Showing papers in "Journal of Health Care for the Poor and Underserved in 2017"
TL;DR: A modified version of Adapted Behavioral Model of health care utilization for transgender people focused on transgender individuals is presented as a guiding theoretical framework that informs recommendations for increasing transgender health care usage.
Abstract: Transgender people face numerous barriers when utilizing health care in the United States. The current study sought to highlight transgender consumer perspectives in order to present theoretically informed, concrete recommendations for increasing transgender health care utilization. The search yielded several prominent themes associated with barriers to health care for transgender people: 1) provider lack of knowledge concerning transgender identity issues and transgender health issues, 2) transgender patients' previous negative experiences with the health care system or anticipation of these experiences, 3) transgender patients' inability to pay for health care services, and 4) health care provider refusal to provide health care services to transgender people. We present a modified version of Adapted Behavioral Model of health care utilization for transgender people focused on transgender individuals as a guiding theoretical framework that informs our recommendations for increasing transgender health care utilization.
91 citations
TL;DR: For AIs and non-AIs, having six or more ACEs significantly increased the odds for depression, anxiety, PTSD, severe alcohol misuse, and smoking compared with individuals with no ACEs.
Abstract: Objectives. To assess the prevalence of Adverse Childhood Experiences (ACEs) and their association with behavioral health in American Indian (AI) and non-AI populations in South Dakota. Methods. We included the validated ACE questionnaire in a statewide health survey of 16,001 households. We examined the prevalence of ACEs and behavioral health conditions in AI and non-AI populations and associations between ACEs and behavioral health. Results. Compared with non-AIs, AIs displayed higher prevalence of ACEs including abuse, neglect, and household dysfunction and had a higher total number of ACEs. For AIs and non-AIs, having six or more ACEs significantly increased the odds for depression, anxiety, PTSD, severe alcohol misuse, and smoking compared with individuals with no ACEs. Conclusions. American Indians in South Dakota experience more ACEs, which may contribute to poor behavioral health. Preventing and mitigating the effects of ACEs may have a significant impact on health disparities in AI populations.
64 citations
TL;DR: Non-traditional indicators of socioeconomic status (SES) may be just as or even more predictive of health outcomes as traditional indicators of SES (e.g., income), and the nuanced link between SES and health behaviors and outcomes should be explored.
Abstract: Non-traditional indicators of socioeconomic status (SES; e.g., home ownership) may be just as or even more predictive of health outcomes as traditional indicators of SES (e.g., income). This study tested whether financial strain (i.e., difficulty paying monthly bills) predicted medication non-adherence and worse self-rated health. Research assistants administered surveys to 1,527 patients with acute coronary syndromes or acute decom-pensated heart failure. In adjusted models, having a higher income was associated with being more adherent ( p p p p
45 citations
TL;DR: Parents of children ages 2–17 were asked questions related to mental disorders in the 2011–2012 National Survey of Children's Health, and Pearson's χ2 test and logistic regression were used to examine sociodemographic differences in the prevalence of mental disorders, mental health service needs, and service use.
Abstract: Parents of children ages 2–17 (N = 85,637) were asked questions related to mental disorders in the 2011–2012 National Survey of Children's Health. Pearson's χ2 test and logistic regression were used to examine sociodemographic differences in the prevalence of mental disorders, mental health service needs, and service use. The lifetime and current prevalence of mental disorders was 21% and 14.8%, respectively. Overall, 7,819 children needed mental health care, representing 9.5% of the total sample; only 61% of them received treatment or counseling. Compared with Hispanics and Blacks, children ages two to five, and children without insurance, Whites, children ages five–11 and 12–17, and children having public insurance had higher odds of service use. Sustained policy initiatives and intervention efforts are needed.
39 citations
TL;DR: The role of racism (i.e., internalized, personally-mediated, and institutionalized) in creating and perpetuating racial disparities at multiple levels of the social ecology is conceptualized by integrating two often-cited theories in the literature.
