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Shan L, He S. Intensified discrimination against tenants and its health effects during the COVID-19 pandemic in large Chinese cities. Sci Rep 2023; 13:22316. [PMID: 38102203 PMCID: PMC10724241 DOI: 10.1038/s41598-023-48935-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
The COVID-19 pandemic in many senses reconstructs social norms and reshapes social behaviour, which typically assumes a close correlation between mobility with a higher risk of COVID-19 infection. This may intensify the pre-existing discrimination against tenants and widen tenure-based health inequalities. Drawing on an online questionnaire survey conducted in five major cities in China in 2020, we employ multi-level regression models to examine the intensified discrimination against tenants during COVID-19 and its impacts on residents' physical and mental health inequalities. Results show that the pre-existing inequalities have been intensified during COVID-19 and the perceived discrimination has rendered worsened self-rated health and mental health and enlarged health inequalities. The discrimination particularly affected tenants with better economic profiles or worse health conditions; by contrast, despite being exposed to more tenant-related discriminatory experiences, rural hukou holders suffered from less severe health inequalities. A clear linkage is found between renting in poorly-managed and larger health gaps generated by discrimination. The negative health impact of intensified discrimination is found to be more significant in communities with lower infection risk, which points to the necessity of understanding the long-term health impact of discrimination against tenants in a more holistic way. In terms of community environment, we discover a positive effect of community social capital, i.e., higher level social capital helps mitigate the health threat of discrimination against tenants during COVID-19. Besides, public housing tenants reported better health outcomes and were less exposed to intensified discrimination during COVID-19 than private housing tenants. These findings provide a nuanced understanding of variations determined by individual and territorial factors, thus present timely policy implications for promoting healthy and inclusive urban development in the post-pandemic era.
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Affiliation(s)
- Lu Shan
- Department of Urban Planning and Design, Urban Systems Institute, and the Social Infrastructure for Equity and Wellbeing Lab, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shenjing He
- Department of Urban Planning and Design, Urban Systems Institute, and the Social Infrastructure for Equity and Wellbeing Lab, The University of Hong Kong, Hong Kong Special Administrative Region, China.
- Department of Urban Planning and Design, Urban Systems Institute, and the Social Infrastructure for Equity and Wellbeing Lab, The University of Hong Kong, Room 836A, 8/F, Knowles Building, Pokfulam Road, Hong Kong, China.
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Delafield R, Watkins-Victorino L, Quint JJ, Freitas SM, Kamaka M, Hostetter CJ, Matagi CE, Ku T, Kaholokula JK. No Kākou, Na Kākou - For Us, By Us: Native Hawaiians and Pacific Islanders Informing Race Data Collection Standards for Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:73-76. [PMID: 37901657 PMCID: PMC10612412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
This article describes recommendations for standardized race data collection developed by the Hawai'i Native Hawaiian and Pacific Islander COVID-19 Response, Recovery, and Resilience Team (NHPI 3R Team). These recommendations attempt to address the expressed desires of Native Hawaiians and the diverse Pacific Islander communities in Hawai'i who seek greater visibility in data and research. The Native Hawaiian and Pacific Islander (NHPI) racial category is 1 of the 5 racial categories listed in the 1997 Statistical Policy Directive #15 issued by the Office of Management and Budget (OMB). The OMB directive sets the minimum standard for collection of race data in federal surveys, administrative forms, records, and other data collection. The NHPI 3R Team's recommendation provides a standard for detailed data collection that could improve smaller communities' ability to identify, advocate for, and address their own needs. The article also describes lessons learned through the collaborative and iterative process that was led by members and leaders of NHPI communities impacted by data driven decisions and policies. The NHPI 3R Team focused on expanding and standardizing race data collection as part of their COVID-19 response efforts, but implementation of the recommendations could produce benefits well beyond the pandemic.
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Affiliation(s)
- Rebecca Delafield
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (RD, MK, JKK)
| | | | | | - Sharde Mersberg Freitas
- Native Hawaiian Pacific Islander COVID-19 Response, Recovery, and Resiliency Team - Data and Research Committee, Honolulu, HI (SMF)
| | - Martina Kamaka
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (RD, MK, JKK)
| | | | | | - Tercia Ku
- Papa Ola Lōkahi, Honolulu, HI (JJQ, CEM, TK)
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Waitzfelder B, Palaniappan L, Varga A, Frankland TB, Li J, Daida YG, Kaholokula JK, Bacong AM, Rawlings AM, Chung S, Howick C, Fortmann SP. Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai'i and California. BMC Public Health 2023; 23:885. [PMID: 37189145 PMCID: PMC10184427 DOI: 10.1186/s12889-023-15795-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the leading cause of death in the US. CVD incidence is influenced by many demographic, clinical, cultural, and psychosocial factors, including race and ethnicity. Despite recent research, there remain limitations on understanding CVD health among Asians and Pacific Islanders (APIs), particularly some subgroups and multi-racial populations. Combining diverse API populations into one study group and difficulties in defining API subpopulations and multi-race individuals have hampered efforts to identify and address health disparities in these growing populations. METHODS The study cohort was comprised of all adult patients at Kaiser Permanente Hawai'i and Palo Alto Medical Foundation in California during 2014-2018 (n = 684,363). EHR-recorded ICD-9 and ICD-10 diagnosis codes were used to indicate coronary heart disease (CHD), stroke, peripheral vascular disease (PVD), and overall CVD. Self-reported race and ethnicity data were used to construct 12 mutually exclusive single and multi-race groups, and a Non-Hispanic White (NHW) comparison group. Logistic regression models were used to derive prevalence estimates, odds ratios, and confidence intervals for the 12 race/ethnicity groups. RESULTS The prevalence of CHD and PVD varied 4-fold and stroke and overall CVD prevalence varied 3-fold across API subpopulations. Among Asians, the Filipino subgroup had the highest prevalence of all three CVD conditions and overall CVD. Chinese people had the lowest prevalence of CHD, PVD and overall CVD. In comparison to Native Hawaiians, Other Pacific Islanders had significantly higher prevalence of CHD. For the multi-race groups that included Native Hawaiians and Other Pacific Islanders, the prevalence of overall CVD was significantly higher than that for either single-race Native Hawaiians or Other Pacific Islanders. The multi-race Asian + White group had significantly higher overall CVD prevalence than both the NHW group and the highest Asian subgroup (Filipinos). CONCLUSIONS Study findings revealed significant differences in overall CVD, CHD, stroke, and PVD among API subgroups. In addition to elevated risk among Filipino, Native Hawaiian, and Other Pacific Islander groups, the study identified particularly elevated risk among multi-race API groups. Differences in disease prevalence are likely mirrored in other cardiometabolic conditions, supporting the need to disaggregate API subgroups in health research.
