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Forman LM, Jackson WE, Arrigain S, Lopez R, Schold JD. Socioeconomic deprivation is associated with worse patient and graft survival following adult liver transplantation. Liver Transpl 2024:01445473-990000000-00380. [PMID: 38767448 DOI: 10.1097/lvt.0000000000000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/05/2024] [Indexed: 05/22/2024]
Abstract
The impact of social determinants of health on adult liver transplant recipient outcomes is not clear at a national level. Further understanding of the impact of social determinants of health on patient outcomes can inform effective, equitable health care delivery. Unadjusted and multivariable models were used to analyze the Scientific Registry of Transplant Recipients to evaluate the association between the Social Deprivation Index (SDI) based on the liver transplant recipient's residential location and patient and graft survival. We included adult recipients between January 1, 2008 and December 1, 2021. Patient and graft survival were lower in adults living in areas with deprivation scores above the median. Five-year patient and graft survival were 78.7% and 76.5%, respectively, in the cohort above median SDI compared to 80.5% and 78.3% below median SDI. Compared to the recipients in low-deprivation residential areas, recipients residing in the highest deprivation (SDI quintile = 5) cohort had 6% higher adjusted risk of mortality (adjusted hazard ratio = 1.06, 95% CI: 1.01-1.13) and 6% higher risk of graft failure (adjusted hazard ratio = 1.06, 95% CI: 1.001-1.11). The increased risks for recipients residing in more vulnerable residential areas were higher (adjusted hazard ratio = 1.11, 95% CI: 1.03-1.20 for both death and graft loss) following the first year after transplantation. Importantly, the overall risk for graft loss associated with SDI was not linear but instead accelerated above the median level of deprivation. In the United States, social determinants of health, as reflected by residential distress, significantly impacts 5-year patient and graft survival. The overall effect of residential deprivation modest, and importantly, results illustrate they are more strongly associated with longer-term follow-up and accelerate at higher deprivation levels. Further research is needed to evaluate effective interventions and policies to attenuate disparities in outcomes among recipients in highly disadvantaged areas.
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Affiliation(s)
- Lisa M Forman
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Surgery, Division of Transplantation, Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado, USA
| | - Whitney E Jackson
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Surgery, Division of Transplantation, Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado, USA
| | - Susana Arrigain
- Department of Surgery, Division of Transplantation, Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado, USA
- Department of Surgery, Division of Transplant Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rocio Lopez
- Department of Surgery, Division of Transplantation, Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado, USA
- Department of Surgery, Division of Transplant Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jesse D Schold
- Department of Surgery, Division of Transplantation, Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado, USA
- Department of Surgery, Division of Transplant Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Thongprayoon C, Vaitla P, Jadlowiec CC, Leeaphorn N, Mao SA, Mao MA, Qureshi F, Kaewput W, Qureshi F, Tangpanithandee S, Krisanapan P, Pattharanitima P, Acharya PC, Nissaisorakarn P, Cooper M, Cheungpasitporn W. Distinct Phenotypes of Non-Citizen Kidney Transplant Recipients in the United States by Machine Learning Consensus Clustering. MEDICINES (BASEL, SWITZERLAND) 2023; 10:medicines10040025. [PMID: 37103780 PMCID: PMC10144541 DOI: 10.3390/medicines10040025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/24/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Better understanding of the different phenotypes/subgroups of non-U.S. citizen kidney transplant recipients may help the transplant community to identify strategies that improve outcomes among non-U.S. citizen kidney transplant recipients. This study aimed to cluster non-U.S. citizen kidney transplant recipients using an unsupervised machine learning approach; Methods: We conducted a consensus cluster analysis based on recipient-, donor-, and transplant- related characteristics in non-U.S. citizen kidney transplant recipients in the United States from 2010 to 2019 in the OPTN/UNOS database using recipient, donor, and transplant-related characteristics. Each cluster's key characteristics were identified using the standardized mean difference. Post-transplant outcomes were compared among the clusters; Results: Consensus cluster analysis was performed in 11,300 non-U.S. citizen kidney transplant recipients and identified two distinct clusters best representing clinical characteristics. Cluster 1 patients were notable for young age, preemptive kidney transplant or dialysis duration of less than 1 year, working income, private insurance, non-hypertensive donors, and Hispanic living donors with a low number of HLA mismatch. In contrast, cluster 2 patients were characterized by non-ECD deceased donors with KDPI <85%. Consequently, cluster 1 patients had reduced cold ischemia time, lower proportion of machine-perfused kidneys, and lower incidence of delayed graft function after kidney transplant. Cluster 2 had higher 5-year death-censored graft failure (5.2% vs. 9.8%; p < 0.001), patient death (3.4% vs. 11.4%; p < 0.001), but similar one-year acute rejection (4.7% vs. 4.9%; p = 0.63), compared to cluster 1; Conclusions: Machine learning clustering approach successfully identified two clusters among non-U.S. citizen kidney transplant recipients with distinct phenotypes that were associated with different outcomes, including allograft loss and patient survival. These findings underscore the need for individualized care for non-U.S. citizen kidney transplant recipients.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Pradeep Vaitla
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | | | - Napat Leeaphorn
- Renal Transplant Program, University of Missouri-Kansas City School of Medicine/Saint Luke's Health System, Kansas City, MO 64108, USA
| | - Shennen A Mao
- Division of Transplant Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Fahad Qureshi
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Supawit Tangpanithandee
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Pattharawin Pattharanitima
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine Thammasat University, Pathum Thani 12120, Thailand
| | - Prakrati C Acharya
- Division of Nephrology, Texas Tech Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Pitchaphon Nissaisorakarn
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, DC 21042, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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3
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Sheehan L, Torres A, Lara JL, Paniagua D, Larson JE, Mayes J, Doig S, Corrigan PW. Qualitative Evaluation of a Peer Navigator Program for Latinos with Serious Mental Illness. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:495-504. [PMID: 29168016 PMCID: PMC5997452 DOI: 10.1007/s10488-017-0839-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Peer navigator programs (PNP) may help reduce physical health disparities for ethnic minorities with serious mental illness (SMI). However, specific aspects of PNP that are important to peer navigators and their clients are under-researched. A qualitative study explored the perspectives of service users (n = 15) and peer navigators (n = 5) participating in a randomized controlled trial of a PNP for Latinos with SMI. Results show PN engagement with service users spans diverse areas and that interactions with peers, trust, and accessibility are important from a service user perspective. PNs discussed needs for high-quality supervision, organizational support, and additional resources for undocumented Latinos.
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Affiliation(s)
- Lindsay Sheehan
- Illinois Institute of Technology, Chicago, USA. .,Department of Psychology, Illinois Institute of Technology, 3424 S. State Street, Chicago, IL, 60616, USA.
| | | | | | | | | | - John Mayes
- Trilogy Behavioral Healthcare, Chicago, USA
| | - Susan Doig
- Trilogy Behavioral Healthcare, Chicago, USA
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Corrigan PW, Torres A, Lara JL, Sheehan L, Larson JE. The Healthcare Needs of Latinos with Serious Mental Illness and the Potential of Peer Navigators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:547-557. [PMID: 27236458 PMCID: PMC5997453 DOI: 10.1007/s10488-016-0737-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Latinos with serious mental illness get sick and die much younger than other adults. In this paper, we review findings of a community based participatory research project meant to identify important healthcare needs, barriers to these needs, solutions to the barriers, and the promise of peer navigators as a solution. Findings from focus groups reflected general concerns of people with mental illness (e.g., insurance, engagement, accessibility) and Latinos with serious mental illness (e.g., immigration, language, and family). Feedback and analyses especially focused on the potential of peer navigators. Implications of these findings for integrated care of Latinos with serious mental illness are discussed.