Abstract: There are clear and compelling racial disparities in access to renal transplant, which is the therapy of choice for many patients with end stage renal disease. This paper conceptualizes the role of racism (i.e., internalized, personally-mediated, and institutionalized) in creating and perpetuating these disparities at multiple levels of the social ecology by integrating two often-cited theories in the literature. Internalized racism is manifested at the intrapersonal level when, for example, African American patients devalue their self-worth, thereby not pursuing the most aggressive treatment available. Personally-mediated racism is manifested at the interpersonal level when, for example, physicians exhibit unconscious race bias that impacts their treatment decisions. One example of institutionalized racism being manifested at the institutional, community, and public policy levels is the longstanding existence of racial residential segregation and empirically established links between neighborhood racial composition and dialysis facility-level transplantation rates. This paper concludes with clinical, research, and policy recommendations.
36 citations
TL;DR: In Syracuse, New York the social determinants of trauma from neighborhood violence are rooted in historical processes, including urban renewal, the Rockefeller drug laws, and de-industrialization, which contributed to destabilizing Syracuse communities of color, resulting in disproportionate incarceration, family disruption, and economic devastation.
Abstract: In Syracuse, New York the social determinants of trauma from neighborhood violence are rooted in historical processes, including urban renewal, the Rockefeller drug laws, and de-industrialization. These contributed to destabilizing Syracuse communities of color, resulting in disproportionate incarceration, family disruption, and economic devastation. Community violence, clustering in densely populated neighborhoods, creates unmanageable stress for the families who live in them. A map of gunshots and gun fatalities (2009 to 2014) illustrates the continuing onslaught of bullets being fired, often in close proximity to elementary schools. A community survey indicated that over half of respondents personally knew more than 10 murder victims. Half the respondents scored positive on the Civilian PTSD Checklist; there thus is a great deal of unaddressed traumatic stress in the community. This analysis, conducted to prepare for planning future interventions to reduce the community trauma and violence, is part of an ongoing university-community collaboration.
36 citations
TL;DR: The all-cancer mortality rate in the Delta Region was higher than all comparison groups across all stratifications and higher rates were seen for cervical and colorectal cancer across comparison groups and stratifications.
Abstract: The Delta Region is a federally designated, socioeconomically disadvantaged region of the United States covering 252 counties in eight states along the Mississippi River. The objective of this study is to describe the Region's cancer mortality burden. National Center for Health Statistics data were used to calculate age-adjusted mortality rates and rate ratios for the Delta Region for all cancers, lung, colorectal, breast (female), cervical, and prostate cancers. Rates were also calculated for comparison groups, and were stratified by gender, race, rurality, and socioeconomic status. The all-cancer mortality rate in the Delta Region was higher than all comparison groups across all stratifications. Higher rates were seen for cervical and colorectal cancer across comparison groups and stratifications. Delta Blacks had higher rates than Whites, and rural Delta residents had higher rates than their urban peers for most cancers. Further research and interventions should be conducted to elucidate and reduce these disparities.
35 citations
TL;DR: Overall, study findings supported the established correlation between mental health issues and substance use as well as a theory of self-medication in people 18–25 years of age.
Abstract: The high rate of co-occurring mental health issues and substance-use disorders has been well documented. The primary objective of this research was to evaluate the association between use of alcohol, marijuana, and other illicit drugs, and unmet mental health need and service use. A secondary aim of this research was to determine if the observed patterns of alcohol, marijuana, and other illicit drugs use and unmet mental health need and mental health service use are consistent with a theory of self-medication theory. On the latter view, people use psychoactive substances as a self-regulation strategy to alleviate distress. Research was conducted through secondary analysis of 2014 National Survey on Drug Use and Health (NSDUH) data. Overall, study findings supported the established correlation between mental health issues and substance use as well as a theory of self-medication. This study focused on people 18-25 years of age.
35 citations
TL;DR: This work analyzed racial distributions of faculty and students at HBCU medical schools compared with all other medical schools and calculated correlations between rates of Black chairs, faculty, and students and found a significant positive correlation.