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Affiliation(s)
- Beth Waitzfelder
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | | | - Alexandra Varga
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Timothy B Frankland
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Jiang Li
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, CA, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | | | | | - Andreea M Rawlings
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | | | - Connor Howick
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Stephen P Fortmann
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA.
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Depression, anxiety and stress among metastatic breast cancer patients on chemotherapy in China. BMC Nurs 2023; 22:33. [PMID: 36747213 PMCID: PMC9901155 DOI: 10.1186/s12912-023-01184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 01/18/2023] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study aimed to assess the level of depression, anxiety and stress among metastatic breast cancer (MBC) patients undergoing chemotherapy (CT) in Beijing, China. METHODS A cross-sectional study was conducted on 176 MBC women receiving CT, selected by purposive sampling. Data were collected using self-administered questionnaires that included participants' socio-demographic status, DASS-21 and Brief COPE. Data were analyzed using descriptive statistics and general linear regression analysis. RESULTS The incidence of depression, anxiety and stress among MBC women were 52.3%, 60.2% and 36.9%, respectively. General linear regression showed that age, marital status, monthly income, physical functioning, emotional functioning, pain, dyspnea, and appetite loss were associated with depression. All variance determined the depression (R2) was 35.6%. Marital status, self-blame and behavioral disengagement were the predictors of stress and accounted for a 35.4% stress variance in MBC women. CONCLUSION Our study demonstrated depression, anxiety, and stress prevalence are high in MBC women. Assessment of psychological distress (depression, anxiety, and stress) is important to recognise MBC patients who need help and further medical and mental help support. This study's findings can increasingly highlight that depression, anxiety, and stress are substantial problems in MBC patients. Therefore, psychological interventions are needed to reduce depression, anxiety, and stress for MBC patients.
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Siddiqui ZA, Sambamoorthi U. Psychological Distress Among Asian Indians and Non-Hispanic Whites in the United States. Health Equity 2022; 6:516-526. [PMID: 36186615 PMCID: PMC9518809 DOI: 10.1089/heq.2021.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: The prevalence of psychological distress (PD) among Asian Indians is unknown. This study estimated and compared moderate–serious PD in Asian Indians and non-Hispanic Whites (NHWs) in the United States. Methods: We used a cross-sectional design using the National Health Interview Survey (2012–2017). Adult (age >18 years) NHWs and Asian Indians (N=2,218) were included. PD was measured using the six-item Kessler (K6) scale. We used multivariable logistic regression to determine the association of Asian Indian ethnicity with PD. Results: In the analysis, 19.9% of NHWs and 11.0% of Asian Indians reported moderate–serious PD. Asian Indians were less likely to report PD in both unadjusted (unadjusted odds ratio=0.50; 95% confidence interval [CI]=0.42–0.58) and fully adjusted (adjusted odds ratio=0.7; 95% CI 0.59–0.82) models. Conclusions: Asian Indians had a lower prevalence of PD than NHWs, likely due to multiple protective factors such as high socioeconomic status and lower multimorbidity.