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Affiliation(s)
- Patrick W Corrigan
- Illinois Institute of Technology, 3424 South State St. First Floor, Room 1B9-2, Chicago, IL, 60616, USA
| | - Alessandra Torres
- Illinois Institute of Technology, 3424 South State St. First Floor, Room 1B9-2, Chicago, IL, 60616, USA
| | - Juana L Lara
- Illinois Institute of Technology, 3424 South State St. First Floor, Room 1B9-2, Chicago, IL, 60616, USA.
| | - Lindsay Sheehan
- Illinois Institute of Technology, 3424 South State St. First Floor, Room 1B9-2, Chicago, IL, 60616, USA
| | - Jonathon E Larson
- Illinois Institute of Technology, 3424 South State St. First Floor, Room 1B9-2, Chicago, IL, 60616, USA
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Corrigan PW, Torres A, Lara JL, Sheehan L, Larson JE. Prioritizing the healthcare needs of Latinos with mental illness. INTERNATIONAL JOURNAL OF CULTURE AND MENTAL HEALTH 2017; 10:19-32. [PMID: 30505348 PMCID: PMC6261424 DOI: 10.1080/17542863.2016.1246581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Latinos with serious mental illness have higher morbidity and mortality rates than same age peers. In this paper, we review findings of a community based participatory research project meant to identify important health needs of this group, barriers to these needs, solutions to the barriers and the promise of peer navigators as a solution. Findings from a prior qualitative study yielded 84 themes related to needs, barriers and solutions. These findings were transposed into individual items, to which 122 Latino participants with mental illness responded using a 7-point importance scale. Results showed item importance means ranging from 4.34 to 5.47, with counseling/therapy services and mental health treatment topping the list for healthcare needs. Analyses also examined differences between those born in the USA versus those born elsewhere. Latinos who were native to the USA differed significantly from those born abroad in over one quarter of importance ratings. Implications of these findings for integrated care of Latinos with serious mental illness are discussed.
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Affiliation(s)
- Patrick W Corrigan
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois
| | - Alessandra Torres
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois
| | - Juana L Lara
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois
| | - Lindsay Sheehan
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois
| | - Jonathon E Larson
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois
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6
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Birth Experiences of Immigrant Latina Women in a New Growth Community. J Racial Ethn Health Disparities 2016; 3:466-72. [PMID: 27294734 DOI: 10.1007/s40615-015-0159-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/06/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
Abstract
A woman's birth experience can impact the physical and mental well-being of mothers long after the birth of their child. Little is known about the experiences of Latina women in areas with small, yet growing Latino populations. To understand Latina's perceptions of their childbirth experience and to see how insurance status impacts that experience, we conducted in-depth, semi-structured interviews with a non-proportional quota sampling of ten Latina women, five with and five without health insurance. Most women reported a positive global experience; the birth of a healthy child was the most important factor influencing birth experiences for all of them. Locus of control and support from medical providers and loved ones also shaped experiences. Uninsured women reported lower levels of perceived control and support, which did impact their birthing experience. These differences could be influenced by social status and position. Medical provider, hospital, and policy recommendations are made which could lead to improvements in uninsured Latinas' childbirth experiences.
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Nesbitt S, Palomarez RE. Review: Increasing Awareness and Education on Health Disparities for Health Care Providers. Ethn Dis 2016; 26:181-90. [PMID: 27103768 DOI: 10.18865/ed.26.2.181] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The focus of this review is to highlight health care disparities and trends in several common diseases in selected populations while offering evidence-based approaches to mitigating health care disparities. Health care disparities cross many barriers and affect multiple populations and diseases. Ethnic minorities, the elderly, and those of lower socioeconomic status (SES) are more at-risk than others. However, many low SES Whites and higher SES racial minorities have poorer health than their racial or SES peers. Also, recent immigrant groups and Hispanics, in particular, maintain high health ratings. The so-called Hispanic Paradox provides an example of how culture and social background can be used to improve health outcomes. These groups have unique determinants of disparity that are based on a wide range of cultural and societal factors. Providing improved access to care and reducing the social determinants of disparity is crucial to improving public health. At the same time, for providers, increasing an understanding of the social determinants promotes better models of individualized care to encourage more equitable care. These approaches include increasing provider education on disparities encountered by different populations, practicing active listening skills, and utilizing a patient's cultural background to promote healthy behaviors.
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8
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Health information seeking of low socioeconomic status Hispanic adults using smartphones. ASLIB J INFORM MANAG 2015. [DOI: 10.1108/ajim-12-2014-0181] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Smartphones have great potential to bridge the digital divide that low-socioeconomic status (SES) Hispanics have been experiencing. However, little is known about this group’s use of smartphones for health information. The purpose of this paper is to fill the gap by exploring the context in which smartphones were used for health information.
Design/methodology/approach
– The authors interviewed 20 low-SES Hispanic participants using the semi-structured interview method. Participants had not obtained college degrees and had annual incomes less than $30,000, but had used their smartphones for health information. The interviews were transcribed and analyzed using the qualitative content analysis method.
Findings
– Being economical was an important reason for low-SES Hispanic users to use smartphones for health information. The users relied heavily on public Wi-Fi to access the internet. They searched a wide range of health topics, mostly using the mobile web rather than apps. They lacked knowledge and skills to effectively using apps, evaluating the quality of health information, and comprehend information.
Research limitations/implications
– Having access to smartphones alone does not help bridge the digital gap for low-SES Hispanics. Interventions need to consider improving these users’ smartphone literacy and health literacy, as well as improving their access to Wi-Fi services and to more quality content in Spanish.
Originality/value
– Prior studies speculated that smartphones could be a means to bridge digital divide experienced by the Hispanic ethnic group. This study provided empirical knowledge about how smartphones are used by these users for health information, and shed light on the design of future informational interventions.
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9
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Hod T, Goldfarb-Rumyantzev AS. The role of disparities and socioeconomic factors in access to kidney transplantation and its outcome. Ren Fail 2014; 36:1193-9. [PMID: 24988495 DOI: 10.3109/0886022x.2014.934179] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Research focused on identifying vulnerable populations and revealing specific risk factors for barriers along the pathway from ESRD to kidney transplantation has been mostly descriptive and the causes of existing disparities remain unclear. However, several socio-economic factors that are associated with the access to and the outcome of the kidney transplantation have been identified. SUMMARY While the presence of racial, gender, and geographic disparities is noted, we were interested mostly to describe potential socio-economic factors associated with and possibly responsible for the presence of such disparities. In this review we focused on five factors: education level, employment status, income, presence of substance addiction or abuse, and marital status. We describe the new method to quantify patients' socio-economic status and identify the group of high risk in terms of the transplant outcome, easily calculated social adaptability index, previously associated with clinical outcome in several patient populations including those with kidney transplant. At the end, based on literature analyzed we offer potential interventions that potentially can be used in order to reduce the degree of disparities. CONCLUSION Based on review of literature socio-economic factors are associated with and possibly responsible for healthcare disparities. Social adaptability index allows quantifying the degree of socio-economic status and identifying the group of high risk for inferior transplant outcome.
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Affiliation(s)
- Tammy Hod
- Division of Nephrology and Center for Vascular Biology Research, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston , MA
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10
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Psychosocial and contextual determinants of alcohol and drug use disorders in the National Latino and Asian American Study. Drug Alcohol Depend 2014; 139:71-8. [PMID: 24742864 PMCID: PMC4117235 DOI: 10.1016/j.drugalcdep.2014.03.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 02/13/2014] [Accepted: 03/05/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND In the U.S., Latino and Asian American immigrants and ethnic minorities may be at increased risk for alcohol and drug use disorders (AUDs/DUDs). The role of psychosocial and contextual characteristics as potential factors underlying this increased risk is unresolved. METHODS Participants include 4649 adults from the National Latino and Asian American Study. Logistic regression was used to determine the relationship between acculturation, acculturative stress, neighborhood characteristics, family characteristics, and discrimination and AUDs/DUDs. Models were stratified by age of immigration and ethnicity and controlled for demographic and mental health characteristics. RESULTS Overall, 9.6% of Latino and 4.1% of Asian participants met criteria for lifetime AUDs/DUDs. Acculturation, family conflict, and discrimination were positively associated with AUDs/DUDs (odds ratios [ORs] and 95% confidence intervals [95%CIs]: 1.80[1.54-2.09], 1.24[1.12-1.36], and 1.54[1.38-1.73]), while neighborhood safety and family cohesion were protective for AUDs/DUDs (ORs[95%CIs]: 0.75[0.66-0.85] and 0.79[0.69-0.90]). Acculturative stress and neighborhood cohesion were not related to AUDs/DUDs. The relationships between family conflict and family cohesion with AUDs/DUDs were attenuated after accounting for other psychosocial and contextual factors. These relationships were generally consistent across ethnic and age of immigration subgroups. CONCLUSIONS Factors such as acculturation, discrimination, and neighborhood safety, are robustly and largely universally related to AUDs/DUDs among first and later generation Latino and Asian immigrants. Further research is required to understand how and why these factors relate to risk of substance misuse, and to identify ways to apply these factors in prevention and intervention efforts.