Abstract: Introduction. Although less than 3% of medical schools are considered Historically Black Colleges and Universities (HBCU), they have played a significant role in the education of Black physicians. Methods. The Association of American Medical Colleges (AAMC) databases were used to obtain faculty and student demographic data from 2003-2013. We analyzed racial distributions of faculty and students at HBCU medical schools compared with all other medical schools and calculated correlations between rates of Black chairs, faculty, and students. Results. Although HBCUs represent 2.4% of medical colleges, they house 31% of Black chairs, 10% of Black faculty and 14% of Black students. A significant ( a *
30 citations
TL;DR: Investigation of factors that facilitate or impede health ministry activities, including the adoption of EBIs, and opportunities to use technology to support/enhance the capacity of FBOs to sustain health-related activities found that participants used technology and social media but older adults did so less often.
Abstract: African American faith-based organizations (FBOs) play an important role in addressing health disparities. Increasingly, churches offer health fairs, screenings, or education through health ministries. However, little is known about linking these organizations with evidence-based interventions (EBIs) developed by research. This study explored 1) factors that facilitate or impede health ministry activities, including the adoption of EBIs, and 2) opportunities to use technology to support/enhance the capacity of FBOs to sustain health-related activities. We conducted 18 key informant interviews with African American pastors and FBO leaders and six focus groups with members. A popular health ministry strategy was distribution of print materials. There was limited awareness of EBIs and how to access them. Challenges included maintaining qualified volunteers, financial resources, and technical assistance needs. Participants used technology and social media but older adults did so less often. Findings have implications for dissemination/implementation research in FBOs, in relation to the translational continuum.
29 citations
TL;DR: A majority of continuing U.S. smokers have low SES, and further progress against the U.s. cigarette epidemic depends on focusing tobacco research and program initiatives on reaching and engaging these smokers in cessation strategies that work for them.
Abstract: Objective. We estimated the proportion of U.S. smokers who have low socioeconomic status (SES). Methods. We used 2012 data from a national supplement to The Attitudes and Behaviors Survey on Health (TABS), a periodic population survey of Colorado adults. We estimated smoking prevalence and total smokers by education, poverty level, occupation, health insurance status, and combinations of these factors. Results. Smoking prevalence across low-SES categories ranged from 24.3% to 42.6%. Combining low-SES categories with the highest smoking prevalence accounted for 31.1% of U.S. adults but half (50.1%) of smokers. Combining all low-SES categories regardless of smoking prevalence accounted for roughly half (53.3%) of adults but nearly three-fourths (72.2%) of smokers. Conclusions. A majority of continuing U.S. smokers have low SES. Further progress against the U.S. cigarette epidemic depends on focusing tobacco research and program initiatives on reaching and engaging these smokers in cessation strategies that work for them.
TL;DR: A mixed-methods study combined direct observations of patient navigators within the Patient Navigation Research Program and outcome data from the trial to understand the contribution of specific navigator activities to improved clinical outcomes.
Abstract: Given the momentum in adopting patient navigation into cancer care, there is a need to understand the contribution of specific navigator activities to improved clinical outcomes A mixed-methods study combined direct observations of patient navigators within the Patient Navigation Research Program and outcome data from the trial We correlated the frequency of navigator tasks with the outcome of rate of diagnostic resolution within 365 days among patients who received the intervention relative to controls A focused content analysis examined those tasks with the strongest correlations between navigator tasks and patient outcomes Navigating directly with specific patients (r = 0679), working with clinical providers to facilitate patient care (r = 0643), and performing tasks not directly related to their diagnostic evaluation for patients were positively associated with more timely diagnosis (r = 0714) Using medical records for non-navigation tasks had a negative association (r = -0643) Content analysis revealed service provision directed at specific patients improved care while systems-focused activities did not
TL;DR: Populations most likely to benefit from genomic research can inform strategies for genetic testing and future research, and have the potential to counter stereotypes of Blacks as non-adherent or low-literate, rather than exacerbate stereotypes.
