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Purpose: This study aims to evaluate how various demographic factors impact the stage at diagnosis and, therefore, prognosis of laryngeal cancer., Materials and Methods: Using the National Cancer Database, 96,409 patients were diagnosed with laryngeal squamous cell carcinoma between 2004 and 2020. Early (stage 0 or I) vs. late-stage (stage IV) cancers were compared based on demographic variables utilizing Chi-square and multivariate analysis with a significance of p < 0.05., Results: Female, Black, and generally older patients were more likely to have late-stage cancer than their counterparts. When compared with a community cancer program, patients treated at other facility types were more likely to be diagnosed late. Patients with private insurance, Medicare, or other government insurance were all less likely to have late-stage cancer compared to patients without insurance. Compared to patients in the lowest median household income quartile, patients in the third quartile and fourth quartile were diagnosed earlier. Patients living in an area with the lowest level of high school degree attainment were most likely to be diagnosed late. Living in a more populous area was associated with a lower chance of being diagnosed late. Increasing Charlson-Deyo Score was associated with a stronger likelihood of being diagnosed at a later stage., Conclusion: Patients who are female, Black, uninsured, have a low household income, live in less populated and less educated areas, are treated at non-community cancer programs, and have more comorbid conditions have later stage diagnoses. This data contributes to understanding inequities in healthcare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The COVID-19 pandemic has forced health care workers to explore alternative personal protective equipment (PPE) strategies due to traditional product shortages in the setting of increased global demand. Some physicians have chosen to use elastomeric face masks (EFMs), traditionally used in non-healthcare industries., Methods: We performed a prospective cohort study of Emergency Medicine (EM) physicians working at a Level 1 Trauma Center who chose to use self-supplied EFMs for PPE. All subjects used commercial EFMs with disposable filters (N95, P95, or P100). All subjects chose their mask size independently with no input from employee health regarding appropriate fit. Per study protocol, subjects were fit tested periodically during clinical shifts over the course of the 6-week study period. All investigators performing fit testing underwent OSHA qualitative fit testing training. Data collected included mask/filters age, subjective assessment of mask seal quality, and fit test results. The data were analyzed using descriptive statistics., Results: 105 fit tests were performed on physicians wearing EFMs over the course of 49 shifts. Physicians felt their fit was adequate for all tests performed. There were no fit test failures in any subjects., Conclusions: EFMs have an extremely low failure rate. Physicians are able to assess the adequacy of fit and accurately choose EFM size., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: Prior research indicates that different types of childhood maltreatment frequently co-occur and confer risk for adulthood intimate partner violence (IPV). However, it is unknown whether the risk of IPV is due to specific type(s) of maltreatment or to their shared association or both. Although these competing explanations have different implications for intervention, they have never been evaluated empirically., Method: Data were drawn from a nationally representative survey of 34,653 US adults, the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Structural equation modeling was used to simultaneously examine the shared and specific effects of five types of childhood maltreatment (i.e., sexual abuse, physical and emotional abuse and neglect) on the risk of different IPV behaviors (i.e., perpetration, victimization and reciprocal violence). Analyses were stratified by sex and adjusted for sociodemographic characteristics (i.e., age, personal income, educational background and race/ethnicity)., Results: Most types of childhood maltreatment increased the risk of victimization, perpetration and reciprocal violence. Effects of maltreatment types on each IPV behavior were exerted mostly through a latent factor representing the shared effect across all different types of maltreatment in both sexes (CFI = 0.990, TLI = 0.990, RMSEA = 0.023), although sexual abuse had an additional effect on victimization., Conclusions: Because childhood maltreatment types increase the risk of each intimate partner violence behavior mainly through a general maltreatment dimension, underlying biological and developmental-ecological mechanisms should be considered important targets of prevention for both victimization and perpetration of abuse in adult relationships., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Utilizing volunteers in research-assistant roles can provide a new model for extending research dollars in epidemiologic studies of the elderly. This is increasingly important with a rapidly growing older population suffering from an increasing prevalence of disability, disease, and the related medical costs. During a two-year cross-sectional study of factors that predict health aging conducted by the Buck Center for Research in Aging in Marin County, California, 82 volunteers were recruited and trained to fill roles often held by paid research assistants. The key activities of telephone screening, interviewing, coding, and data entry were successfully completed by trained volunteers following standards and within a time frame comparable to similar studies. Volunteer research assistants contributed approximately 13,600 hours that resulted in a savings in personnel costs of over $100,000. Many of the people recruited and trained as volunteer research assistants were healthy older adults and retired workers. The project utilized their transferable skills and talents in an interesting and productive capacity.

Home health care is an integral part of the health care system. As home care grows--a natural outcome with a growing elderly population and earlier discharges from the hospital under DRGs--so do the many challenges. Proposed Medicare budget cuts, managed care and Medicaid block grants are just a few of the pressing issues faces by not only home care, but the entire health care industry.