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Affiliation(s)
- Zasim Azhar Siddiqui
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center, Morgantown, West Virginia, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center, Morgantown, West Virginia, USA
- Department of Pharmacotherapy, College of Pharmacy, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, Texas, USA
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Marchi M, Magarini FM, Chiarenza A, Galeazzi GM, Paloma V, Garrido R, Ioannidi E, Vassilikou K, de Matos MG, Gaspar T, Guedes FB, Primdahl NL, Skovdal M, Murphy R, Durbeej N, Osman F, Watters C, van den Muijsenbergh M, Sturm G, Oulahal R, Padilla B, Willems S, Spiritus-Beerden E, Verelst A, Derluyn I. Experience of discrimination during COVID-19 pandemic: the impact of public health measures and psychological distress among refugees and other migrants in Europe. BMC Public Health 2022; 22:942. [PMID: 35538463 PMCID: PMC9090600 DOI: 10.1186/s12889-022-13370-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background The COVID-19 pandemic has had a disproportionately hard impact on refugees and other migrants who are often exposed to the virus with limited means to protect themselves. We tested the hypothesis that during the COVID-19 pandemic, refugees and other migrants have suffered a negative impact on mental health and have been unjustly discriminated for spreading the disease in Europe (data collection from April to November 2020). Methods Participants in the ApartTogether Survey (N = 8297, after listwise deletion of missing items final N = 3940) provided data regarding to their difficulties to adhere to preventive recommendations against COVID-19 infection (CARE), self-perceived stigmatization (SS), and psychological distress (PD). Structural Equation Modeling was used to investigate PD as a mediator in the pathway linking CARE to SS, while adjusting for the housing and residence status. To improve confidence in the findings, single hold-out sample cross-validation was performed using a train/test split ratio of 0.8/0.2. Results In the exploratory set (N = 3159) SS was associated with both CARE (B = 0.200, p < 0.001) and PD (B = 0.455, p < 0.001). Moreover, PD was also associated with CARE (B = 0.094, p = 0.001) and mediated the effect of CARE on SS (proportion mediated = 17.7%, p = 0.001). The results were successfully replicated in the confirmation set (N = 781; total effect = 0.417, p < 0.001; proportion mediated = 29.7%, p < 0.001). Follow-up analyses also found evidence for an opposite effect (i.e., from SS to CARE, B = 0.132; p < 0.001), suggesting that there might be a vicious circle between the self-perceived stigmatization and the access to health care and the use of preventive measures against COVID-19 infection. Conclusions Refugees and other migrants who had more difficulties in accessing health care and preventive measures against COVID-19 infection experienced worse mental health and increased discrimination. These negative effects appeared to be stronger for those with more insecure housing and residence status, highlighting from one side the specific risk of insecure housing in the impact of COVID-19 upon mental health and infection protection, and for another side the need to proper housing as a strategy to prevent both COVID-19 and mental distress. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13370-y.
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Affiliation(s)
- Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287 -, 41125, Modena, Italy.,Dipartimento di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2 -, 42122, Reggio Emilia, Italy
| | - Federica Maria Magarini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287 -, 41125, Modena, Italy
| | - Antonio Chiarenza
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287 -, 41125, Modena, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287 -, 41125, Modena, Italy. .,Dipartimento di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2 -, 42122, Reggio Emilia, Italy.
| | - Virginia Paloma
- Department of Social Psychology, Universidad de Sevilla, 41018, Seville, Spain
| | - Rocío Garrido
- Department of Social Psychology, Universidad de Sevilla, 41018, Seville, Spain
| | - Elisabeth Ioannidi
- Research Center for Greek Society, Academy of Athens, 15126, Athens, Greece
| | | | | | - Tania Gaspar
- Institute of Environmental Health/ISAMB, University of Lisbon, Lisbon, Portugal
| | | | - Nina Langer Primdahl
- Department of Public Health, University of Copenhagen, 1014, Copenhagen, Denmark
| | - Morten Skovdal
- Department of Public Health, University of Copenhagen, 1014, Copenhagen, Denmark
| | - Rebecca Murphy
- Department of Psychology, Maynooth University, W23 F2K8, Co. Kildare, Maynooth, Ireland
| | - Natalie Durbeej
- Department of Child Health and Parenting, Uppsala University, 75236, Uppsala, Sweden
| | - Fatumo Osman
- Department of Child Health and Parenting, Uppsala University, 75236, Uppsala, Sweden.,School of Health and Welfare, Dalarna University, Högskolegatan 2, 79188, Falun, Sweden
| | - Charles Watters
- Department of School of Education and Social Work, University of Sussex, Sussex, UK
| | | | - Gesine Sturm
- LCPI Laboratory, EA-4591, Department Clinique du Sujet, University of Toulouse 2, 31058, Toulouse, France
| | - Rachid Oulahal
- La Reunion University FR, DIRE research center, French Collaborative Institute on Migration, CS, 92003, 15 Av. René Cassin, Saint-Denis, Cedex 9 97400, Réunion
| | - Beatriz Padilla
- Department of Sociology, University of South Florida, Tampa, FL, 33620, USA
| | - Sara Willems
- Department of Public Health and Primary Care, Quality and Safety Ghent, Ghent University, 9000, Ghent, Belgium
| | - Eva Spiritus-Beerden
- Department of Social Work and Social Pedagogy, Ghent University, 9000, Ghent, Belgium
| | - An Verelst
- Department of Social Work and Social Pedagogy, Ghent University, 9000, Ghent, Belgium
| | - Ilse Derluyn
- Department of Social Work and Social Pedagogy, Ghent University, 9000, Ghent, Belgium
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Abstract
OBJECTIVES African Americans experience relatively low rates of mental disorder despite being disproportionately exposed to psychosocial stressors. Coping is an understudied area that may help explain the mental health resilience among this population. METHODS Using data from the National Survey of American Life, I use negative binomial logistic regression to investigate the relationships between stress exposure/appraisal, ten coping responses, and mental health among older African American adults. RESULTS Seven of 10 coping responses were predictive of psychological distress. I also found evidence of moderation for six responses. Active coping, instrumental social support, looking for something good in what has happened, and two measures of acceptance were protective against psychological distress associated with high levels of stress. Substance use generally exacerbated the association between stress and psychological distress. DISCUSSION Problem-focused coping and acceptance responses were effective coping strategies for older African Americans under high levels of stress exposure/appraisal.
