close organizational attention to clinic patients. High underuse sites lacked these characteristics. Multivariate modeling found that hospitals with strong approaches to follow‐up had low underuse rates ( RR  = 0.28; 0.08–0.95); individual patient characteristics were not significant. Conclusions At safety‐net hospitals, underuse of needed cancer therapies is associated with organizational approaches to track and follow‐up treatment. Findings provide varying approaches to safety nets to improve cancer care delivery.
    Type of Medium: Online Resource
    ISSN: 0017-9124 , 1475-6773
    URL: Issue
    URL: Article
    DOI: 10.1111/hesr.2017.52.issue-6
    DOI: 10.1111/1475-6773.12605
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2078493-4
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