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Allen JD, Leyva B, Torres AI, Ospino H, Tom L, Rustan S, Bartholomew A. Religious beliefs and cancer screening behaviors among Catholic Latinos: implications for faith-based interventions. J Health Care Poor Underserved 2014; 25:503-26. [PMID: 24858865 PMCID: PMC4162660 DOI: 10.1353/hpu.2014.0080] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although most U.S. Latinos identify as Catholic, few studies have focused on the influence of this religious tradition on health beliefs among this population. This study explores the role of Catholic religious teachings, practices, and ministry on cancer screening knowledge, attitudes, and behaviors among Latinos. Eight focus groups were conducted with 67 Catholic Latino parishioners in Massachusetts. Qualitative analysis provided evidence of strong reliance on faith, God, and parish leaders for health concerns. Parishes were described as vital sources of health and social support, playing a central role in the community's health. Participants emphasized that their religious beliefs promote positive health behaviors and health care utilization, including the use of cancer screening services. In addition, they expressed willingness to participate in cancer education programs located at their parishes and provided practical recommendations for implementing health programs in parishes. Implications for culturally appropriate health communication and faith-based interventions are discussed.
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12
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Dutta S, Biswas N, Muhkherjee G. Evaluation of Socio-demographic Factors for Non-compliance to Treatment in Locally Advanced Cases of Cancer Cervix in a Rural Medical College Hospital in India. Indian J Palliat Care 2013; 19:158-65. [PMID: 24347906 PMCID: PMC3853394 DOI: 10.4103/0973-1075.121530] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction: Carcinoma cervix is a leading cause of cancer in India. However, majority of the patients face a problem of not being able to complete the treatment. Aim: This study was an attempt to find out the important causes of this non-compliance to treatment in a rural Medical College Hospital where majority of the cancer cases are of cervical cancer. Results: Out of 144 patients studied over 2 years 88 cases could not complete the treatment. The study revealed that due old age 58.33% cases were defaulters, having many children at home meant a burden to 76.92% cases and 63.89% cases had a problem of not been able to travel a far distance of more than 100 km from home to hospital for treatment. Conclusion: These were the important factors of non-compliance and suggested more important than the issues of literacy and poor socio-economic status.
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Affiliation(s)
- Samrat Dutta
- Department of Radiotherapy, North Bengal Medical College and Hospital, Sushrutanagar, District Darjeeling, West Bengal, India
| | - Nandita Biswas
- Department of Gynaecology and Obstetrics, North Bengal Medical College and Hospital, Sushrutanagar, District Darjeeling, West Bengal, India
| | - Goutam Muhkherjee
- Department of Gynaecology and Obstetrics, North Bengal Medical College and Hospital, Sushrutanagar, District Darjeeling, West Bengal, India
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Carrion IV, Nedjat-Haiem FR, Marquez DX. Examining cultural factors that influence treatment decisions: a pilot study of Latino men with cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:729-737. [PMID: 23881820 DOI: 10.1007/s13187-013-0522-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The objective of this study was to explore beliefs and treatment decisions of foreign-born Latino men from Cuba, Mexico, Colombia, and Venezuela, who have been diagnosed with cancer and who live in Central Florida, USA. Experiences related to knowledge of diagnosis, treatment decisions, communication with health providers, family involvement, and advance care planning (ACP) discussions following the diagnosis of cancer are central to this study. This study used qualitative in-depth semi-structured interviews and thematic analysis. The interviews were conducted with 15 Latino men who have been diagnosed with cancer within the past 5 years and who reside in the community. The interviews were conducted and transcribed in Spanish and then translated into English. The median age was 55.4 years. Nine Latino men had prostate cancer, two had brain cancer, two had colorectal cancer, and two had lung cancer. Emerging themes involved the suddenness of the diagnosis, fear of dying, expectations of diagnosis-related communication, reliance on physicians for treatment decisions, limited information pertaining to ACP, family support, and role changes. Latino men's limited knowledge of cancer diagnosis and treatment options coupled with their fear led them to immediately believe that they were going to die. Knowledge gaps regarding diagnosis-related communication, treatment decisions, and ACP varied among the men. The forthright diagnosis communication and the expectation to engage in decision making are contrary to Latinos men's beliefs of reliance on health providers decisions. The findings contribute to understanding Latino men's beliefs about a cancer diagnosis and treatment decisions.
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Affiliation(s)
- Iraida V Carrion
- School of Social Work, University of South Florida, 13301 Bruce B. Downs Blvd. MHC 1438, Tampa, FL, 33612-3807, USA,
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14
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Zhao X. Relationships between sources of health information and diabetes knowledge in the U.S. Hispanic population. HEALTH COMMUNICATION 2013; 29:574-585. [PMID: 24131235 DOI: 10.1080/10410236.2013.784937] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Data from the 2007 Hispanic Healthcare Survey were analyzed to examine the relationship between health information use and diabetes knowledge in the U.S. Hispanic population. A nationally representative sample of 4,013 adults self-identified as Hispanics or Latinos was generated through stratified random digit dialing (RDD) and interviewed using Computer Assisted Telephone Interviewing (CATI). Results showed that receiving health information from health care providers, family and friends, newspapers and magazines, and the Internet was positively associated with diabetes knowledge. Getting health information from churches and community organizations, however, was negatively associated with diabetes knowledge. Use of television as a source of health information showed mixed results. Implications of these findings for diabetes interventions targeting the Hispanic population in the United States are discussed.
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Affiliation(s)
- Xiaoquan Zhao
- a Department of Communication , George Mason University
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15
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Reyes-Rodríguez ML, Bulik CM, Hamer RM, Baucom DH. Promoviendo una Alimentación Saludable (PAS) design and methods: engaging Latino families in eating disorder treatment. Contemp Clin Trials 2013; 35:52-61. [PMID: 23376815 PMCID: PMC3640683 DOI: 10.1016/j.cct.2013.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/18/2013] [Accepted: 01/27/2013] [Indexed: 11/21/2022]
Abstract
The use of culturally sensitive intervention could improve mental health care for the eating disorder (ED) treatment in the Latino population. The aim of this report is to describe the rationale, design, and methods of the ongoing study entitled "Engaging Latino families in eating disorders treatment." The primary aim of the study is to compare (a) the combined effect of individual cognitive behavioral therapy for bulimia nervosa (CBT-BN) that has been previously adapted for the Latino population plus Family Enhanced (FE) modules, with (b) the standard adapted individual CBT-BN in a proof-of-principle study with 40 Latina adults with eating disorders and one relative or significant other per patient. We hypothesize that 1) the feasibility, acceptability, and adherence of participants in CBT-BN+FE will be superior to individual CBT-BN only; 2) relatives in CBT-BN+FE will report greater treatment satisfaction, greater reduction in family conflict, and greater decreases in caregiver burden than relatives in the individual CBT-BN only condition; and 3) patients who participate in CBT-BN+FE will show trends towards greater decreases in ED symptoms compared with patients in CBT-BN only; although power will be limited to detect this difference. However, we predict that they will show greater retention in treatment, greater treatment satisfaction, and greater decreases in family conflict than patients in CBT-BN only. The completion of this investigation will yield important information regarding the acceptability and feasibility of a culturally sensitive evidence-based treatment model for Latinos with eating disorders.