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Affiliation(s)
- Dawne M Mouzon
- Department of Sociology Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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Graves BS, Hall ME, Dias-Karch C, Haischer MH, Apter C. Gender differences in perceived stress and coping among college students. PLoS One 2021; 16:e0255634. [PMID: 34383790 PMCID: PMC8360537 DOI: 10.1371/journal.pone.0255634] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Many college students register each semester for courses, leading to productive careers and fulfilled lives. During this time, the students have to manage many stressors stemming from academic, personal, and, sometimes, work lives. Students, who lack appropriate stress management skills, may find it difficult to balance these responsibilities. Objectives This study examined stress, coping mechanisms, and gender differences in undergraduate students towards the end of the semester. Design and method University students (n = 448) enrolled in three different undergraduate exercise science courses were assessed. Two instruments, the Perceived Stress Scale and Brief Cope, were administered during the twelfth week of the semester, four weeks prior to final exams. T-tests were used to detect gender differences for the stress levels and coping strategies. Results Overall, females indicated higher levels of stress than their male counterparts. Gender differences were evident in both coping dimensions and individual coping strategies used. Females were found to utilize the emotion-focused coping dimension and endorsed the use of four coping strategies more often than males. These included self-distraction, emotional support, instrumental support, and venting. Conclusions This research adds to the existing literature by illuminating the level of perceived stress and different coping strategies used by undergraduate female and male students. In turn, students may need educational interventions to develop effective and healthy coping strategies to last a lifetime. Faculty and other university officials may want to highlight and understand these various factors to protect the students’ wellbeing in their classes.
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Affiliation(s)
- B. Sue Graves
- Department of Exercise Science and Health Promotion Department, College of Science, Florida Atlantic University, Boca Raton, Florida, United States of America
- * E-mail:
| | - Michael E. Hall
- Department of Exercise Science and Health Promotion Department, College of Science, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Carolyn Dias-Karch
- Department of Exercise Science and Health Promotion Department, College of Science, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Michael H. Haischer
- Athletic and Human Performance Research Center, Marquette University, Milwaukee, Wisconsin, United States of America
- Program in Exercise Science–Department of Physical Therapy, College of Health Sciences, Marquette University, Milwaukee, Wisconsin, United States of America
| | - Christine Apter
- Campus Recreation Department, Florida Atlantic University, Boca Raton, Florida, United States of America
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Garvey G, Cunningham J, Mayer C, Letendre A, Shaw J, Anderson K, Kelly B. Psychosocial Aspects of Delivering Cancer Care to Indigenous People: An Overview. JCO Glob Oncol 2021; 6:148-154. [PMID: 32031444 PMCID: PMC6998016 DOI: 10.1200/jgo.19.00130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Globally, a growing body of evidence has reported significant disparities in cancer outcomes between indigenous and nonindigenous people. Although some effort is being made to address these disparities, relatively little attention has been directed toward identifying and focusing on the psychosocial aspects of cancer care for indigenous patients, which are critical components in improving cancer care and outcomes. The purpose of this article is to describe the results of a scoping review of the psychosocial aspects of cancer care for indigenous people. We highlight considerations in undertaking research in this field with indigenous people and the implications for clinical practice.
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Affiliation(s)
- Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Carole Mayer
- Health Sciences North Research Institute, Sudbury, Ontario, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Angeline Letendre
- Alberta Cancer Prevention Legacy Fund, Alberta Health Services, Edmonton, Alberta, Canada
| | - Joanne Shaw
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Kate Anderson
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Brian Kelly
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Experiences of Racism among Older Aboriginal and Torres Strait Islander People: Prevalence, Sources, and Association with Mental Health. Can J Aging 2021; 39:178-189. [PMID: 31230607 DOI: 10.1017/s071498081900031x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cet article présente une analyse inédite de l'association entre la discrimination raciale et la détresse psychologique chez les personnes âgées indigènes et insulaires du détroit de Torres. Les résultats indiquent : (1) qu'une minorité importante d'aînés appartenant aux populations indigènes et insulaires du détroit de Torres ont été victimes de racisme (tel qu'expérimenté et mesuré en fonction d'inégalités de traitement) et d'évitement ; (2) qu'une association entre les expériences de racisme ou d'évitement et la détresse psychologique peut être mise en évidence, et que cette relation demeure robuste malgré la considération d'une variété de facteurs confondants et de caractéristiques complexes associées à la conception des enquêtes ; et (3) les associations entre le racisme et la détresse sont amplifiées en fonction de l'intensité du racisme et des comportements d'évitement. L'association reste robuste ou se trouve renforcée lorsque le racisme et l'évitement se produisent dans le cadre de contextes cruciaux au développement du capital humain des personnes âgées (p. ex. soins de santé, éducation, milieu de travail). Nos résultats soulignent l'importance des programmes et des services sociaux et de santé culturellement sécuritaires, ainsi que la nécessité de contrer la discrimination sous toutes ses formes. This article presents the first nationally representative analysis of the association between racial discrimination and psychological distress among older Aboriginal and Torres Strait Islander people. Results show: (1) experiences of racism (as measured by unfair treatment) and avoidance are encountered by a significant minority of older Aboriginal and Torres Strait Islander people; (2) there is a clear association between experiences of racism and avoidance with psychological distress, with these results being robust to a range of confounding factors and complex survey design features; and (3) the associations between racism and distress are amplified by the severity of racism, and, when occurring, with avoidance. The association remains strong or is strengthened when racism and avoidance occur in contexts or situations crucial to the human capital development of older people (e.g., health care, education, and the workplace). Our findings underscore the importance of culturally safe health and social services/programs and further the imperative to address discrimination in all its forms.
