“Wherever the Authority of the Federal Government Extends”: Banning Segregation in Veterans’ Hospitals (1945–1960)

Grillot, Thomas; Peretz, Pauline; Philippe, Yann

doi:10.1093/jahist/jaaa181

Cited by 2 publications

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“… 41 , 42 Similarly, federal and state-sponsored hospital segregation directed minoritized patients to receive their health care in hospitals separate from White individuals. The legacy of such policies, which were also present in the VA, 43 have likely had important impacts on equitable access to care between racial and ethnic groups.…”

Section: Discussionmentioning

confidence: 99%

Veterans Affairs Medical Center Racial and Ethnic Composition and Initiation of Anticoagulation for Atrial Fibrillation

Essien,

Kim,

Hausmann

et al. 2024

JAMA Netw Open

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ImportanceRacial and ethnic disparities exist in anticoagulation therapy for atrial fibrillation (AF). Whether medical center racial and ethnic composition is associated with these disparities is unclear.ObjectiveTo determine whether medical center racial and ethnic composition is associated with overall anticoagulation and disparities in anticoagulation for AF.Design, Setting, and ParticipantsRetrospective cohort study of Black, White, and Hispanic patients with incident AF from 2018 to 2021 at 140 Veterans Health Administration medical centers (VAMCs). Data were analyzed from March to November 2023.ExposureVAMC racial and ethnic composition, defined as the proportion of patients from minoritized racial and ethnic groups treated at a VAMC, categorized into quartiles. VAMCs in quartile 1 (Q1) had the lowest percentage of patients from minoritized groups (ie, the reference group).Main Outcomes and MeasuresThe odds of initiating any anticoagulant, direct-acting oral anticoagulant (DOAC), or warfarin therapy within 90 days of an index AF diagnosis, adjusting for sociodemographics, medical comorbidities, and facility factors.ResultsThe cohort comprised 89 791 patients with a mean (SD) age of 73.0 (10.1) years; 87 647 (97.6%) were male, 9063 (10.1%) were Black, 3355 (3.7%) were Hispanic, and 77 373 (86.2%) were White. Overall, 64 770 individuals (72.1%) initiated any anticoagulant, 60 362 (67.2%) initiated DOAC therapy, and 4408 (4.9%) initiated warfarin. Compared with White patients, Black and Hispanic patients had lower rates of any anticoagulant and DOAC therapy initiation but higher rates of warfarin initiation across all quartiles of VAMC racial and ethnic composition. Any anticoagulant therapy initiation was lower in Q4 than Q1 (69.8% vs 74.9%; adjusted odds ratio [aOR], 0.80; 95% CI, 0.69-0.92; P &lt; .001). DOAC and warfarin initiation were also lower in Q4 than in Q1 (DOAC, 69.4% vs 65.3%; aOR, 0.85; 95% CI, 0.74-0.97; P &lt; .001; warfarin, 5.4% vs 4.5%; aOR, 0.82; 95% CI, 0.67-1.00; P &lt; .001). In adjusted models, patients in Q4 were significantly less likely to initiate any anticoagulant therapy than those in Q1 (aOR, 0.88; 95% CI, 0.78-0.99). Patients in Q3 (aOR, 0.75; 95% CI, 0.60-0.93) and Q4 (aOR, 0.69; 95% CI, 0.55-0.87) were significantly less likely to initiate warfarin therapy than those in Q1. There was no significant difference in the adjusted odds of initiating DOAC therapy across racial and ethnic composition quartiles. Although significant Black-White and Hispanic-White differences in initiation of any anticoagulant, DOAC, and warfarin therapy were observed, interactions between patient race and ethnicity and VAMC racial composition were not significant.Conclusions and RelevanceIn a national cohort of VA patients with AF, initiation of any anticoagulant and warfarin, but not DOAC therapy, was lower in VAMCs serving more minoritized patients.

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Section: Discussionmentioning

confidence: 99%

Veterans Affairs Medical Center Racial and Ethnic Composition and Initiation of Anticoagulation for Atrial Fibrillation

Essien,

Kim,

Hausmann

et al. 2024

JAMA Netw Open

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“…These ongoing adaptations muddled already incoherent juridical concepts and in turn, increased politicized demands for institutionalizing police expertise through specialized training. 5 Lvovsky deftly navigates these interplays between political conflict and judicial independence, procedural rights, and surveillance technologies, as well as between emerging psychiatric authority over homosexuality and established legal expertise over criminality.…”

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confidence: 99%

Into Law's Artifice: Postwar Policing, Sexual Difference, and the Epistemic Gap

Pitts

2022

Law hist. rev.

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Vice Patrol analyzes how reconfigurations in postwar gay public life, psychiatric research, and policing surveillance technologies recast Americans’ chimerical commitments to purging sexual vice. Before a more radical, visible queer liberation movement emerged after 1969, vice enforcement was not a monolithic project but rather a conglomeration of newly empowered post-Prohibition liquor agents, policing units, and judicial institutions. Enforcement practices and institutional priorities generated inconsistencies over policing sexual difference, creating conflicts that became embedded in judicial processes, themselves fraught with institutional pressures and contradictions. These legal and administrative configurations did more than enforce existing law regulating sexual deviance; they actively produced identifiable targeted groups believed to be predisposed to sexual criminality. Vice Patrol’s insights are urgent; they reveal and explain the historical, institutional, and political processes of negotiating human expression into criminal acts requiring state policing intervention. The intrusive tactics that Lvovsky chronicles did not disappear; they were redirected, which is best articulated in the liberal disillusionment with “urban renewal” and with the Nixon administration's “War on Crime” that targeted “high crime” areas in urban communities of color, propelling forward racialized mass incarceration.

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“Wherever the Authority of the Federal Government Extends”: Banning Segregation in Veterans’ Hospitals (1945–1960)

Cited by 2 publications

References 1 publication

Veterans Affairs Medical Center Racial and Ethnic Composition and Initiation of Anticoagulation for Atrial Fibrillation

Veterans Affairs Medical Center Racial and Ethnic Composition and Initiation of Anticoagulation for Atrial Fibrillation

Into Law's Artifice: Postwar Policing, Sexual Difference, and the Epistemic Gap

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