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Affiliation(s)
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
- Department of Nutrition, University of North Carolina, Chapel Hill, NC
| | - Robert M. Hamer
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Donald H. Baucom
- Department of Psychology, University of North Carolina, Chapel Hill, NC
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Garg J, Karim M, Tang H, Sandhu GS, DeSilva R, Rodrigue JR, Pavlakis M, Hanto DW, Baird BC, Goldfarb-Rumyantzev AS. Social adaptability index predicts kidney transplant outcome: a single-center retrospective analysis. Nephrol Dial Transplant 2012; 27:1239-1245. [DOI: 10.1093/ndt/gfr445] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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McGuire AA, Garcés-Palacio IC, Scarinci IC. A successful guide in understanding Latino immigrant patients: an aid for health care professionals. FAMILY & COMMUNITY HEALTH 2012; 35:76-84. [PMID: 22143490 PMCID: PMC4174359 DOI: 10.1097/fch.0b013e3182385d7c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The recent growth of Latino immigrants in the United States has presented great challenges to the health care system, particularly in "emerging Latino states." An educational DVD was developed to aid professionals in providing culturally competent care to Latino immigrants and better understand their expectations when seeking care, as well as common cultural beliefs and practices. Knowledge and confidence was assessed through pre- and posttest measurements among 515 health care professionals nationwide. Results indicated significant increase (P < .001) in overall knowledge/confidence in Latino cultural beliefs as they relate to health care seeking, differences in health care systems between the United States and Latin America, and barriers to health care. Such multimedia training may be a promising approach to improving health care with Latino immigrants in the United States.
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Affiliation(s)
- Allison A McGuire
- Division of Preventive Medicine, University of Alabama at Birmingham, Alabama 35294, USA.
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Goldfarb-Rumyantzev AS, Rout P, Sandhu GS, Barenbaum A, Patibandla BK, Narra A, Chawla V, Williams M. Social adaptability index predicts overall mortality in patients with diabetes. J Diabetes Complications 2012; 26:44-9. [PMID: 22321220 DOI: 10.1016/j.jdiacomp.2011.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 12/19/2011] [Accepted: 12/19/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND A quantifiable assessment of socioeconomic status and its bearing on clinical outcome in patients with diabetes is lacking. The social adaptability index (SAI) has previously been validated in the general population and in patients with chronic kidney disease, including those on dialysis and with kidney transplant. We hypothesize that SAI could be used in diabetes practice to identify a disadvantaged population at risk for inferior outcomes. METHODS The NHANES-3 database of patients who have diabetes was analyzed. The association of the SAI (calculated as the linear combination of indicators of education status, employment, income, marital status, and substance abuse) with patient survival was evaluated using Cox model. RESULTS The study population consisted of 1634 subjects with diabetes mellitus with mean age of 61.9±15.3 years; 40.9% males; 38.5% white, 27.7% African American, and 31.3% Mexican American. The highest SAI was in whites (6.9±2.5), followed by Mexican Americans (6.5±2.3), and then African Americans (6.1±2.6) (ANOVA, P<.001). SAI was higher in subjects living in metropolitan areas (6.8±2.6) compared to the rural population (6.3±2.4) (T test, P<.001). Also, SAI was greater in males (7.1±2.4) than in females (6.1±2.4) (T test, P<.001). SAI had significant association with survival (hazard ratio 0.9, P<.001) in the entire study population and in most of the subgroups (divided by race, sex, and urban/rural location). Furthermore, SAI divided into tertiles (≤5, 6 to 8, >8) demonstrated a significant and "dose-dependent" association with survival. CONCLUSION Social adaptability index is associated with mortality in the diabetic population and is useful in identifying individuals who are at risk for inferior outcomes.
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Goldfarb-Rumyantzev A, Barenbaum A, Rodrigue J, Rout P, Isaacs R, Mukamal K. New social adaptability index predicts overall mortality. Arch Med Sci 2011; 7:720-7. [PMID: 22291811 PMCID: PMC3258768 DOI: 10.5114/aoms.2011.24145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 08/24/2010] [Accepted: 08/27/2010] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Definitions of underprivileged status based on race, gender and geographic location are neither sensitive nor specific; instead we proposed and validated a composite index of social adaptability (SAI). MATERIAL AND METHODS Index of social adaptability was calculated based on employment, education, income, marital status, and substance abuse, each factor contributing from 0 to 3 points. Index of social adaptability was validated in NHANES-3 by association with all-cause and cause-specific mortality. RESULTS Weighted analysis of 19,593 subjects demonstrated mean SAI of 8.29 (95% CI 8.17-8.40). Index of social adaptability was higher in Whites, followed by Mexican-Americans and then the African-American population (ANOVA, p < 0.001). The SAI was higher in subjects living in metropolitan compared to rural areas (T-test, p < 0.001), and was greater in men than in women (T-test, p < 0.001). In Cox models adjusted for age, comorbidity index, BMI, race, sex, geographic location, hemoglobin, serum creatinine, albumin, cholesterol, and glycated hemoglobin levels, SAI was inversely associated with mortality (HR 0.87 per point, 95% CI 0.84-0.90, p < 0.001). This association was confirmed in subgroups. CONCLUSIONS We proposed and validated an indicator of social adaptability with a strong association with mortality, which can be used to identify underprivileged populations at risk of death.
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Sandhu GS, Khattak M, Rout P, Williams ME, Gautam S, Baird B, Goldfarb-Rumyantzev AS. Social Adaptability Index: application and outcomes in a dialysis population. Nephrol Dial Transplant 2011; 26:2667-74. [PMID: 21257678 DOI: 10.1093/ndt/gfq789] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patient groups associated with disparities in health care are usually defined on the basis of race, gender or geographic location. Social Adaptability Index (SAI), calculated based on education, marital status, income, employment and substance abuse, has been strongly associated with clinical outcome in other patient populations and may be used to identify individuals at risk. We used data from the United States Renal Data System to evaluate the role of SAI in survival of patients on dialysis. METHODS We used Cox model analyses to study the association between SAI and patient survival in patients with ESRD on dialysis, as well as in the subgroups based on age, race, sex, comorbidites and diabetic status. RESULTS We analyzed 3396 patients (age of ESRD onset 56.9 ± 16.1 years, 54.2% males, 64.2% white, 30.3% African-American). Mean SAI of the entire population was 7.1 ± 2.5 (range 0-12 points). SAI was higher in whites (7.4 ± 2.4) than in African-Americans (6.5 ± 2.5) (analysis of variance, P <0.001) and greater in men (7.4 ± 2.4) than in women (6.7 ± 2.5) (t-test, P <0.001). In a Cox model adjusted for potential confounders, SAI was associated with decreased mortality [hazards ratio of 0.97 (95% confidence interval 0.95-0.99), P = 0.006]. Subgroup analysis demonstrated an association of SAI with survival in most of the subgroups. Potential limitations of the study include reverse causality, possible misclassification and retrospective design. CONCLUSION We demonstrated that SAI is significantly associated with mortality in dialysis patients. SAI could be used to identify individuals at risk for inferior clinical outcomes.
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Affiliation(s)
- Gurprataap Singh Sandhu
- Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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Kudadjie-Gyamfi EK, Magai C, Consedine NS. The obscuring object of race: Clinical breast exams and coping styles in ethnic subpopulations of women. Br J Health Psychol 2010; 15:289-305. [DOI: 10.1348/135910709x463723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Saleh M, Barlow-Stewart K, Meiser B, Tucker K, Eisenbruch M, Kirk J. Knowledge, attitudes and beliefs of Arabic-Australians concerning cancer. Psychooncology 2010; 21:195-202. [PMID: 22271540 DOI: 10.1002/pon.1884] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 10/10/2010] [Accepted: 10/17/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To explore with Arabic-Australian patients and their communities, the cultural context of cancer, both sporadic and inherited, by examining their beliefs about its causes and the modes of communication about cancer with family, friends and the community. METHOD The design is an ethnographic and qualitative interview study with thematic analysis. Arabic-Australian participants were recruited in two stages. First, patients who had attended a family cancer clinic in Sydney, Australia, were invited to participate. Second, participants from the general community in Sydney were recruited with the aim of either verifying or challenging the reported findings from the clinic sample. RESULTS A total of 38 interviews with 26 females and 12 males provided cultural descriptions of illnesses, including cancer, and its causes. The terminologies around cancer and a cancer diagnosis were believed to have more impact and generate greater fear in people in the Arabic community living in Australia than the terms used to describe a diagnosis of other illnesses. Despite this, those interviewed were aware of screening and community programs and were open to discuss their views about cancer with the research team. CONCLUSION Arabic-Australians are an important group in the community with unique culture-specific attributes that can affect communication about cancer in the clinical setting. Barriers to communication such as the negative feelings associated with the word cancer and the stigma it arouses must be acknowledged. Culturally competent clinical practices with this group include the incorporation of these belief systems into the communication process and avoidance of stereotyping.
