Acceptability of a hypothetical dengue vaccine and the potential impact of dengue vaccination on personal vector control behavior: a qualitative study in Fortaleza, Brazil.

Background: Dengue is the most rapidly spreading viral vector-borne disease in the world. Promising new dengue vaccines have contributed to a growing consensus that effective dengue control will require integrated strategies of vaccination and vector control. In this qualitative study, we explored the perspectives of residents of Fortaleza, Brazil on acceptability of a hypothetical safe and effective dengue vaccine, specific drivers of dengue vaccine acceptance or hesitance, and the expected impact of dengue vaccination on their personal vector control practices.

Expanding access to parasite-based malaria diagnosis through retail drug shops in Tanzania: evidence from a randomized trial and implications for treatment.

Background: Tanzania has seen a reduction in the fraction of fevers caused by malaria, likely due in part to scale-up of control measures. While national guidelines require parasite-based diagnosis prior to treatment, it is estimated that more than half of suspected malaria treatment-seeking in Tanzania initiates in the private retail sector, where diagnosis by malaria rapid diagnostic test (RDT) or microscopy is illegal. This pilot study investigated whether the introduction of RDTs into Accredited Drug Dispensing Outlets (ADDOs) under realistic market conditions would improve case management practices.

Community Health Workers' Provision of Family Planning Services in Low- and Middle-Income Countries: A Systematic Review of Effectiveness.

This systematic review evaluates the strength of the evidence that community health workers' (CHW) provision of family planning (FP) services in low- and middle-income countries is effective. In a search of eight databases, articles were screened by study design and outcome measure and ranked by strength of evidence. Only randomized trials, longitudinal studies with a comparison group, and pre-test/post-test studies met inclusion criteria.

The hazards of off-road motor sports: Are four wheels better than two?

Background: Off-road motorsports are an increasing popular activity, yet the relative safety profile of all-terrain vehicles (ATV) to off-road motorcycles (ORMC) has not been compared.

Study Design: A retrospective review of the 2002-2006 US National Trauma Data Bank of ATV and ORMC crash victims. Patients were described according to demographic (age, sex, race and ethnicity, insurance status) and injury characteristics (Injury Severity Score, hypotension, motor component of the Glasgow Coma Score, presence of a severe head or extremity injury) known to affect trauma outcomes.

Unconscious Race and Class Biases among Registered Nurses: Vignette-Based Study Using Implicit Association Testing.

Background: Implicit bias is an unconscious preference for a specific social group that can have adverse consequences for patient care. Acute care clinical vignettes were used to examine whether implicit race or class biases among registered nurses (RNs) impacted patient-management decisions.

Study Design: In a prospective study conducted among surgical RNs at the Johns Hopkins Hospital, participants were presented 8 multi-stage clinical vignettes in which patients' race or social class were randomly altered.

Unconscious race and social class bias among acute care surgical clinicians and clinical treatment decisions.

Importance: Significant health inequities persist among minority and socially disadvantaged patients. Better understanding of how unconscious biases affect clinical decision making may help to illuminate clinicians' roles in propagating disparities.

Objective: To determine whether clinicians' unconscious race and/or social class biases correlate with patient management decisions.

Incremental Cost of Emergency Versus Elective Surgery.

Objective: To determine hospital costs and the adjusted risk of death associated with emergent versus elective surgery.

Background: Emergency surgery has a higher cost and worse outcomes compared with elective surgery. However, no national estimates of the excess burden of emergency surgery exist.

Unconscious race and class bias: its association with decision making by trauma and acute care surgeons.

Background: Recent studies have found that unconscious biases may influence physicians' clinical decision making. The objective of our study was to determine, using clinical vignettes, if unconscious race and class biases exist specifically among trauma/acute care surgeons and, if so, whether those biases impact surgeons' clinical decision making.

Methods: A prospective Web-based survey was administered to active members of the Eastern Association for the Surgery of Trauma.

Association between intentional injury and long-term survival after trauma.

Objective: To determine the risk-adjusted mortality of intentionally injured patients within 7 to 9 years postinjury, compared with unintentionally injured patients.

Background: Violent injury contributes significantly to trauma mortality in the United States. Homicide is the second leading killer of American youth, aged 15 to 24 years.

Increased complications after appendectomy in patients with cerebral palsy: are special needs patients at risk for disparities in outcomes?

Background: Cerebral palsy (CP) is a nonprogressive neurologic disorder. Anecdotal evidence suggests there are worse outcomes in this population after common operative procedures like appendectomy. This study aims to classify whether there are relevant disparities in postoperative outcomes in CP versus non-CP patients after open or laparoscopic appendectomy.

Socioeconomic disparity in inpatient mortality after traumatic injury in adults.

Background: Prior studies have demonstrated that race and insurance status predict inpatient trauma mortality, but have been limited by their inability to adjust for direct measures of socioeconomic status (SES) and comorbidities. Our study aimed to identify whether a relationship exists between SES and inpatient trauma mortality after adjusting for known confounders.

Methods: Trauma patients aged 18-65 years with an Injury Severity Scores (ISS) of ≥9 were identified using the 2003-2009 Nationwide Inpatient Sample.

Counting the lives lost: how many black trauma deaths are attributable to disparities?

Background: The number of black trauma deaths attributable to racial disparities is unknown. The objective of this study was to quantify the excess mortality experienced by black patients given disparities in the risk of mortality.

Materials And Methods: We performed a retrospective analysis of patients aged 16-65 y with blunt and penetrating injuries, who were included in the National Trauma Data Bank from 2007-2010.

Increased risk of pneumonia among ventilated patients with traumatic brain injury: every day counts!

Background: Patients with traumatic brain injury (TBI) frequently require mechanical ventilation (MV). The objective of this study was to examine the association between time spent on MV and the development of pneumonia among patients with TBI.

Materials And Methods: Patients older than 18 y with head abbreviated injury scale (AIS) scores coded 1-6 requiring MV in the National Trauma Data Bank 2007-2010 data set were included.

National cost of trauma care by payer status.

Background: Several studies have described the burden of trauma care, but few have explored the economic burden of trauma inpatient costs from a payer's perspective or highlighted the differences in the average costs per person by payer status. The present study provides a conservative inpatient national trauma cost estimate and describes the variation in average inpatient trauma cost by payer status.

Methods: A retrospective analysis of patients who had received trauma care at hospitals in the Nationwide Inpatient Sample from 2005-2010 was conducted.

Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors.

It is well known that there are significant racial disparities in health care outcomes, including surgery. However, the mechanisms that lead to these disparities are still not fully understood. In this comprehensive review of the currently published surgical disparity literature in the United States, we assess racial disparities in outcomes after surgical procedures, focusing on patient, provider, and systemic factors.

Association between hospitals caring for a disproportionately high percentage of minority trauma patients and increased mortality: a nationwide analysis of 434 hospitals.

Objective: To determine whether there is an increased odds of mortality among trauma patients treated at hospitals with higher proportions of minority patients (ie, black and Hispanic patients combined).

Design: Hospitals were categorized on the basis of the percentage of minority patients admitted with trauma. The adjusted odds of in-hospital mortality were compared between hospitals with less than 25% of patients who were minorities (the reference group) and hospitals with 25% to 50% of patients who were minorities and hospitals with more than 50% of patients who were minorities.