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Batchelder AW, Safren S, Coleman J, Boroughs M, Thiim A, Ironson G, Shipherd JC, O’Cleirigh C. Indirect Effects From Childhood Sexual Abuse Severity to PTSD: The Role of Avoidance Coping. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP5476-NP5495. [PMID: 30246600 PMCID: PMC6785355 DOI: 10.1177/0886260518801030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Men who have sex with men (MSM) disproportionately experience childhood sexual abuse (CSA) compared with heterosexual men, often resulting in continued trauma-related sequelae, including symptoms of posttraumatic stress disorder (PTSD) such as avoidance. The variability in trauma-related sequelae may be associated with chronicity or duration of CSA. The relationship between duration of CSA and later PTSD symptom severity is not well understood, including the extent coping strategies account for these relationships. We used linear regression to examine these relationships and to assess the indirect effects of avoidance (behavioral disengagement and denial) and adaptive coping strategies on the relationship between CSA duration and adult PTSD symptom severity on a diverse sample included 290 MSM with a history of CSA. In adjusted models, CSA duration was significantly associated with adult PTSD symptom severity (standardized β = .23, p < .000) and with avoidance coping (standardized β = .19, p = .002). Separating this out, behavioral disengagement was significantly associated with CSA duration (standardized β = .20, p = .001) but denial was not. In adjusted analyses assessing indirect effects, avoidance coping partially accounted for the relationship between CSA duration and total trauma symptom severity (standardized β reduced from .23 to .17; Sobel = 2.90, p = .004). Similarly, behavioral disengagement partially accounted for the association between CSA duration and total symptoms (standardized β reduced from .23 to .18; Sobel = 2.68, p = .007). Avoidance coping, and behavioral disengagement specifically, may play a role in the severity of PTSD symptoms experienced by MSM with CSA histories. This work emphasizes the need for clinicians to consider behavioral disengagement in understanding PTSD symptom severity among MSM with histories of CSA.
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Affiliation(s)
- A. W. Batchelder
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street Boston, MA 02114
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215
| | - S. Safren
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215
- University of Miami, 1320 S Dixie Hwy, Coral Gables, FL 33146
| | - J.N. Coleman
- Department of Psychology and Neuroscience & Duke Global Health Institute, Duke University, NC 27710
| | - M.S. Boroughs
- University of Windsor, 401 Sunset Ave, Windsor, ON N9B 3P4, Canada
| | - A. Thiim
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215
| | - G. Ironson
- University of Miami, 1320 S Dixie Hwy, Coral Gables, FL 33146
| | - J. C Shipherd
- Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Program, Veterans Health Administration, 810 Vermont Avenue, NW Washington, DC 20420
- National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Street, Boston, MA 02130
- Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118
| | - C. O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street Boston, MA 02114
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215
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Baghcheghi N, Koohestani H. Designing and psychometric properties of coping strategies scale for family caregivers of hemodialysis patients. ACTA FACULTATIS MEDICAE NAISSENSIS 2021. [DOI: 10.5937/afmnai38-29501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The present study tries to design and evaluate the psychometric properties of coping strategies scale for family caregivers of hemodialysis patients. This study consisted of two phases: phase one was a qualitative study to analyze the experiences of coping strategies of hemodialysis patients' family caregivers' (N = 14). Then, the items were extracted from the interviews and the literature. Phase two was a psychometric assessment including face validity, content validity, construct validity (N = 245) and reliability. In phase one, 89 items were extracted and after face and content validity, 56 items remained. Construct validity of the scale, based on exploratory factor analysis, removed another 22 items. The remaining 34 items contained nine subscales (active coping, positive thinking, appeal to spirituality, help-seeking, altruism, acting out, self-blaming, seeking isolation, and intentional forgetting). The reliability of the scale with Cronbach's Alpha was 0.91 and its stability was obtained through test-retest (ICC = 0.9). Coping strategies scale for family caregivers of hemodialysis patients has an acceptable validity and reliability. The tool can be used to assess effective and ineffective coping strategies in family caregivers of hemodialysis patients that may be useful for facilitating management and education of efficient coping strategies to family caregivers of hemodialysis patients.
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13
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Ma L, Gao L, Chiu DT, Ding Y, Wang W, Wang Y. Depressive symptoms prevalence, associated family factors, and gender differences: A national cohort study of middle school students in China. J Affect Disord 2020; 274:545-552. [PMID: 32663987 DOI: 10.1016/j.jad.2020.05.128] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/18/2020] [Accepted: 05/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study examined prevalence and change in depressive symptoms in Chinese adolescents, and roles of inter-parental (I-P) relationship and parent-child (P-C) relationships in its etiology and gender differences. METHODS Survey data on depressive symptoms, I-P relationship, and indicators of P-C relationships were collected in China Education Panel Survey (2013-2015) from a nationally representative sample of adolescents (n=9,869) at 7th (at baseline), 8th and 9th (follow-up) grades. RESULTS Prevalence of depressive symptoms was 17.9% in 7th graders and higher at 25.7% for 9th graders, more remarkably in girls. Better I-P relationship could reduce the risk of depressive symptoms among all (OR=0.53, 95%CI: 0.48, 0.58), girls (OR=0.61, 95%CI: 0.54, 0.69), and boys (OR=0.54, 95%CI: 0.49, 0.61). Greater mother-child (M-C) and father-child (F-C) closeness were protective of depressive symptoms in all and girls (ORs=0.94 to 0.96, p<0.01). More P-C interactions was associated with reduced risk of depressive symptoms among all (OR=0.91, 95%CI: 0.89, 0.93), boys (OR=0.91, 95%CI: 0.89, 0.94), and girls (OR=0.93, 95%CI: 0.91, 0.96). Better I-P relationship increased M-C closeness, F-C closeness, and P-C interactions, which in turn reduced depressive symptoms risk (indirect effects: β=-0.03, 95% CI: -0.04, -0.03). LIMITATIONS The brief depressive inventory was only able to capture higher depressive symptoms, not clinical depression. CONCLUSIONS Depressive symptoms are prevalent in Chinese adolescents with increases from early to middle adolescence. I-P and P-C relationships reduce depressive symptoms risk. P-C relationships mediated associations between I-P relationship and depressive symptoms. Future interventions may target these family factors to reduce depression among Chinese adolescents.
