While much has been written about immigrant traditions, music, food culture, folklore, and other aspects of ethnic identity, little attention has been given to the study of medical culture, until ...now. In Medical Caregiving and Identity in Pennsylvania’s Anthracite Region, 1880–2000, Karol Weaver employs an impressive range of primary sources, including folk songs, patent medicine advertisements, oral history interviews, ghost stories, and jokes, to show how the men and women of the anthracite coal region crafted their gender and ethnic identities via the medical decisions they made. Weaver examines communities’ relationships with both biomedically trained physicians and informally trained medical caregivers, and how these relationships reflected a sense of “Americanness.” She uses interviews and oral histories to help tell the story of neighborhood healers, midwives, Pennsylvania German powwowers, medical self-help, and the eventual transition to modern-day medicine. Weaver is able to show not only how each of these methods of healing was shaped by its patrons and their backgrounds but also how it helped mold the identities of the new Americans who sought it out.
Performing medicine Brown, Michael
2017., 20171001, 2017, 2018-02-28, 20110101
eBook
The book offers a fresh and distinctive account of the transformation of provincial English medicine from the late eighteenth to the mid nineteenth centuries. Written by one of the leading scholars ...in the field it demonstrates how the roots of modern medicine can be located in the cultural, political and ideological upheavals of the age of reform.
Overweight patients report weight discrimination in health care settings and subsequent avoidance of routine preventive health care. The purpose of this study was to examine implicit and explicit ...attitudes about weight among a large group of medical doctors (MDs) to determine the pervasiveness of negative attitudes about weight among MDs. Test-takers voluntarily accessed a public Web site, known as Project Implicit®, and opted to complete the Weight Implicit Association Test (IAT) (N = 359,261). A sub-sample identified their highest level of education as MD (N = 2,284). Among the MDs, 55% were female, 78% reported their race as white, and 62% had a normal range BMI. This large sample of test-takers showed strong implicit anti-fat bias (Cohen's d = 1.0). MDs, on average, also showed strong implicit anti-fat bias (Cohen's d = 0.93). All test-takers and the MD sub-sample reported a strong preference for thin people rather than fat people or a strong explicit anti-fat bias. We conclude that strong implicit and explicit anti-fat bias is as pervasive among MDs as it is among the general public. An important area for future research is to investigate the association between providers' implicit and explicit attitudes about weight, patient reports of weight discrimination in health care, and quality of care delivered to overweight patients.
Objective
To determine which area‐based socioeconomic status (SES) indicator is best suited to monitor health care disparities from a delivery system perspective.
Data Sources/Study Setting
142,659 ...adults seen in a primary care network from January 1, 2009 to December 31, 2011.
Study Design
Cross‐sectional, comparing associations between area‐based SES indicators and patient outcomes.
Data Collection
Address data were geocoded to construct area‐based SES indicators at block group (BG), census tract (CT), and ZIP code (ZIP) levels. Data on health outcomes were ed from electronic records. Relative indices of inequality (RIIs) were calculated to quantify disparities detected by area‐based SES indicators and compared to RIIs from self‐reported educational attainment.
Principal Findings
ZIP indicators had less missing data than BG or CT indicators (p < .0001). Area‐based SES indicators were strongly associated with self‐report educational attainment (p < .0001). ZIP, BG, and CT indicators all detected expected SES gradients in health outcomes similarly. Single‐item, cut point defined indicators performed as well as multidimensional indices and quantile indicators.
Conclusions
Area‐based SES indicators detected health outcome differences well and may be useful for monitoring disparities within health care systems. Our preferred indicator was ZIP‐level median household income or percent poverty, using cut points.
This study shows how a small number of medical reformers introduced modern healthcare services between 1928-1945 in China when Chinese people were suffering by the millions from infectious disease, ...maternal child mortality, and battlefield casualties.
Abstract Orthogeriatric co-management (OGCM) describes a collaboration of orthopedic surgeons and geriatricians for the treatment of fragility fractures in geriatric patients. While its ...cost-effectiveness for hip fractures has been widely investigated, research focusing on fractures of the upper extremities is lacking. Thus, we conducted a health economic evaluation of treatment in OGCM hospitals for forearm and humerus fractures. In a retrospective cohort study with nationwide health insurance claims data, we selected the first inpatient stay due to a forearm or humerus fracture in 2014–2018 either treated in hospitals that were able to offer OGCM (OGCM group) or not (non-OGCM group) and applied a 1-year follow-up. We included 31,557 cases with forearm (63.1% OGCM group) and 39,093 cases with humerus fractures (63.9% OGCM group) and balanced relevant covariates using entropy balancing. We investigated costs in different health sectors, length of stay, and cost-effectiveness regarding total cost per life year or fracture-free life year gained. In both fracture cohorts, initial hospital stay, inpatient stay, and total costs were higher in OGCM than in non-OGCM hospitals. For neither cohort nor effectiveness outcome, the probability that treatment in OGCM hospitals was cost-effective exceeded 95% for a willingness-to-pay of up to €150,000. We did not find distinct benefits of treatment in OGCM hospitals. Assigning cases to study groups on hospital-level and using life years and fracture-free life years, which might not adequately reflect the manifold ways these fractures affect the patients’ health, as effectiveness outcomes, might have underestimated the effectiveness of treatment in OGCM hospitals.
Objective
We test whether nursing homes serving predominately low‐income and racial minority residents (compositional explanation) or located in neighborhoods with higher concentrations of low‐income ...and racial minority residents (contextual explanation) have worse financial outcomes and care quality.
Data Sources
Healthcare Cost Report Information System, Nursing Home Compare, Online Survey Certification and Reporting Certification, and American Community Survey.
Study Design
A cross‐sectional study design of nursing homes within U.S. metropolitan areas.
Data Collection/Extraction Methods
Data were obtained from Centers for Medicare & Medicaid Services and U.S. Census Bureau.
Principal Findings
Medicaid‐dependent nursing homes have a 3.5 percentage point lower operating ratio. Those serving primarily racial minorities have a 2.64‐point lower quality rating. A 1 percent increase in the neighborhood population living in poverty is associated with a 1.20‐point lower quality rating, on a scale from 10 to 50, and a 1 percent increase in the portion of neighborhood black residents is associated with a 0.8 percentage point lower operating ratio and a 0.37 lower quality rating.
Conclusions
Medicaid dependency (compositional effect) and concentration of racial minority residents in neighborhoods (contextual effect) are associated with higher fiscal stress and lower quality of care, indicating that nursing homes’ geographic location may exacerbate long‐term care inequalities.
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