Hispanic incorporation and access to health care in Houston and Harris County, Texas: Adopting an Hispanic perspective to the Aday and Andersen model

This study examines Hispanic levels of incorporation and access to health care. Applying the Aday and Andersen framework for the study of access, the study examined the relationship between two levels of Hispanic incorporation into U.S. society, i.e., mainstream versus ethnic, and potential and realized measures of access to health care. Data for the study were drawn from a 1992 telephone survey of 600 randomly selected Hispanics in Houston and Harris County.^ The hypotheses tested were: (1) Hispanics who are incorporated into mainstream society are more likely to have better potential and realized access to health care than those who are incorporated into ethnic-group enclaves regardless of their socioeconomic status (SES), health status and health needs, and (2) there is no interaction between the levels of incorporation (mainstream or ethnic) and SES, health status, and health needs in predicting potential and realized access.^ The data analysis supported Hypothesis One for the two measures of potential access. The results of bivariate and multiple logistic regression analyses indicated that for Hispanics in Houston and Harris County, being in the "mainstream" incorporation category increased their potential access to care, having "health insurance" and a "regular place of care". For the selected measure of realized access, having a "regular check-up", the analysis did not demonstrate statistically significant differences in having a regular check-up among Hispanics incorporated in the ethnic or mainstream incorporation categories.^ Hypothesis Two, that there is no interaction between the levels of incorporation and socioeconomic characteristics, health status, and health needs in predicting potential and realized access among Hispanics was supported by the data. The results of the logistic regression analysis showed that, after adjusting for socioeconomic status, health status, and health needs, the association between "level of incorporation" and the two measures of potential access ("health insurance" and having a "usual place of care") was not modified by the control variables nor by their interaction with level of incorporation. That is, the effect of incorporation on Hispanics' health insurance coverage, and having a usual place of care, was homogenous across Hispanics with different SES and health status.^ The main research implication of this dissertation is the employment of a theoretical framework for the assessment of cultural factors essential to research on migrating heterogeneous subpopulations. It also provided strategies to solve practical and methodological difficulties in the secondary analyses of data on these populations. ^

HOUSE-TO-HOUSE SURVEY OF ACCESS TO AND USE OF PUBLIC HEALTH FACILITIES IN METROPOLITAN LAGOS, NIGERIA

One of the broad objectives of the Nigerian health service, vigorously being pursued at all levels of government, is to make comprehensive health care available and accessible to the population at the lowest possible cost, within available resources. Some state governments in the federation have already introduced free medical service as a practical way to remove financial barriers to access and in turn to encourage greater utilization of publicly funded care facilities.^ To aid health planners and decision makers in identifying a shorter corridor through which urban dwellers can gain access to comprehensive health care, a health interview survey of the metropolitan Lagos was undertaken. The primary purpose was to ascertain the magnitude of access problems which urban households face in seeking care from existing public facilities at the time of need. Six categories of illness chosen from the 1975 edition of the International Classification of Disease were used as indicators of health need.^ Choice of treatment facilities in response to illness episode was examined in relation to distance, travel time, time of use and transportation experiences. These were graphically described. The overall picture indicated that distance and travel time coexist with transportation problems in preventing a significant segment of those in need of health care from benefitting in the free medical service offered in public health facilities. Within this milieu, traditional medicine and its practitioners became the most preferred alternative. Recommendations were offered for action with regard to decentralization of general practitioner (GP) consultations in general hospitals and integration of traditional medicine and its practitioners into public health service. ^