Abstract: Background. Variants of the APOL1 gene increase risk for kidney failure 10-fold, and are nearly exclusively found in people with African ancestry. To translate genomic discoveries into practice, we gathered information about effects and challenges incorporating genetic risk in clinical care. Methods. An academic-community-clinical team tested 26 adults with self-reported African ancestry for APOL1 variants, conducting in-depth interviews about patients’ beliefs and attitudes toward genetic testing- before, immediately, and 30 days after receiving test results. We used constant comparative analysis of interview transcripts to identify themes. Results. Themes included: Knowledge of genetic risk for kidney failure may motivate providers and patients to take hypertension more seriously, rather than inspiring fatalism or anxiety. Having genetic risk for a disease may counter stereotypes of Blacks as non-adherent or low-literate, rather than exacerbate stereotypes. Conclusion. Populations most likely to benefit from genomic research can inform strategies for genetic testing and future research.
TL;DR: Findings suggest that navigation services must be tailored to the specific screening test provided, and Federally qualified community health centers should establish excellent patient tracking systems and establish multiple protocols to facilitate screening completion.
Abstract: In the U.S., colorectal cancer (CRC) incidence and mortality have declined due to screening and improvements in early detection; however, racial/ethnic disparities in screening and mortality persist. Patient navigation has been shown to be effective in increasing CRC screening prevalence. This systematic review answered three questions about navigation in federally qualified community health centers (FQHCs): 1) Which navigation activities increased CRC screening prevalence? 2) What were the challenges to implementing these programs in FQHCs? 3) Which clinic protocols supported screening completion? Findings suggest that navigation services must be tailored to the specific screening test provided. Federally qualified community health centers report difficulty maintaining a current electronic medical records system and sustaining funding; they should establish excellent patient tracking systems (for follow-up and annual rescreening) and establish multiple protocols to facilitate screening completion. With the movement toward patient-centered care models, patient navigation will be integral to FQHCs and their clients.
TL;DR: Assessment of the acceptability of a screening and intervention program to address food insecurity in pediatric primary care and positive results can help to inform implementation of routine FI screening in clinical practice.
Abstract: Our project's purpose was to assess the acceptability of a screening and intervention program to address food insecurity (FI) in pediatric primary care. We implemented systematic FI screening during routine health supervision visits. Our positive results can help to inform implementation of routine FI screening in clinical practice.
TL;DR: Mexican im/migrants at post-migration phases had lower likelihood of receiving health care and having a usual source of care, and higher rates of forgone care, than their counterparts at pre-departure.
Abstract: Objectives. We examined differences in, and factors associated with, access to health services among Mexican im/migrants to the U.S. across migration phases, including pre-departure, destination, interception, and return. Methods. Using data from a cross-sectional survey conducted in Tijuana, Mexico (N = 1,541), we computed descriptive statistics and staged logistic regressions to estimate health care access indicators and factors associated with access to services. Results. Im/migrants at post-migration phases had lower likelihood of receiving health care and having a usual source of care, and higher rates of forgone care, than their counterparts at pre-departure. These differences were partly explained by length of migration phase, health insurance status, transportation barriers, and detention or imprisonment. Conclusions. Mexican im/migrants face challenges in accessing health services across the migration continuum, especially at post-migration phases. Binational efforts to provide affordable insurance coverage and reduce transportation limitations and incarceration could contribute to improving health care access among Mexican im/migrants.
TL;DR: It is suggested that among low-income minority adults continuity of care is more strongly associated with screening than medical mistrust, and shifting focus from medical mistrust to establishing health care homes may be a more effective strategy for reducing racial and socioeconomic disparities in cancer screening.
Abstract: Background. Racial minorities and low-income individuals are generally less likely to have adequate cancer screening than Whites or higher-income individuals. Purpose. To examine the roles of medical mistrust and lack of provider continuity in cancer screening in a low-income minority population. Methods. A total of 144 urban federally qualified health center patients completed a cross-sectional survey that included the Group Based Medical Mistrust Scale and questions on provider continuity and cancer-screening-history. Results. Breast cancer screening was associated with continuity of care but not mistrust (respectively p = .002, p .05); colon cancer screening was not significantly associated with either factor (p .05). Conclusions. Findings suggest that among low-income minority adults continuity of care is more strongly associated with screening than medical mistrust. Shifting focus from medical mistrust—a patient-level issue—to establishing health care homes—a system-level issue—may be a more effective strategy for reducing racial and socioeconomic disparities in cancer screening.
