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Two-dimensional model of cultural disconnection between Anglos and Hispanics. (Data source: https://geerthofstede.com/research-and-vsm/dimension-data-matrix/)

Two-dimensional model of cultural disconnection between Anglos and Hispanics. (Data source: https://geerthofstede.com/research-and-vsm/dimension-data-matrix/)

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Whether because of economic conditions, war, genocide or other reasons, many people are relocating from their under-developed (or under-duress) countries of origin to urban and suburban areas in more peaceful and affluent countries. The close geographic juxtaposition of these newly emerging populations alongside established native populations can l...

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... Specifically, prior studies have suggested that patients of Hispanic descent have a high power-distance score and high collectivism score based on Hofstede cultural dimensions. 23 Thus, indicating a low likelihood for questioning authority, the physician, and high likelihood for operating from the belief that one's decisions should be based on the needs of the group or family. 23 In agreement with findings in non-EGS patient populations, our study population also demonstrated an increased risk of leaving AMA as percentile median household income decreased. ...
... 23 Thus, indicating a low likelihood for questioning authority, the physician, and high likelihood for operating from the belief that one's decisions should be based on the needs of the group or family. 23 In agreement with findings in non-EGS patient populations, our study population also demonstrated an increased risk of leaving AMA as percentile median household income decreased. This indicates that financially burdened patients are more likely to leave AMA when other factors are considered. ...
Article
Background Emergency general surgery has higher adverse outcomes than elective surgery. Patients leaving the hospital against medical advice (AMA) have a greater risk for readmission and complications. We sought to identify clinical and demographic characteristics along with hospital factors associated with leaving AMA after EGS operations. Methods A retrospective review of the Nationwide Inpatient Sample was performed. All patients who underwent an EGS procedure accounting for >80% of the burden of EGS-related inpatient resources were identified. 4:1 propensity score analysis was conducted. Regression analyses determined predictive factors for leaving AMA. Results 546,856 patients were identified. 1085 (0.2%) patients who underwent EGS left AMA. They were more likely to be men (59% versus 42%), younger (median age 51 y, IQR [37.61] versus 54, IQR [38.69]), qualify for Medicaid (26% versus 13%) or be self-pay (17% versus 9%), and be within the lowest quartile median household income (40% versus 28%) (all P < 0.05). After applying 4:1 propensity score matching, individuals who were self-pay (OR 3.15, 95% CI 2.44-4.06) or insured through Medicare (OR 2.75, 95% CI 2.11-3.57) and Medicaid (OR 3.58, 95% CI 2.83-4.52) had increased odds of leaving AMA compared with privately insured patients. In addition, history of alcohol (OR 2.21, 95% CI 1.65-2.98), drug abuse (OR 4.54, 95% CI 3.23-6.38), and psychosis (OR 2.31, 95% CI 1.65-3.23) were associated with higher likelihood for leaving AMA. Conclusions Patients undergoing EGS have a high risk of complications, and leaving AMA further increases this risk. Interventions to encourage safe discharge encompassing surgical, psychiatric, and socioeconomic factors are warranted to prevent a two-hit effect and compound postoperative risk.