Browsing by Subject "Social Class"
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Item Donald W. Seldin, M.D., Research Symposium finalist presentations(2022-04-29) Almonte, Matthew; Duvalyan, Angela; McAdams, Meredith; Onyirioha, Kristeen; Saez-Calveras, Nil; Triana, TaylorThis edition of the UT Southwestern Internal Medicine Grand Rounds features presentations by the six Foster Fellows selected as finalists from the Seventh Annual Donald W. Seldin, M.D. Research Symposium, which was held on April 21, 2022. These Foster Fellows presented work that spanned the breadth and depth of scholarly activity across the department, and at the close of Grand Rounds, one will be selected as the 2022 Seldin Scholar, in honor of Dr. Donald W. Seldin. The Grand Rounds presentation includes additional award presentations recognizing Clinical Vignettes, as well as the Award for Research in Quality and Education at Parkland Hospital and the Social Impact Award.Item Low Dose Aspirin Increases Live Birth Rate Differentially along Socioeconomic Status(2017-01-17) Agrawala, Shilpi; Schisterman, Enrique F.; Halvorson, Lisa M.; Sjaarda, Lindsey A.INTRODUCTION: Low socioeconomic status (SES) is associated with adverse pregnancy outcomes such as preterm birth and low birth weight. Lower medical advice compliance and decreased access to health care contribute to these events in this population. In addition, some studies suggest that women of low SES may have greater difficulty achieving pregnancy, although mechanisms for this phenomenon are not known. Low-dose aspirin (LDA) has been shown to increase pregnancy and live birth rates in women with elevated inflammatory markers. Since low SES is also associated with chronic, low-level inflammation, we hypothesized that low-dose aspirin may also increase live birth and pregnancy rates in low SES women. METHODS: We performed a secondary analysis of The Effects of Aspirin in Gestation and Reproduction (EAGeR) Trial, a multisite, blockrandomized, controlled trial. 1228 women were randomly allocated to either 81mg of aspirin + 400mcg of folic acid (n=615) or placebo + 400 mcg of folic acid (n=613). Participants took the study medication for six menstrual cycles or until 36 weeks' gestation if pregnancy was achieved. For this analysis, women were stratified by socioeconomic measures, which included income (low, mid, high) and a combined grouping of education and income (low-low, low-high, high-low, high-high). The effect of LDA vs. placebo was then determined within each strata. RESULTS: LDA increased live birth rates (RR 1.23, 95% CI: 1.03, 1.45) in the high-income group compared to placebo and increased pregnancy rates (RR 1.23, 95%CI: 1.06, 1.42) in the high education-high income group compared to placebo. The low-education low-income group also demonstrated an increased pregnancy rate (RR 1.22, 95% CI: 1.02, 1.46) compared to placebo, but no effects were observed among the participants grouped by low income alone. DISCUSSION: Our analysis shows high SES women consistently benefited from LDA as demonstrated by increased pregnancy and live birth rates compared to placebo. Less consistent effects of LDA in low SES women were observed, and no significant benefit of LDA was observed in mid-SES groups. Differences in factors such as underlying health risk factors and medication compliance may contribute to the different effects of LDA by SES on reproductive outcomes.Item On wealth and wrongdoing: how social class influences unethical behavior(2013-03-12) Piff, Paul K.Social class exerts a significant influence on ethical decisions and behavior. Psychological research finds that individuals from higher social class backgrounds are more likely to prioritize themselves---their individual needs and desires relative to individuals from lower social class backgrounds, who are more likely to be sensitive to others. Guided by this work, Paul K. Piff, Ph.D., will report studies showing that higher social class is associated with increased unethical behavior, decreased altruism, and increased utilitarian moral reasoning, as well as provide data to shed light on the reasons for these class differences. The talk highlights that social class is a powerful force in the realm of ethics.Item Socioeconomic Disparities in Follow-up Care for Young Adults with Type 1 Diabetes and Impact on Glycemic Control(2018-01-23) Viroslav, Hannah; Hsu, Jesse; Long, Judith; Eiel, Jack; Agarwal, ShivamiBACKGROUND: Only 13% of young adults (YA) with type 1 diabetes (T1D), nationally, achieve the American Diabetes Association glycemic target of <7%. YA with T1D of low socioeconomic status (SES) have incrementally worse glycemic control, due to personal, social, and healthcare system factors. Engagement in regular diabetes follow-up has been shown to be beneficial in preventing acute complications and improving glycemic control in YA with T1D, but little is known whether disparities exist in follow-up care based on SES. The purpose of this study was to a) compare differences in diabetes follow-up patterns between low and higher SES YA with T1D and b) evaluate the impact of interrupted care on glycemic control. METHODS: 203 YA with T1D, 18-30 years, were recruited from the adult diabetes clinic at the University of Pennsylvania. Demographic, clinical, and follow-up visit data were extracted from medical charts. Low SES individuals were defined as having medical coverage under a federal or state-sponsored (public) insurance plan while higher SES individuals were defined as having coverage under a commercial (private) insurance plan. Baseline demographic and clinical characteristics were compared by insurance type. Multilevel mixed effects logistic and linear regression models were used to compare differences in follow-up rates and the impact on glycemic control. All models were adjusted for age, sex, race, diabetes duration, insulin regimen, and time in diabetes providerメs care. RESULTS: 203 participants were included for analysis. Mean age was 23.5 years and 55% were female. Forty-six percent (n=95) had public insurance and 53% (n=108) had private insurance; 42% (n=40) of publicly insured YA were black compared to 11% (n=12) of privately insured YA. Mean diabetes duration was 11.8 years with no significant difference between publicly and privately insured. Mean overall HbA1c was 9.0%, with mean HbA1c 9.9% for publicly insured and 8.8% for privately insured (p<0.001). Publicly insured YA were 1.5 times more likely to no show for scheduled visits (OR=1.53, p=0.009) and were 2.3 times more likely to be lost to diabetes follow-up after 6 months (OR 2.3, p<0.001), compared to privately insured YA. Glycemic control worsened substantially with each successive no show to a scheduled visit (HbA1c +1.10% per no show, p=0.001). CONCLUSION: Low SES YA with T1D are less likely to consistently follow up in diabetes care, are more likely to be completely lost to diabetes care after 6 months, and have worse glycemic control as a result of inconsistent follow-up, compared to higher SES YA. Further research needs to explore why disparities in follow-up exist, as well as innovative healthcare delivery modalities.