TL;DR: This paper used a modified Delphi method to establish consensus on a set of basic principles and practices for developing a universal design based on person-centered care, enhanced by recovery-oriented care and trauma-informed care, as the basis for a universal approach to health care.
Abstract: Person-centered care has yet to be widely implemented in health care settings, a circumstance that disproportionately affects individuals with behavioral health disorders and those with trauma histories. A need exists for a universal approach to care that encompasses compassionate, collaborative relationships between providers and service users. Person-centered care, enhanced by recovery-oriented care and trauma-informed care, forms the basis for a universal approach to health care. For this paper, we adopted a modified Delphi method to establish consensus on a set of basic principles and practices for developing a universal design based on these three frameworks. We used a two-stage process to arrive at guidelines for use in health and human service settings by: 1) convening an expert panel to draft guidelines; and 2) conducting an online survey of multidisciplinary experts to refine the guidelines. We conclude with recommendations for implementation.
TL;DR: HIV chronicity has resulted in increased life expectancy for many African American women who acquired the disease during the epidemic’s peak years, but as these women live longer and age, their social support needs may increase.
Abstract: HIV chronicity has resulted in increased life expectancy for many African American women who acquired the disease during the epidemic's peak years. As these women live longer and age, their social support needs may increase. Five focus groups were conducted in Washington, DC with 23 HIV-positive African American women aged 52-65 to explore women's perceptions about how aging and HIV chronicity affects their social support needs. Participants were recruited from the longitudinal Women's Interagency HIV Study (WIHS) participant pool. A constant comparison approach was applied during data analysis. Participants reported needing increased social support, especially emotional support from health care providers, family, and HIV-positive peers. The importance of providers and HIV-positive peers was discussed most frequently relative to meeting these needs. Health care providers in particular may need to increase their provision of emotional support when devising treatment plans to meet the social support needs of older HIV-positive African American women.
TL;DR: Neonatal abstinence syndrome is epidemic in the eastern Tennessee area of Appalachia, with unique maternal and infant characteristics that have important implications for primary, secondary, and tertiary prevention.
Abstract: Objective. To describe the epidemiology of neonatal abstinence syndrome (NAS) in a 16-county Appalachian area of eastern Tennessee. Methods. The Tennessee Surveillance System for NAS provided data on maternal sources of opioids. Data linking hospital discharge diagnosis for NAS to birth certificate data allowed us to compare maternal, delivery, and infant characteristics for NAS births with those for non-NAS births. Results. There were 339 cases of NAS in 2013 and 367 in 2014, for NAS rates of 25.5 and 28.5 per 1,000 live births, respectively. When compared with the state overall, mothers of NAS infants in eastern Tennessee were more likely to use opioids that had been prescribed to another person. There were numerous maternal, infant, and delivery characteristics that were significantly different for NAS births compared with non-NAS births. Conclusion. Neonatal abstinence syndrome is epidemic in the eastern Tennessee area of Appalachia, with unique maternal and infant characteristics that have important implications for primary, secondary, and tertiary prevention.
TL;DR: There is evidence that AI/ANs start cancer therapy later than NHWs, and the modest magnitude of delays suggests that they are unlikely to be a determinant of survival disparities.
Abstract: To assess whether timing of initial post-diagnosis cancer care differs between American Indian and Alaska Native (AI/AN) and non-Hispanic White (NHW) patients, we accessed SEER-Medicare data for breast, colorectal, lung, and prostate cancers (2001-2007). Medicare claims data were examined for initiation of cancer-directed treatment. Overall, AI/ANs experienced longer median times to starting treatment than NHWs (45 and 39 days, p
TL;DR: It is concluded that modern contraceptive use remains weak, hence, programs aiming to encourage contraceptive use must address barriers at both the health facility and the household level.
Abstract: Given the current low contraceptive use and corresponding high levels of unwanted pregnancies leading to induced abortions and poor maternal health outcomes among rural populations, a detailed understanding of the factors that limit contraceptive use is essential. Our study investigated household and health facility factors that influence contraceptive use decisions among rural women in rural Burkina Faso. We collected data on fertile non-pregnant women in 24 rural districts in 2014. Of 8,657 women, 1,098 used a modern contraceptive. Women having a living son, a child younger than one year, and household wealth were more likely to use modern contraceptives. Women in polygamous marriages and women living at least 5 kilometers from a health facility were less likely to use contraception. We conclude that modern contraceptive use remains weak, hence, programs aiming to encourage contraceptive use must address barriers at both the health facility and the household level.