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Affiliation(s)
- Lu Ma
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Liwang Gao
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Dorothy T Chiu
- Community Health Sciences Division, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Yixin Ding
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Weidong Wang
- Department of Sociology, School of Sociology and Population Studies, Renmin University of China, Beijing, China.
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Fisher Institute of Health and Well-Being, Department of Nutrition and Health Science, College of Health, Ball State University, Muncie, USA.
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14
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Lewis ME. The Effects of an Indigenous Health Curriculum for Medical Students. MEDICAL SCIENCE EDUCATOR 2020; 30:891-903. [PMID: 34457747 PMCID: PMC8368427 DOI: 10.1007/s40670-020-00971-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Indigenous patients experience a variety of healthcare challenges including accessing and receiving needed healthcare services, as well as experiencing disproportionate amounts of bias and discrimination within the healthcare system. In an effort to improve patient-provider interactions and reduce bias towards Indigenous patients, a curriculum was developed to improve first-year medical students' Indigenous health knowledge. METHOD Two cohorts of students were assessed for their Indigenous health knowledge, cultural intelligence, ethnocultural empathy, and social justice beliefs before the lecture series, directly after, and 6 months later. RESULTS Results of paired t test analysis revealed that Indigenous health knowledge significantly improved after the training and 6 months later. Some improvements were noted in the areas of cultural intelligence and ethnocultural empathy in the second cohort. CONCLUSIONS It is feasible to teach and improve Indigenous-specific health knowledge of medical students using a brief intervention of lectures. However, other critical components of culturally appropriate care including social justice beliefs and actions, ethnocultural empathy, and cultural humility may require increased and immersed cultural training.
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Affiliation(s)
- Melissa E. Lewis
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO USA
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15
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Goreis A, Asbrock F, Nater UM, Mewes R. What Mediates the Relationship Between Ethnic Discrimination and Stress? Coping Strategies and Perceived Social Support of Russian Immigrants in Germany. Front Psychiatry 2020; 11:557148. [PMID: 33192672 PMCID: PMC7533615 DOI: 10.3389/fpsyt.2020.557148] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/13/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Experiences of ethnic discrimination may constitute major stressors for ethnic minority groups. This study examined the associations between different forms of ethnic discrimination and levels of perceived stress in Russian immigrants living in Germany, taking into account potential moderating (in-group identification) and mediating (coping and social support) factors. METHODS Russian immigrants (N = 308) were assessed using online questionnaires (e.g., perceived stress scale, behaviors from intergroup affect and stereotype treatment scale, and brief COPE). Three forms of ethnic discrimination were examined: active harm (e.g., open aggression), passive harm (e.g., paternalistic behavior), and everyday discrimination (e.g., receiving poor service). Moderation by in-group identification and mediation via coping and social support were tested. RESULTS Passive harm was more prevalent than everyday discrimination and active harm. Passive harm and everyday discrimination were associated with higher perceived stress (rs = .22 and .18, ps <.01), and in-group identification did not moderate these associations (ps >.27). The coping strategy self-blame mediated the association between active harm and stress. Substance use and self-blame mediated the association between passive harm and stress, whereas venting, behavioral disengagement, denial, self-blame, and social support mediated the association between everyday discrimination and stress. A direct effect remained for passive harm and everyday discrimination. CONCLUSION The present study revealed that Russian immigrants encounter different forms of ethnic discrimination, and that this is associated with higher levels of stress. This association was partly explained by coping and social support, illustrating possibilities for interventions aimed at improving the use of adaptive coping strategies and promoting social support-seeking for Russian immigrants.