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Affiliation(s)
- Mona Saleh
- Centre for Genetics Education, Royal North Shore Hospital, St Leonards, Sydney, Australia.
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Vargas Bustamante A, Chen J, Rodriguez HP, Rizzo JA, Ortega AN. Use of preventive care services among Latino subgroups. Am J Prev Med 2010; 38:610-9. [PMID: 20494237 DOI: 10.1016/j.amepre.2010.01.029] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Revised: 12/01/2009] [Accepted: 01/11/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies demonstrate a clear gap in access and receipt of preventive care between Latinos and non-Latino whites. Most of this work, however, pools Latinos together when they compare different racial and ethnic groups. There is currently no information about the consistency of preventive care utilization across major Latino subgroups. PURPOSE This study tests for three bundles of preventive care services to analyze the main determinants of adult preventive care receipt among the largest subgroups of U.S. Latinos and non-Latino whites. It also examines the contribution of observed and unobserved factors in explaining differences in the provision of preventive care services. METHODS The Medical Expenditure Panel Survey and the National Health Interview Survey from 2000 to 2006 were merged in 2009. The sample consisted of 28,781 Latinos and 78,979 non-Latino whites. This study compared disparities in the receipt of adult preventive care services and separately examined differences in the provision of the most cost-effective preventive services. Multivariate models adjust for confounding factors. The decomposition technique was used to parse out differences into observed and unobserved components. RESULTS Latinos of Mexican and Central/South American origin are much less likely to receive guideline-recommended preventive care services than non-Latino whites and other Latino subgroups. Larger disparities were observed for the most cost-effective preventive care services: smoking-cessation advice, colorectal cancer screening, and influenza vaccination. Observed factors accounted for a larger share of disparities across measures (33%-100%), with lack of health insurance coverage and not having a usual source of care as the largest and most consistent factors explaining disparities. CONCLUSIONS Health insurance coverage expansion and more integration of Latinos into primary care practices can substantially reduce disparities in the receipt of preventive care services. Preventive care initiatives should prioritize the availability of cost-effective services among Latinos of Mexican and Central/South American heritage.
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Goldfarb-Rumyantzev AS, Rout P, Sandhu GS, Khattak M, Tang H, Barenbaum A. Association between social adaptability index and survival of patients with chronic kidney disease. Nephrol Dial Transplant 2010; 25:3672-81. [PMID: 20353959 DOI: 10.1093/ndt/gfq177] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND While individual socioeconomic factors have been associated with clinical outcome, a composite index has not been developed. In this project, we tested the hypothesis that Social Adaptability Index (SAI) based on employment, education, income, marital status and substance abuse is associated with survival in chronic kidney disease (CKD) patients. METHODS This is a retrospective cohort study of patients with CKD stage 2 or greater. We used the Third National Health and Nutrition Examination Survey (NHANES III) cohort data between 1988 and 1994 including those 18 years or older. Our primary variable of interest is SAI. Each component of SAI (employment status, education, marital status, and substance abuse) has been graded on the scale of 0-3, income has been graded on the scale 0-1. Age, sex, race, diabetes, co-morbidity index, body mass index (BMI), geographic location, haemoglobin, serum creatinine, serum albumin, serum cholesterol and Hba1c were used as covariates in multivariate analysis. The outcome of the study is patient's mortality. The time to death was calculated as time between the first interview by NHANES and death. RESULTS We analysed 13 400 subjects with mean age of 50.6 ± 20-53.6% males, 44.4% white, 29.7% African American and 22.1% Mexican American-with 8.5% having diabetes, with an average number of co-morbid conditions of 2.7 ± 1.1. Lower SAI is associated with greater stage of CKD. Higher SAI was associated with decreased mortality [hazard ratio (HR) 0.88, P < 0.001, 95% confidence interval (CI) 0.86-0.89]. When SAI quintiles were analysed, we demonstrated a 'dose-dependent' association between SAI and survival. Subgroup analysis showed that this association of SAI and survival was present in all studied subgroups. The limitations of the study include retrospective design, potential misreporting and misclassification, and reverse causality. CONCLUSION We demonstrated that SAI has a strong and clinically significant association with mortality in CKD patients.
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Sammarco A, Konecny LM. Quality of life, social support, and uncertainty among Latina and Caucasian breast cancer survivors: a comparative study. Oncol Nurs Forum 2010; 37:93-9. [PMID: 20044344 DOI: 10.1188/10.onf.93-99] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the differences between Latina and Caucasian breast cancer survivors in perceived social support, uncertainty, and quality of life (QOL), and the differences between the cohorts in selected demographic variables. DESIGN Descriptive, comparative study. SETTING Selected private hospitals and American Cancer Society units in a metropolitan area of the northeastern United States. SAMPLE 182 Caucasian and 98 Latina breast cancer survivors. METHODS Participants completed a personal data sheet, the Social Support Questionnaire, the Mishel Uncertainty in Illness Scale-Community Form, and the Ferrans and Powers QOL Index-Cancer Version III at home and returned the questionnaires to the investigators via postage-paid envelope. MAIN RESEARCH VARIABLES Perceived social support, uncertainty, and QOL. FINDINGS Caucasians reported significantly higher levels of total perceived social support and QOL than Latinas. CONCLUSIONS Psychiatric illness comorbidity and lower level of education in Latinas were factors in the disparity of QOL. IMPLICATIONS FOR NURSING Nurses should be mindful of the essential association of perceived social support, uncertainty, and QOL in Latina breast cancer survivors and how Latinas differ from Caucasian breast cancer survivors. Factors such as cultural values, comorbidities, and education level likely influence perceived social support, uncertainty, and QOL.
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Affiliation(s)
- Angela Sammarco
- Nursing Department at College of Staten Island, City University of New York, New York, USA.
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Kobetz E, Kornfeld J, Vanderpool RC, Finney Rutten LJ, Parekh N, O'Bryan G, Menard J. Knowledge of HPV among United States Hispanic women: opportunities and challenges for cancer prevention. JOURNAL OF HEALTH COMMUNICATION 2010; 15 Suppl 3:22-9. [PMID: 21154081 PMCID: PMC3858859 DOI: 10.1080/10810730.2010.522695] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In the United States, Hispanic women contribute disproportionately to cervical cancer incidence and mortality. This disparity, which primarily reflects lack of access to, and underutilization of, routine Pap smear screening may improve with increased availability of vaccines to prevent Human Papillomavirus (HPV) infection, the principal cause of cervical cancer. However, limited research has explored known determinants of HPV vaccine acceptability among Hispanic women. The current study examines two such determinants, HPV awareness and knowledge, using data from the 2007 Health Interview National Trends Survey (HINTS) and a cross-section of callers to the National Cancer Institute's (NCI) Cancer Information Service (CIS). Study data indicate that HPV awareness was high in both samples (69.5% and 63.8% had heard of the virus) but that knowledge of the virus and its association with cervical cancer varied between the two groups of women. The CIS sample, which was more impoverished and less acculturated than their HINTS counterparts, were less able to correctly identify that HPV causes cervical cancer (67.1% vs. 78.7%) and that it is a prevalent sexually transmitted infection (STI; 66.8% vs. 70.4%). Such findings imply that future research may benefit from disaggregating data collected with Hispanics to reflect important heterogeneity in this population subgroup's ancestries, levels of income, educational attainment, and acculturation. Failing to do so may preclude opportunity to understand, as well as to attenuate, cancer disparity.