TL;DR: Analysis of ethnic identity in relation to hazardous alcohol use, illicit drug use, and risky sexual behavior in 266 college students recruited on the campus of a historically Black college/university (HBCU) found no relationship among the risk variables and ethnic identity.
Abstract: We examined ethnic identity in relation to hazardous alcohol use, illicit drug use, and risky sexual behavior in 266 college students recruited on the campus of a historically Black college/university (HBCU). Participants were primarily African American students participating in HIV education and prevention outreach efforts. Data regarding prevalence of substance use, binge drinking, and sexual risk behaviors are reported. Results found no relationship among the risk variables and ethnic identity. HIV knowledge score results demonstrated a need to continue HIV education to include the less publicized facts about HIV transmission. Results are discussed in terms of implications for prevention efforts with African American college students.
TL;DR: Despite unfavorable demographic characteristics, records for patients with hypertension who used IUSOC as a regular provider of primary care compared favorably with national data.
Abstract: Purpose. To characterize the quality of health care at student-run free clinics (SRFCs) by analyzing hypertension management and outcomes at the Indiana University Student Outreach Clinic (IUSOC). Methods. A retrospective review of medical records was conducted for hypertensive patients managed at IUSOC over 15 months (N = 64). Indiana University Student Outreach Clinic's hypertension control rate was compared with National Health and Nutrition Examination Survey (NHANES) data. Results. Blood pressure control rates increased significantly over the study period. Indiana University Student Outreach Clinic's control rate did not differ significantly with the NHANES national average, but was significantly greater than the NHANES group with no usual source of care. Similarly, IUSOC patients without insurance or with unknown insurance status had greater control rates than an uninsured NHANES group, but did not differ significantly from an insured NHANES group. Conclusions. Despite unfavorable demographic characteristics, records for patients with hypertension who used IUSOC as a regular provider of primary care compared favorably with national data.
TL;DR: Physical access to digital devices, use of e-mail and social media tools, and perceptions of telemedicine among American Indian patients with diabetes mellitus (DM) are evaluated.
Abstract: Introduction Health care access for medically underserved patients managing chronic conditions is challenging. While telemedicine can support patient education and engagement, the "digital divide" may be particularly problematic among the medically underserved. This study evaluated physical access to digital devices, use of e-mail and social media tools, and perceptions of telemedicine among American Indian (AI) patients with diabetes mellitus (DM). Methods Survey data were collected from AI patients with DM during teleophthalmology exams. Results Eighty-eight percent of patients had access to digital device(s), 70% used e-mail, and 56% used social media. Younger age and greater education were positively associated with e-mail and social media use (p l .05). Most (60%) considered telemedicine an excellent medium for health-related patient education. Discussion American Indian patients with DM had access enabling patient education via telemedicine. Future work should examine patient technology preferences and effectiveness of technology-based education in improving outcomes among medically underserved populations.
TL;DR: Four housing-related themes emerged: challenges meeting basic needs, complex chronic care management difficulties, stigma and relationship with provider, and stress and other mental health issues, which highlight specific mechanisms by which housing challenges may lead to hospitalization.
Abstract: Objective To analyze patient perspectives on the role of housing in their potentially preventable hospitalization Methods Individuals admitted with cardiovascular-or diabetes-related diagnoses (n = 90) in a major medical center in Hawai'i completed an in-person interview eliciting patient perspectives on key factors leading to hospitalization Using the framework approach, two independent coders identified themes This study focused on housing-related findings Results Overall, 23% of participants reported housing as a precipitating factor to their hospitalization, including 12 with no regular place to stay Four housing-related themes emerged: challenges meeting basic needs, complex chronic care management difficulties, stigma and relationship with provider, and stress and other mental health issues Discussion Almost 25% of patients identified housing as a key factor to their hospital stay Patient-reported themes highlight specific mechanisms by which housing challenges may lead to hospitalization Addressing housing issues could help reduce the number and associated cost burden of preventable hospitalizations
TL;DR: Holding providers accountable for their patients' ED use should avoid penalizing PCPs who care for poor and otherwise vulnerable populations, and expected use targets should account for neighborhood-level variables such as income, as well as other risk factors.
