Purpose To examine characteristics associated with disparities in digital access (i.e., access to high‐speed Internet via a computer or smartphone) in American rural and urban households given that digital access has a direct impact on access to telemedicine‐based services. Methods Using the 2019 American Community Survey, we analyzed the proportions of geographic area, race/ethnicity, and socioeconomic status according to device and high‐speed Internet access. Maximum likelihood logit estimators estimated how these factors influenced device and high‐speed Internet access. Findings Of 105,312,959 households, 32.29% were without a desktop or laptop computer with high‐speed Internet (WDW), 21.51% were without a smartphone with a data plan for wireless Internet (WSW), and 14.02% were without any digital access (WDA). Nonmetropolitan households were significantly more likely to be WDA than metropolitan households (odds ratio [OR] = 1.87; 95% confidence interval [CI]: 1.83‐1.91). Relative to non‐Hispanic Whites, non‐Hispanic Blacks (OR = 1.60; 95% CI: 1.56‐1.64), American Indian or Alaska natives (OR = 2.00; 95% CI: 1.82‐2.19), or Hispanics (OR = 1.70; 95% CI: 1.66‐1.74) were significantly more likely to be WDA. When compared to households with private health insurance coverage, households WDA were significantly more likely to have no insurance (OR = 2.44; 95% CI: 2.36‐2.53) or public insurance coverage (OR = 3.78; 95% CI: 3.70‐3.86). Households with any digital access reported higher income and more family members living at home. Using the same predictors, similar findings were reported for households WDW or WSW. Conclusions Significant disparities in digital access exist among nonmetropolitan households, racial/ethnic minority households, and lower‐income households. The lack of digital access has implications for the accessibility of health care services via telemedicine and thus could exacerbate health disparities.
Indoor dust has been widely used to monitor flame retardants (FRs) in indoor environment, but most studies only focused on floor dust. In the present study, FRs were examined in indoor dust from different locations. Dust from air conditioner (AC) filters, beddings, floor, and windows in bedrooms, and dust from AC filters, printer table surface, computer table surface, floor, and windows in offices were collected, respectively. Polybrominated diphenyl ether congener 209 (BDE 209) and decabromodiphenyl ethane (DBDPE) were the most abundant brominated flame retardants (BFRs), and tris(chloroisopropyl) phosphate (TCIPP), tris(1,3-dichloroisopropyl) phosphate (TDCIPP), and triphenyl phosphate (TPHP) were the most abundant phosphate flame retardants (PFRs). In bedrooms, the AC filter dust had the highest median levels of BDE 209 (536 ng/g) and DBDPE (2720 ng/g), while bed dust had the highest median levels of ΣPFRs (2750 ng/g) among dust samples. In offices, printer table dust had higher median levels of BDE 209 (1330 ng/g), DBDPE (8470 ng/g), and ΣPFRs (11,000 ng/g) than those in other dust samples. The high dust ingestion values of BDE 209, DBDPE, and individual PFR were 0.28, 1.20, and <0.01-0.32 ng/kg bw/day and 7.37, 31.2, and <0.01-4.54 ng/kg bw/day for BDE 209, DBDPE, and individual PFR for adults and toddlers, respectively. The high dermal exposure values of individual PFR during sleeping were <0.01-0.23 and <0.01-0.36 ng/kg bw/day for adults and toddlers, respectively. More human exposure pathways other than dust ingestion should be considered, such as the dermal contact with beddings and furniture.
Objectives Electronic Medical Records (EMR) have the potential to improve the coordination of healthcare in this country, yet the field of psychiatry has lagged behind other medical disciplines in its adoption of EMR. Methods Psychiatrists at 18 of the top US hospitals completed an electronic survey detailing whether their psychiatric records were stored electronically and accessible to non-psychiatric physicians. Electronic hospital records and accessibility statuses were correlated with patient care outcomes obtained from the University Health System Consortium Clinical Database available for 13 of the 18 top US hospitals. Results 44% of hospitals surveyed maintained most or all of their psychiatric records electronically and 28% made psychiatric records accessible to non-psychiatric physicians; only 22% did both. Compared with hospitals where psychiatric records were not stored electronically, the average 7-day readmission rate of psychiatric patients was significantly lower at hospitals with psychiatric EMR (5.1% vs. 7.0%, p = .040). Similarly, the 14 and 30-day readmission rates at hospitals where psychiatric records were accessible to non-psychiatric physicians were lower than those of their counterparts with non-accessible records (5.8% vs. 9.5%, p = .019, 8.6% vs. 13.6%, p = .013, respectively). The 7, 14, and 30-day readmission rates were significantly lower in hospitals where psychiatric records were both stored electronically and made accessible than at hospitals where records were either not electronic or not accessible (4% vs 6.6%, 5.8% vs 9.1%, 8.9 vs 13%, respectively, all with p = 0.045). Conclusions Having psychiatric EMR that were accessible to non-psychiatric physicians correlated with improved clinical care as measured by lower readmission rates specific for psychiatric patients.
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