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Affiliation(s)
- Erin Kobetz
- Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, 1120 NW 14 Street, Miami, FL 33136, USA.
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Lopez-Class M, Jurkowski J. The Limits of Self-Management: Community and Health Care System Barriers Among Latinos With Diabetes. JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 2010; 20:808-826. [PMID: 21686047 PMCID: PMC3114450 DOI: 10.1080/10911351003765967] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Although numerous studies examine diabetes self-care, few regard ecological framework correlates such as community and institutional level factors as fundamental for understanding diabetes management for Latinos. This article addresses the dearth of research that exists regarding social contextual forces and diabetes management for Latinos. Given the scarcity of research on this topic, studies of non-Latino groups were reviewed to illustrate the importance of community and institutional influences on diabetes care. Consideration of fundamental correlates within the ecological framework may better discern the underlying rationale for inadequate diabetes self-management for individuals who live in impoverished communities.
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Affiliation(s)
- Maria Lopez-Class
- Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
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Waters EA, Sullivan HW, Finney Rutten LJ. Cancer prevention information-seeking among Hispanic and non-Hispanic users of the National Cancer Institute's Cancer Information Service: trends in telephone and LiveHelp use. JOURNAL OF HEALTH COMMUNICATION 2009; 14:476-86. [PMID: 19657927 PMCID: PMC2728243 DOI: 10.1080/10810730903032952] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Evidence-based strategies to enable, encourage, and support cancer prevention information seeking among Hispanic populations are needed. We examined cancer prevention information requests to the Cancer Information Service (CIS) via telephone (1-800-4-CANCER toll-free telephone information service) and LiveHelp (an instant messaging service provided in English only) from 2003 to 2006. We summarized differences in the communication channel utilized by ethnicity (Hispanic vs. non-Hispanic) and, among Hispanic information seekers, the language used during the contact (English vs. Spanish). Utilization of LiveHelp was higher among non-Hispanic than Hispanic seekers of cancer prevention information. LiveHelp use for seeking cancer prevention information increased between 2003 and 2006 for both groups, but the increase was greater among non-Hispanics than Hispanics. Nearly half of Hispanics who sought cancer prevention information did so in Spanish. Because LiveHelp is not available in Spanish, the number of Spanish-only speakers who preferred to contact CIS via LiveHelp instead of telephone is unknown. When communicating cancer prevention information via multiple channels, it is important to consider differences in access to communication technologies and preferred communication channels among ethnic minority groups.
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Affiliation(s)
- Erika A Waters
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA.
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Mistretta A, Veroux M, Grosso G, Contarino F, Biondi M, Giuffrida G, Gagliano M, Giaquinta A, Zerbo D, Tallarita T, Corona D, Veroux P. Role of Socioeconomic Conditions on Outcome in Kidney Transplant Recipients. Transplant Proc 2009; 41:1162-7. [DOI: 10.1016/j.transproceed.2009.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vanderpool RC, Kornfeld J, Rutten LF, Squiers L. Cancer information-seeking experiences: the implications of Hispanic ethnicity and Spanish language. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2009; 24:141-7. [PMID: 19431032 PMCID: PMC3101580 DOI: 10.1080/08858190902854772] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Strategies to support cancer information-seeking among Hispanics are needed. METHODS We analyzed data from the 2005 Health Information National Trends Survey (HINTS) to explore cancer information-seeking experiences among respondents according to ethnicity and language of interview. RESULTS Over 80% of Spanish-speaking Hispanics had never looked for cancer information. Compared to English-speaking respondents, Spanish-speaking Hispanics who sought cancer information indicated their search took a lot of effort (67%), was hard to understand (54%), and frustrating (42%). Spanish-speaking Hispanics noted minimal confidence in obtaining cancer information. CONCLUSIONS Language and cultural differences must be considered in the design, implementation, and dissemination of cancer information.
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Affiliation(s)
- Robin C Vanderpool
- Mid South Region Cancer Information Service, University of Kentucky Markey Cancer Control Program 2365 Harrodsburg Road, Suite A230, Lexington, KY 40504, USA.
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Are health-care relationships important for mammography adherence in Latinas? J Gen Intern Med 2008; 23:2024-30. [PMID: 18839258 PMCID: PMC2596511 DOI: 10.1007/s11606-008-0815-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 04/18/2008] [Accepted: 09/12/2008] [Indexed: 01/15/2023]
Abstract
BACKGROUND Latinas are the fastest growing racial ethnic group in the United States and have an incidence of breast cancer that is rising three times faster than that of non-Latino white women, yet their mammography use is lower than that of non-Latino women. OBJECTIVES We explored factors that predict satisfaction with health-care relationships and examined the effect of satisfaction with health-care relationships on mammography adherence in Latinas. DESIGN AND SETTING We conducted a cross-sectional survey of 166 Latinas who were >or=40 years old. Women were recruited from Latino-serving clinics and a Latino health radio program. MEASUREMENTS Mammography adherence was based on self-reported receipt of a mammogram within the past 2 years. The main independent variable was overall satisfaction with one's health-care relationship. Other variables included: self report of patient-provider communication, level of trust in providers, primary language, country of origin, discrimination experiences, and perceptions of racism. RESULTS Forty-three percent of women reported very high satisfaction in their health-care relationships. Women with high trust in providers and those who did not experience discrimination were more satisfied with their health-care relationships compared to women with lower trust and who experienced discrimination (p < .01). Satisfaction with the health-care relationship was, in turn, significantly associated with mammography adherence (OR: 3.34, 95% CI: 1.47-7.58), controlling for other factors. CONCLUSIONS Understanding the factors that impact Latinas' mammography adherence may inform intervention strategies. Efforts to improve Latina's satisfaction with physicians by building trust may lead to increased use of necessary mammography.
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Abstract
Primary care physicians should continue their efforts in disease prevention and also should expand their scope of service to support patients' interests in wellness and health optimization. Taking on this role will require additional time and continuing education, but by knowledgeably helping patients to maximize their health, physicians will provide a needed service, contribute to the health of their patients, and reap the rewards of a stronger doctor-patient bond.
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Affiliation(s)
- Roger Zoorob
- Family and Community Medicine, Meharry Medical College, 1005 Dr. DB Todd Boulevard, Nashville, TN 37208, USA.
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Gurman TA, Becker D. Factors affecting Latina immigrants' perceptions of maternal health care: findings from a qualitative study. Health Care Women Int 2008; 29:507-26. [PMID: 18437597 DOI: 10.1080/07399330801949608] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Due to the influx of Latino immigration in the United States, health care services are faced with the challenge of meeting the needs of this growing population. In this qualitative study, we explored Latina immigrants' experiences with maternal health care services. We found that despite enduring language barriers and problems, Spanish-speaking women expressed satisfaction with their care. Factors influencing women's perceptions of care included sociocultural norms (respeto, personalismo, and familismo), previous experiences with care in their countries of origin, having healthy babies, and knowledge about entitlement to interpreter services. We offer recommendations for public health practice and research.
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Affiliation(s)
- Tilly A Gurman
- Department of Population, Family, and Reproductive Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Petersen E, Baird BC, Barenbaum LL, Leviatov A, Koford JK, Shihab F, Goldfarb-Rumyantzev AS. The impact of employment status on recipient and renal allograft survival. Clin Transplant 2008; 22:428-38. [DOI: 10.1111/j.1399-0012.2008.00803.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fonseca-Becker F, Perez-Patron MJ, Munoz B, O'Leary M, Rosario E, West SK. Health competence as predictor of access to care among Latinos in Baltimore. J Immigr Minor Health 2007; 12:354-60. [PMID: 18060500 DOI: 10.1007/s10903-007-9101-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 11/13/2007] [Indexed: 11/25/2022]
Abstract
The goal of this study is to identify the underlying structure of Health Competence and its value as a predictor of access to care among the Latino population in Baltimore, Maryland. Data on a cross-sectional urban probability sample were collected from 330 foreign-born Latino men and women aged 21-75 years residing in Baltimore at the time of the survey. Principal components analysis yielded a two-component solution: the first component comprised "factors enabling" access to care; the second, "perceived barriers". When testing the predictive power of the Health Competence construct using model building and the log likelihood criteria the "enabling factors" added significantly (P < .005) to the power of the socio-demographic variables to predict access to care, making it an important tool for programs aiming to improve US Latinos' health.
