Preparing a Health Literate Workforce: The Role of Area Health Education Centers.

Area Health Education Centers (AHEC) play a vital role in creating health literate organizations. In this report, we highlight the work of three AHECs. The Massachusetts AHEC trains oral language healthcare interpreters who can effectively convey complex medical information to patients with limited English proficiency (LEP). The University of Kentucky AHEC trains providers to use the Universal Precautions Health Literacy Toolkit. Finally, the Wisconsin AHEC prepares community health workers (CHWs) to play a vital role in making it easy for people to navigate the healthcare system. These three AHECs serve as models of health literacy's diffusion.

Opioid Epidemic in the United States: Empirical Trends, and A Literature Review of Social Determinants and Epidemiological, Pain Management, and Treatment Patterns.

OBJECTIVES: Dramatic increases in opioid and drug overdose mortality have occurred in the United States (US) over the past two decades. To address this national public health crisis and identify gaps in the literature, we analyzed recent empirical trends in US drug overdose mortality by key social determinants and conducted a selective review of the recent literature on the magnitude of the opioid crisis facing different racial/ethnic, socioeconomic, and rural-urban segments of the US population. METHODS: We used the 1999-2017 mortality data from the US National Vital Statistics System to analyze trends in drug overdose mortality by race/ethnicity, age, and geographic area. Log-linear regression was used to model mortality trends. Using various key words and their combinations, we searched PubMed and Google Scholar for select peer-reviewed journal articles and government reports published on the opioid epidemic between 2010 and 2018. RESULTS: Our original analysis and review indicate marked increases in drug overdose mortality overall and by race/ethnicity and geographic regions, with adolescents and young adults experiencing steep increases in mortality between 1999 and 2017. Our selective search yielded 405 articles, of which 39 publications were selected for detailed review. Suicide mortality from drug overdose among teens aged 12-19 increased consistently between 2009 and 2017, particularly among teen girls. The rise of efficient global supply chains has increased opioid prescription use and undoubtedly contributed to the opioid epidemic. Many other important contributing factors to the epidemic include lack of education and economic opportunities, poor working conditions, and low social capital in disadvantaged communities. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: Our analysis and review indicate substantial disparities in drug overdoses and related mortality, pain management, and treatment outcomes according to social determinants. Increases in drug overdoses and resultant mortality are not only unique to the US, but have also been observed in other industrialized countries. Healthcare systems, community leaders, and policymakers addressing the opioid epidemic should focus on upstream structural factors including education, economic opportunity, social cohesion, racial/ethnic disadvantage, geographic isolation, and life satisfaction.

Racial/Ethnic, Nativity, and Sociodemographic Disparities in Maternal Hypertension in the United States, 2014-2015.

This study examines racial/ethnic, nativity, and sociodemographic variations in the prevalence of maternal hypertension in the United States. The 2014-2015 national birth cohort data (N = 7,966,573) were modeled by logistic regression to derive unadjusted and adjusted differentials in maternal hypertension consisting of both pregnancy-related hypertension and chronic hypertension. Substantial racial/ethnic differences existed, with prevalence of maternal hypertension ranging from 2.2% for Chinese and 2.9% for Vietnamese women to 8.9% for American Indians/Alaska Natives (AIANs) and 9.8% for non-Hispanic blacks. Compared with Chinese women, women in all other ethnic groups had significantly higher risks of maternal hypertension, with Filipinos, non-Hispanic blacks, and AIANs showing 2.0 to 2.9 times higher adjusted odds. Immigrant women in most racial/ethnic groups had lower rates of maternal hypertension than the US-born, with prevalence ranging from 1.9% for Chinese immigrants to 10.3% for US-born blacks. Increasing maternal age, lower education, US-born status, nonmetropolitan residence, prepregnancy obesity, excess weight gain during pregnancy, and gestational diabetes were other important risk factors. AIANs, non-Hispanic whites, blacks, Puerto Ricans, and some Asian/Pacific Islander subgroups were at substantially higher risk of maternal hypertension. Ethnicity, nativity status, older maternal age, and prepregnancy obesity and excess weight gain should be included among the criteria used for screening for gestational hypertension.

Social Determinants of Health in the United States: Addressing Major Health Inequality Trends for the Nation, 1935-2016.

OBJECTIVES: This study describes key population health concepts and examines major empirical trends in US health and healthcare inequalities from 1935 to 2016 according to important social determinants such as race/ethnicity, education, income, poverty, area deprivation, unemployment, housing, rural-urban residence, and geographic location. METHODS: Long-term trend data from the National Vital Statistics System, National Health Interview Survey, National Survey of Children's Health, American Community Survey, and Behavioral Risk Factor Surveillance System were used to examine racial/ethnic, socioeconomic, rural-urban, and geographic inequalities in health and health care. Life tables, age-adjusted rates, prevalence, and risk ratios were used to examine health differentials, which were tested for statistical significance at the 0.05 level. RESULTS: Life expectancy of Americans increased from 69.7 years in 1950 to 78.8 years in 2015. However, despite the overall improvement, substantial gender and racial/ethnic disparities remained. In 2015, life expectancy was highest for Asian/Pacific Islanders (87.7 years) and lowest for African-Americans (75.7 years). Life expectancy was lower in rural areas and varied from 74.5 years for men in rural areas to 82.4 years for women in large metro areas, with rural-urban disparities increasing during the 1990-2014 time period. Infant mortality rates declined dramatically during the past eight decades. However, racial disparities widened over time; in 2015, black infants had 2.3 times higher mortality than white infants (11.4 vs. 4.9 per 1,000 live births). Infant and child mortality was markedly higher in rural areas and poor communities. Black infants and children in poor, rural communities had nearly three times higher mortality rate compared to those in affluent, rural areas. Racial/ethnic, socioeconomic, and geographic disparities were particularly marked in mortality and/or morbidity from cardiovascular disease, cancer, diabetes, COPD, HIV/AIDS, homicide, psychological distress, hypertension, smoking, obesity, and access to quality health care. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: Despite the overall health improvement, significant social disparities remain in a number of health indicators, most notably in life expectancy and infant mortality. Marked disparities in various health outcomes indicate the underlying significance of social determinants in disease prevention and health promotion and necessitate systematic and continued monitoring of health inequalities according to social factors. A multi-sectoral approach is needed to tackle persistent and widening health inequalities among Americans.

HIPAA compliance in the OR.

Many current information management practices in the OR will have to change to comply with the Health Insurance Portability and Accountability Act and meet Joint Commission on Accreditation of Healthcare Organizations standards for managing health care information. Demands for accurate, timely, confidential, and secure data make an integrated automated system for information management imperative. Delivering health care in today's OR environment results in enormous amounts of data. Caregivers must transform this data into useable information, while protecting patient privacy, confidentiality, and the security of health care information.