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Affiliation(s)
- Andreas Goreis
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria.,Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Frank Asbrock
- Department of Psychology, Chemnitz University of Technology, Chemnitz, Germany
| | - Urs M Nater
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Ricarda Mewes
- Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
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Dawson AZ, Walker RJ, Campbell JA, Davidson TM, Egede LE. Telehealth and indigenous populations around the world: a systematic review on current modalities for physical and mental health. Mhealth 2020; 6:30. [PMID: 32632368 PMCID: PMC7327286 DOI: 10.21037/mhealth.2019.12.03] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022] Open
Abstract
Approximately 370-500 million Indigenous people live worldwide. While Indigenous peoples make up only 5% of the world's population, they account for 15% of the extreme poor and have life expectancy that is 20 years shorter than that of non-Indigenous people. Access to healthcare has been identified as an important social determinant of health and key driver of health outcomes. Indigenous populations often face barriers to accessing healthcare including living in remote areas, lacking financial resources, and having cultural differences. Telehealth, the utililzation of any synchronous modality, including phone, video, or teleconferencing technology used to support the provision of long-distance health care and health education, is a feasible and cost-effective treatment delivery mechanism that has successfully addressed access barriers faced by vulnerable populations globally, however, few studies have included indigenous populations and the application of this technology to improve physical and mental health outcomes. This systematic review aims to identify trials that were conducted among Indigenous adults, and to summarize the components of interventions that have been found to effectively improve the health of Indigenous peoples. The PRISMA guidelines for reporting of systematic reviews were followed in preparing this manuscript. Studies were identified by searching PubMed, Scopus, and PsychInfo databases for clinical trial articles on Indigenous peoples and mental and physical health, published between January 1, 1998 and December 31, 2018. Eligibility criteria for determining studies to include in the analysis were as follows: (I) ≥18 years of age; (II) indigenous peoples; (III) any technology-based intervention; (IV) studies included at least one of the following mental health (depression, post-traumatic stress disorder, suicide) and physical health (mortality, blood pressure, hemoglobin A1C, cholesterol, quality of life) outcomes; (V) clinical trials. A total of 2,662 articles were identified and six were included in the final review based on pre-specified eligibility criteria. Three were conducted in the United States, one study was conducted in Canada, and two were conducted in New Zealand. Study sample sizes ranged from 20 to 762, intervention delivery times ranged from three to 20 months and utilized telephone, internet and SMS messaging as the type of technology. There is a paucity of evidence on the use of telehealth programs to increase access to chronic disease programs in Indigenous populations. This review highlights the importance of culturally tailoring programs despite the modality in which they are delivered, and recommends telephone-based delivery facilitated by a trained health professional. Telehealth has great promise for meeting the health needs of highly marginalized Indigenous populations around the world, however, at this point more research is needed to understand how best to structure and deliver these programs for maximum effect.
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Affiliation(s)
- Aprill Z. Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J. Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A. Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Leonard E. Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
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Walker RJ, Campbell JA, Dawson AZ, Egede LE. Prevalence of psychological distress, depression and suicidal ideation in an indigenous population in Panamá. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1199-1207. [PMID: 31055631 PMCID: PMC6790172 DOI: 10.1007/s00127-019-01719-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/25/2019] [Indexed: 03/01/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of serious psychological distress (SPD), depression, and suicidal ideation in an adult Indigenous population in Panamá. METHODS Data were collected from 211 Kuna adults using a paper-based survey. Depression and suicidal ideation were measured using the Patient Health Questionnaire (PHQ-9), and SPD was measured using the Kessler-6. Univariate analyses were used to describe demographic variables, followed by chi2 tests to compare differences in demographic variables for each of the mental health outcomes (depression, serious psychological distress, suicidal ideation). A regression model, adjusted for all demographic variables, was then run for each mental health outcome to understand independent correlates. RESULTS Within the sample surveyed, 6.2% (95% CI 3.4-10.4) reported serious psychological distress, 32.0% (95% CI 25.7-38.9) reported depression, and 22.9% (95% CI 17.4-29.1) reported suicidal ideation. Significant demographic differences existed with 14% of individuals between the age of 60-90 and 17% of individuals with no education reporting SPD. Women were nearly 5 times more likely to report depression than men (OR 4.90, 95% CI 1.27-19.00) and those with higher incomes were less likely to report depression (OR 0.32, 95% CI 0.13-0.78). CONCLUSION High levels of depression, SPD, and suicidal ideation were present in an Indigenous Kuna community in Panamá. Women and individuals with low income were more likely to report depression, and SPD was more common in older individuals and those with low levels of education. Suicidal ideation was high across all demographic factors, suggesting that a community-wide program to address suicide may be warranted.
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Affiliation(s)
- Rebekah J. Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Jennifer A. Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Aprill Z. Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E. Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
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Jones R, Crowshoe L, Reid P, Calam B, Curtis E, Green M, Huria T, Jacklin K, Kamaka M, Lacey C, Milroy J, Paul D, Pitama S, Walker L, Webb G, Ewen S. Educating for Indigenous Health Equity: An International Consensus Statement. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:512-519. [PMID: 30277958 PMCID: PMC6445615 DOI: 10.1097/acm.0000000000002476] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education's influence-for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these inequities. However, there is evidence that medical education is not adequately fulfilling this role and, in fact, may be complicit in perpetuating inequities.This article seeks to examine the factors underpinning medical education's role in Indigenous health inequity, to inform interventions to address these factors. The authors developed a consensus statement that synthesizes evidence from research, evaluation, and the collective experience of an international research collaboration including experts in Indigenous medical education. The statement describes foundational processes that limit Indigenous health development in medical education and articulates key principles that can be applied at multiple levels to advance Indigenous health equity.The authors recognize colonization, racism, and privilege as fundamental determinants of Indigenous health that are also deeply embedded in Western medical education. To contribute effectively to Indigenous health development, medical education institutions must engage in decolonization processes and address racism and privilege at curricular and institutional levels. Indigenous health curricula must be formalized and comprehensive, and must be consistently reinforced in all educational environments. Institutions' responsibilities extend to advocacy for health system and broader societal reform to reduce and eliminate health inequities. These activities must be adequately resourced and underpinned by investment in infrastructure and Indigenous leadership.