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Affiliation(s)
- Fannie Fonseca-Becker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 111 Market Place, Baltimore, MD 21202, USA.
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Callahan ST, Hickson GB, Cooper WO. Health care access of Hispanic young adults in the United States. J Adolesc Health 2006; 39:627-33. [PMID: 17046497 DOI: 10.1016/j.jadohealth.2006.04.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 04/20/2006] [Accepted: 04/20/2006] [Indexed: 11/24/2022]
Abstract
PURPOSE Hispanic persons in the United States experience higher rates of many chronic conditions than non-Hispanic whites. Access to care, especially during young adulthood, may afford opportunities for prevention or early management of these conditions. Given the heterogeneity of the Hispanic population, the specific aims of this study were to assess health insurance coverage and health care access and utilization for different Hispanic subgroups young adults in the U.S. METHODS We analyzed data from 5189 Hispanic and 13,214 white young adults (19-29 years old) completing the National Health Interview Survey (NHIS) from 1999-2002. Health care access/utilization measures included reports of 1) uninsurance, 2) lacking a usual source of care, 3) no health professional contact, and 4) delaying needed care because of cost. Multivariate analyses were used to estimate the risk of access barriers after adjusting for sociodemographic variables and citizenship. RESULTS Young adults of Central/South American, Mexican, or Puerto Rican origins were more likely than whites to be uninsured (28%-64% vs. 22%; p < .01) and this was especially true for noncitizens. Central/South American and Mexican young adults without U.S. citizenship were most likely to be uninsured (63% and 73%, respectively). The majority of noncitizens also lacked a usual source of care and had no health professional contact in the prior year. After adjustment, the risk of uninsurance was 60% higher for Mexican and Central/South American young adults relative to white peers. Mexican young adults also had higher risk of lacking a usual source of care and having no health professional contact. CONCLUSIONS Substantial variability in rates of uninsurance and health care access/utilization measures exist among subgroups of Hispanic young adults participating in the NHIS. U.S. citizenship and sociodemographic factors explain much, but not all of the differences.
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Affiliation(s)
- S Todd Callahan
- Child and Adolescent Health Research Unit, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee 37212-3100, USA.
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Garcés IC, Scarinci IC, Harrison L. An examination of sociocultural factors associated with health and health care seeking among Latina immigrants. J Immigr Minor Health 2006; 8:377-85. [PMID: 16636902 DOI: 10.1007/s10903-006-9008-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to examine the sociocultural factors associated with health maintenance and health care seeking among Latina immigrants. Data were collected from eight focus groups with 54 Latina immigrants between the ages of 19 and 62 (M=29.3+/-9.34). The PEN-3 model provided the framework for the study. Most of the participants came from Mexico; 46% had not completed high school; 85.2% had been in the United States for less than 7 years, and 73.6% reported not having health insurance coverage. Participants identified both positive and negative perceptions, enablers, and nurturers associated with health maintenance and health care seeking. Participants acknowledged the importance of physical, mental, and spiritual health and what they should do to be healthy. Despite such knowledge, they tended to engage in unhealthy behaviors due to a variety of nonstructural barriers such as lack of time, "tradition," and procrastination. They tended to use alternative/complementary medicine first, and then seek medical help if these practices are not effective. Many women believe that they do not have control over their own health attributing this lack of control to the "system." Participants also mentioned structural barriers to seeking health care such as lack of transportation, lack of proper documentation, lack of health insurance, language barriers, long waiting time at the clinics, and lack of knowledge on where to go for affordable care. Our study suggests that there are important structural and nonstructural barriers that hinder health maintenance and care seeking. The findings also lend support to the PEN-3 model, and suggest that positive perceptions, enablers, and nurturers associated with health maintenance and health care seeking, if properly reinforced, can counterbalance negative perceptions, enablers and nurturers in this population.
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Affiliation(s)
- Isabel C Garcés
- Division of Preventive Medicine, University of Alabama at Birmingham, 1530 3rd Avenue South, MT 631, Birmingham, Alabama 35294, USA .
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Willsie SK, Foreman MG. Disparities in Lung Cancer: Focus on Asian Americans and Pacific Islanders, American Indians and Alaska Natives, and Hispanics and Latinos. Clin Chest Med 2006; 27:441-52, vi. [PMID: 16880054 DOI: 10.1016/j.ccm.2006.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Significant population changes in the United States are expected over the next few decades. The changing demographics inclusive of native and newly native individuals will significantly impact health care because racial and ethnic groups vary widely in their risks for disease and approach to medical care. For lung cancer specifically, racial and ethnic groups differ in smoking habits, metabolism of nicotine, presentation, stage at diagnosis, treatment received, and outcomes. This article summarizes current information on lung cancer for American and Pacific Islanders, American Indians and Alaska natives,and Hispanics and Latinos with an emphasis on tobacco use, epidemiologic issues sur-rounding acculturation and assimilation, genetic epidemiology, and disparities in treatment outcomes.
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Affiliation(s)
- Sandra K Willsie
- Department of Medicine, Kansas City University of Medicine and Biosciences, 1750 Independence Avenue, Kansas City, MO 64106, USA.
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Affiliation(s)
- Victor Alejandro Diaz
- Department of Family and Community Medicine, Jefferson Medical College, 1015 Walnut Street, 401 Curtis, Philadelphia, PA 19107, USA.
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Goldfarb-Rumyantzev AS, Koford JK, Baird BC, Chelamcharla M, Habib AN, Wang BJ, Lin SJ, Shihab F, Isaacs RB. Role of socioeconomic status in kidney transplant outcome. Clin J Am Soc Nephrol 2006; 1:313-22. [PMID: 17699222 DOI: 10.2215/cjn.00630805] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There is controversy regarding the influence of genetic versus environmental factors on kidney transplant outcome in minority groups. The goal of this project was to evaluate the role of certain socioeconomic factors in allograft and recipient survival. Graft and recipient survival data from the United States Renal Data System were analyzed using Cox modeling with primary variables of interest, including recipient education level, citizenship, and primary source of pay for medical service. College (hazard ratio [HR] 0.93, P < 0.005) and postcollege education (HR 0.85, P < 0.005) improved graft outcome in the whole group and in patients of white race. Similar trends were observed for recipient survival (HR 0.9, P < 0.005 for college; HR 0.88, P = 0.09 for postcollege education) in the whole population and in white patients. Resident aliens had a significantly better graft outcome in the entire patient population (HR 0.81, P < 0.001) and in white patients in subgroup analysis (HR 0.823, P < 0.001) compared with US citizens. A similar effect was observed for recipient survival. Using Medicare as a reference group, there is a statistically significant benefit to graft survival from having private insurance in the whole group (HR 0.87, P < 0.001) and in the black (HR 0.8, P < 0.001) and the white (HR 0.89, P < 0.001) subgroups; a similar effect of private insurance is observed on recipient survival in the entire group of patients and across racial groups. Recipients with higher education level, resident aliens, and patients with private insurance have an advantage in the graft and recipient outcomes independent of racial differences.
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Bernard AC, Summers A, Thomas J, Ray M, Rockich A, Barnes S, Boulanger B, Kearney P. Novel Spanish Translators for Acute Care Nurses and Physicians: Usefulness and Effect on Practitioners’ Stress. Am J Crit Care 2005. [DOI: 10.4037/ajcc2005.14.6.545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
• Background Language barriers are significant impediments to providing quality healthcare, and increased stress levels among nurses and physicians are associated with these barriers. However, little evidence supports the usefulness of a translation tool specific to healthcare.
• Objectives To evaluate the effectiveness of a novel English-Spanish translator designed specifically for nurses and physicians. The hypothesis was that the translator would be useful and that use of the translator would decrease stress levels among nurses and physicians caring for Spanish-speaking patients.