Abstract: Much of emergency department use is avoidable, and high-quality primary care can reduce it, but performance measures related to ED use may be inadequately risk-adjusted. To explore associations between emergency department (ED) use and neighborhood poverty, we conducted a secondary analysis of Massachusetts managed care network data, 2009–2011. For enrollees with commercial insurance (n = 64,623), we predicted any, total, and total primary-care-sensitive (PCS) ED visits using claims/enrollment (age, sex, race, morbidity, prior ED use), network (payor, primary care provider [PCP] type and quality), and census-tract-level characteristics. Overall, 14.6% had any visit; mean visits per 100 persons were 18.8 (±0.2) total and 7.6 (±0.1) PCS. Neighborhood poverty predicted all three outcomes (all P
TL;DR: To understand better what is known in this area and incentives and barriers to related research, semi-structured interviews with leaders and researchers in for-and non-profit organizations developing interventions to bridge health and social service delivery are conducted.
Abstract: Despite a growing national interest in health care-based strategies focused on patients' social determinants of health (SDH), little has been compiled about the impacts of SDH interventions undertaken in clinical settings. To understand better what is known in this area and incentives and barriers to related research, we conducted 30 semi-structured interviews with leaders and researchers in for-and non-profit organizations developing interventions to bridge health and social service delivery. Key informants described evaluation activities primarily concentrated on program design and implementation, and less commonly on impact evaluations and dissemination research. A diversity of outcome variables being used in intervention research limits the ability to draw conclusions about comparative effectiveness. Major barriers to advancing effective research on these topics relate to confusion around ownership of the SDH space within the health care sector.
TL;DR: Results confirm the importance of examining the racial dynamics factor and the need to address this sensitive topic early in the academic programs so students are prepared more fully to have sincere and meaningful encounters with their patients during the clinical years and as health care providers.
Abstract: Using the Self-Assessment of Perceived Level of Cultural Competence (SAPLCC) questionnaire, frequencies, means, and ANOVAS were determined to create medical and pharmacy student profiles of cultural competence. Profiles were used to identify needs for training and underscore critical issues that should be given priority in the curriculum. Significant differences were found in several domains of cultural competence (knowledge, skills, attitudes, and abilities); they may be explained by differences in the implementation of a pilot curriculum, the racial composition of students in both programs, and other characteristics. However, in the awareness domain, the main differences found may be explained only by respondents' attitudes and their personal experiences. Results confirm the importance of examining the racial dynamics factor and the need to address this sensitive topic early in the academic programs so students are prepared more fully to have sincere and meaningful encounters with their patients during the clinical years and as health care providers.
TL;DR: Higher socioeconomic position was associated with better oral health status than low socioeconomic position, and the oral health of women studied was not optimal.
Abstract: Objective. To determine the association between oral health and socioeconomic position in institutionalized older women in Mexico City. Methods. A cross-sectional study was performed in two groups: high socioeconomic position (HSEP), living in a private retirement home, and low socioeconomic position (LSEP), living in a public assistance center. Oral health was determined by edentulism, oral hygiene, healthy teeth, experience of dental caries, missing and filled teeth, gingival bleeding, dental calculus, and periodontal disease. A latent class analysis (LCA) was used to classify oral health status in dentate. Results. Included were 170 women (HSEP 54.1% and LSEP 45.8%), average age 77.3 (SD = 9.3) years. Oral health status was formed: Edentulous 32.4% HSEP and 67.6% LSEP; Class 1 Unfavorable 0% HSEP and 100% LSEP; Class2 Slightly favorable 41.2% HSEP and58.8% LSEP; and Class3 Favorable 84.6% HSEP and 15.4% LSEP. There was a statistically significant association between socioeconomic position (p