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Affiliation(s)
- Rhys Jones
- R. Jones is senior lecturer, Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand
| | - Lynden Crowshoe
- L. Crowshoe is associate professor, Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Papaarangi Reid
- P. Reid is professor and Tumuaki, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Betty Calam
- B. Calam is associate professor, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elana Curtis
- E. Curtis is associate professor, Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand
| | - Michael Green
- M. Green is professor and head, Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Tania Huria
- T. Huria is senior lecturer, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Kristen Jacklin
- K. Jacklin is professor, Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minnesota, and professor, Human Sciences Division, Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada
| | - Martina Kamaka
- M. Kamaka is associate professor, Department of Native Hawaiian Health, University of Hawai‘i at Manoa John A. Burns School of Medicine, Honolulu, Hawai‘i
| | - Cameron Lacey
- C. Lacey is senior lecturer, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Jill Milroy
- J. Milroy is professor, School of Indigenous Studies, University of Western Australia, Perth, Western Australia, Australia
| | - David Paul
- D. Paul is professor, School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Suzanne Pitama
- S. Pitama is associate professor, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Leah Walker
- L. Walker is associate director, Centre for Excellence in Indigenous Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gillian Webb
- G. Webb is associate professor, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Shaun Ewen
- S. Ewen is professor and director, Melbourne Poche Centre for Indigenous Health, and pro vice chancellor (Indigenous), University of Melbourne, Melbourne, Victoria, Australia
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Temple JB, Kelaher M. Is disability exclusion associated with psychological distress? Australian evidence from a national cross-sectional survey. BMJ Open 2018; 8:e020829. [PMID: 29794096 PMCID: PMC5988124 DOI: 10.1136/bmjopen-2017-020829] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine the association between disability exclusion and psychological distress. DESIGN Cross-sectional study. SETTING Population-based study of individuals living in households across Australia. PARTICIPANTS Respondents were persons aged 15 and over living with a disability. PRIMARY OUTCOME MEASURES Reporting an experience of discrimination or avoidance behaviour due to a respondent's disability. High or very high levels of psychological distress measured using the Kessler K10 instrument. METHODOLOGY Using the Survey of Disability, Ageing and Carers, we calculated the prevalence of persons with a disability experiencing psychological distress, disaggregated by experiences of disability exclusion, including discrimination and avoidance. Logistic regression models were fitted to examine the association between disability exclusion and psychological distress, once extensive controls and adjustments for survey design and presence of psychosocial disabilities were considered. RESULTS About 62% of persons citing an experience of disability discrimination were in psychological distress, compared with 27% of those citing no discrimination. Furthermore, 53% of those who actively avoided social, familial or economic activities because of their disability experienced psychological distress, compared with 19% of those who did not avoid these situations. After controlling for demographic characteristics and disabling conditions, reporting an experience of disability discrimination or disability avoidance increased the odds of psychological distress by 2.2 (95% CI 1.74 to 2.26) and 2.6 (95% CI 2.28 to 2.97) times, respectively. Those who experienced both avoidance and discrimination were 3.7 (95% CI 2.95 to 4.72) times more likely to be in psychological distress than those experiencing neither. Avoidance and discrimination in healthcare settings were also found to be strongly associated with experiencing psychological distress. CONCLUSIONS Given new policy initiatives to improve disability care, coupled with the increasing speed of population ageing, the onus is on governments and its citizenry to address disability exclusion to offset potential mental health impacts.
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Affiliation(s)
- Jeromey B Temple
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Otsuka Y, Kaneita Y, Itani O, Nakagome S, Jike M, Ohida T. Relationship between stress coping and sleep disorders among the general Japanese population: a nationwide representative survey. Sleep Med 2017; 37:38-45. [PMID: 28899538 DOI: 10.1016/j.sleep.2017.06.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/18/2017] [Accepted: 06/01/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To clarify the prevalence of stress, and examine the relationship between sleep disorders and stress coping strategies among highly stressed individuals in the general Japanese population. METHODS A cross-sectional nationwide survey was undertaken in November 2007. Men and women were randomly selected from 300 districts throughout Japan. Data from 7671 (3532 men (average age 53.5 ± 17.0 years) and 4139 women (average age 53.9 ± 17.7 years)) were analyzed. Participants completed a self-reported questionnaire on stress, sleep disorders, and stress coping strategies in the previous month. RESULTS Highly stressed individuals comprised 16.6% (95% confidence interval 15.8-17.5%) of the total sample, and most were aged 20-49 years. In multiple logistic regression, symptoms of insomnia (ie, difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening), excessive daytime sleepiness, nightmares, daytime malfunction, and lack of rest due to sleep deprivation were more prone to occur in highly stressed individuals. In addition, logistic regression analysis controlling for other adjustment factors revealed that stress coping strategies such as 'giving up on problem-solving', 'enduring problems patiently', 'smoking' and 'drinking alcohol' were positively associated with the above-mentioned sleep disorders. On the other hand, stress coping strategies such as 'exercising', 'enjoying hobbies', and 'sharing worries' were inversely associated with the above-mentioned sleep disorders. CONCLUSIONS Distraction-based stress coping (eg, hobbies, exercise, and optimistic thinking) was found to be preferable to problem-based stress coping in a highly stressed Japanese general population.
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Affiliation(s)
- Yuichiro Otsuka
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshitaka Kaneita
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University, Oita, Japan.
| | - Osamu Itani
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University, Oita, Japan
| | - Sachi Nakagome
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Maki Jike
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Takashi Ohida
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
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