• Methods Novel English-Spanish translators were developed entirely on the basis of input from critical care nurses and physicians. After 7 months of use, users completed surveys. Usefulness of the translator and stress levels among users were reported.
• Results A total of 60% of nurses (n = 32) and 71% (n = 25) of physicians responded to the survey. A total of 96% of physicians and 97% of nurses considered the language barrier an impediment to delivering quality care. Nurses reported significantly more stress reduction than did physicians (P = .01). Most nurses and physicians had used the translator during the survey period. Overall, 91% of nurses and 72% of physicians found that the translator met their needs at the bedside some, most, or all of the time. All nurses thought that they most likely would use the translator in the future.
• Conclusions The translator was useful for most critical care nurses and physicians surveyed. Healthcare providers, especially nurses, experienced decreased stress levels when they used the translator.
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Affiliation(s)
- Andrew C. Bernard
- Departments of Surgery (acb, ar, sb, bb, pk), Nursing (as, jt), and Patient Services (mr), University of Kentucky Medical Center, Lexington, Ky
| | - Audra Summers
- Departments of Surgery (acb, ar, sb, bb, pk), Nursing (as, jt), and Patient Services (mr), University of Kentucky Medical Center, Lexington, Ky
| | - Jennifer Thomas
- Departments of Surgery (acb, ar, sb, bb, pk), Nursing (as, jt), and Patient Services (mr), University of Kentucky Medical Center, Lexington, Ky
| | - Myrna Ray
- Departments of Surgery (acb, ar, sb, bb, pk), Nursing (as, jt), and Patient Services (mr), University of Kentucky Medical Center, Lexington, Ky
| | - Anna Rockich
- Departments of Surgery (acb, ar, sb, bb, pk), Nursing (as, jt), and Patient Services (mr), University of Kentucky Medical Center, Lexington, Ky
| | - Stephen Barnes
- Departments of Surgery (acb, ar, sb, bb, pk), Nursing (as, jt), and Patient Services (mr), University of Kentucky Medical Center, Lexington, Ky
| | - Bernard Boulanger
- Departments of Surgery (acb, ar, sb, bb, pk), Nursing (as, jt), and Patient Services (mr), University of Kentucky Medical Center, Lexington, Ky
| | - Paul Kearney
- Departments of Surgery (acb, ar, sb, bb, pk), Nursing (as, jt), and Patient Services (mr), University of Kentucky Medical Center, Lexington, Ky
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Hansen LK, Feigl P, Modiano MR, Lopez JA, Escobedo Sluder S, Moinpour CM, Pauler DK, Meyskens FL. An educational program to increase cervical and breast cancer screening in Hispanic women: a Southwest Oncology Group study. Cancer Nurs 2005; 28:47-53. [PMID: 15681982 DOI: 10.1097/00002820-200501000-00007] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We conducted a community-based pilot study to train Hispanic cancer survivors as promotoras (lay health educators) to encourage their social contacts to obtain breast and cervical cancer screening. Promotoras were recruited from a private oncologist's practice at a Minority-Based Community Clinical Oncology Program (MBCCOP). Five Hispanic women were trained to serve as promotoras by attending a 12-week course. They shared cancer screening information with family and social contacts and encouraged them to obtain Papanicolaou smears and/or mammograms. Study endpoints included the number of women recruited and trained to serve as promotoras, the number of contacts made per promotora, and the number of contacts who were screened; data were based on contact logs maintained for 1 year. Screening examinations were documented by a postcard returned by the contact or by review of community health clinic records. Five promotoras contacted 141 (range = 24-49 per promotora) women to share cancer screening information. Fifty Hispanic women obtained screening after contact with a promotora. Twenty-nine underwent mammography (ages 25-58) and 43 received a Papanicolaou smear (ages 23-62). Hispanic female cancer survivors can be trained as promotoras. Screening information conveyed by a promotora can successfully prompt Hispanic women to obtain mammography and Papanicolaou smears.
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Affiliation(s)
- Lisa K Hansen
- Columbia River CCOP, Legacy Good Samaritan Hospital, 1015 NW 22nd Avenue, W-003, Portland, OR 97210, USA.
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Bard MR, Goettler CE, Schenarts PJ, Collins BA, Toschlog EA, Sagraves SG, Rotondo MF. Language Barrier Leads to the Unnecessary Intubation of Trauma Patients. Am Surg 2004. [DOI: 10.1177/000313480407000907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Airway evaluation in trauma patients is performed immediately upon patient contact, with communication being a vital component to this exam. Language and communication barriers may lead to the unnecessary placement of an artificial airway with resultant patient risk and elevation of health care costs. The objective of our study was to evaluate potentially preventable intubations in Spanish-speaking patients. A 9-year retrospective review was performed using the National Trauma Registry for The American College of Surgeons (NTRACS) database. We evaluated patients intubated on arrival to the trauma center and remaining intubated for less than 48 hours. Deaths were excluded. Patients who typically speak English were compared with patients who typically speak Spanish. Mechanism of injury (MOD, hypotension during resuscitation (HDR), illicit substance use, alcohol use, mean Glasgow Coma Score (GCS), mean Injury Severity Score (ISS), payer source, and hospital cost were compared. Forty-nine per cent and 38 per cent of Spanish and English speaking individuals, respectively, were intubated for less than 48 hours ( P = 0.072). MOI, HDR, ISS, illicit substance use, alcohol use, and payer source were similar. GCS was statistically higher in the Spanish-speaking group (14 vs 12; P = 0.004). Language and communication barriers lead to potentially preventable intubations in trauma patients.
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Affiliation(s)
- Michael R. Bard
- From the Department of Surgery, The Brody School of Medicine, East Carolina University, The Center of Excellence for Trauma and Surgical Critical Care, University Health Systems of Eastern North Carolina, Greenville, North Carolina
| | - Claudia E. Goettler
- From the Department of Surgery, The Brody School of Medicine, East Carolina University, The Center of Excellence for Trauma and Surgical Critical Care, University Health Systems of Eastern North Carolina, Greenville, North Carolina
| | - Paul J. Schenarts
- From the Department of Surgery, The Brody School of Medicine, East Carolina University, The Center of Excellence for Trauma and Surgical Critical Care, University Health Systems of Eastern North Carolina, Greenville, North Carolina
| | - Beth A. Collins
- From the Department of Surgery, The Brody School of Medicine, East Carolina University, The Center of Excellence for Trauma and Surgical Critical Care, University Health Systems of Eastern North Carolina, Greenville, North Carolina
| | - Eric A. Toschlog
- From the Department of Surgery, The Brody School of Medicine, East Carolina University, The Center of Excellence for Trauma and Surgical Critical Care, University Health Systems of Eastern North Carolina, Greenville, North Carolina
| | - Scott G. Sagraves
- From the Department of Surgery, The Brody School of Medicine, East Carolina University, The Center of Excellence for Trauma and Surgical Critical Care, University Health Systems of Eastern North Carolina, Greenville, North Carolina
| | - Michael F. Rotondo
- From the Department of Surgery, The Brody School of Medicine, East Carolina University, The Center of Excellence for Trauma and Surgical Critical Care, University Health Systems of Eastern North Carolina, Greenville, North Carolina
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Abstract
Ethnic disparities in health care have been historically well documented, but their causes still remain poorly explained. In the US, ethnic minorities have a higher incidence and prevalence of systemic lupus erythematosus and also experience less favorable outcomes when compared with the Caucasian majority. These discrepancies can be explained, at least in part, by genetic-related ethnic factors; however, nongenetic factors emerging from differences in socioeconomic status and related individual social (poverty, limited access to quality health care) and cultural characteristics (inadequate health belief patterns, distrust in medical institutions) are also likely to contribute to these discrepancies. A comprehensive recognition of current unfavorable, but modifiable, circumstances will provide the framework to develop strategic approaches toward eliminating existent disparities in health, including those occurring in patients with systemic lupus erythematosus.
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Affiliation(s)
- América G Uribe
- Department of Medicine, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, 830 FOT, Birmingham, AL 35294, USA
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