FACTORS INFLUENCING ACCESS TO HEALTH CARE AMONG MEXICAN AMERICAN ELDERLY IN TEXAS

Differential access to health care services has been observed among various groups in the United States. Minorities and low-income groups have been especially notable in their decreased access to regular providers of care. This is believed by many to account for some of the higher rates of morbidity and mortality and shorter life expectancies of these groups.^ This research delineated the factors associated with health care access for a particular subset of a minority group, the Mexican American elderly in Texas. Hospital admission and evidence of a regular source of medical care and dental care were chosen as the indicators of access to health care.^ This study analyzed survey interview data from the Texas Study on Aging, 1976. The 597 Mexican American elderly included in this study were representative of the non-institutionalized Mexican American elderly in Texas aged 55 or older.^ The results indicate that hospital admission is not a question of discretion and that common barriers to access, such as income, health insurance, and distance to the nearest facility, are not important in determining hospital admission. Mexican American elderly who need to be hospitalized, as indicated by self-perception of health and disability days, will be hospitalized.^ The results also indicate that having a regular source of medical care is influenced by many factors, some mutable and some immutable. The well-established and immutable factors of age, sex, and need were confirmed. However, the mutable factors such as area of residence and income were also found to have a significant influence. Mexican American elderly living in urban areas had significantly less access to a regular source of medical care as did those who were near the poverty level (as opposed to those who were well below the poverty level). In general, persons claiming a regular source of medical care were more likely to be women, persons who had many health needs, were near the poverty level, lived in urban areas, and had extensive social support systems.^ Persons claiming a regular source of dental care tended to be more advantaged. They had more education, a more extensive informal social support network, higher income, and were generally younger and in better health. They were also more likely to have private health insurance. . . . (Author's abstract exceeds stipulated maximum length. Discontinued here with permission of author.) UMI ^

Access to oral care --- A systematic review of a continuing public health issue among older adults

Oral health is essential for the general well being of the individual and collectively for the health of the population. Oral health can be maintained by routine dental care and visits to dental professionals, but accessing professional dental care may be a continuing difficulty in vulnerable older adult population. Many older adults are not frequent users of dental care, though oral health is crucial to their well-being and overall health. Access to care is the timely use of personal health services to achieve the best possible health outcomes. ^ Objectives: The aims of this review are to (i) to analyze and elucidate the relationship between socio-economic disparities in gender, ethnicity, poverty status, education and the continuing public issue of access to oral care, (ii) to identify the underlying causes through which these factors can affect access to oral care. This review will provide a knowledgeable basis for development of interventions to provide adequate access to oral care in older adults and implementing policies to ensure access to oral care; through highlighting the various socio economic factors that affect access to oral care among older adults. ^ Methods: This paper used a purposeful review of literature on socioeconomic disparities in access to oral care among older adults. The references considered in this review included all the relevant articles, surveys and reports published in English language, since the year 1985 to 2010, in the United States. The articles selected were scrutinized for relevancy to the topic of access to oral care and which included discussions of the effects of gender, ethnicity, poverty status, educational status in accessing oral care. ^ Results: Evidence confirmed the continuing disparity in access to oral care among older adults. The possible links identified were gender inequality, ethnic differences, income levels and educational differences affecting access to oral care. The underlying causes linking these factors with access to oral care were established. ^ Conclusion: The analysis of the literature review findings supported the prevalence of disparities in gender, ethnicity, income and education with its possible links affecting access to oral care. The underlying causes helped to understand the reasons behind this growing issue of inaccessible oral care. Further research is needed to develop policies and target dental public health efforts towards specific problem areas ensuring equitable access to oral services and consequently, improve the health of older adults.^

Evaluation of the impact of access to free influenza vaccine on immunization rates for children with cystic fibrosis

Children with cystic fibrosis are at increased risk of seasonal influenza associated complications, which makes them a judicious target of interventions designed to increase influenza vaccination rates. The Baylor College of Medicine/Texas Children's Hospital Pediatric Cystic Fibrosis (BCM/TCH CF) Care Center implemented an enhanced multi-component initiative designed to increase influenza vaccination rates in its patient population during the 2011-2012 influenza season. We evaluated the impact of specific components of this intervention on vaccination rates among the clinic's patient population via a historical medical chart review and examined the relationship between vaccination status and the number of pulmonary exacerbations requiring hospital admission during the influenza season. The multi-component intervention was comprised of providing influenza free of charge in the CF Care Center, reminders via phone call and letters, and drive through influenza vaccine clinics on nights and weekends. The intervention to increase influenza vaccination rates led to overall improved vaccination rates among the patients at the BCM/TCH CF Care Center, increasing from 90% adherence observed during the 2010-2011 season to 94% adherence during the 2011-2012 season. The availability of free influenza vaccine in the CF Care Center, combined with reminders about being vaccinated early in the season proved to be the most effective practices for improving the vaccination rate in the CF Care Center.^

Minors’ Access to Contraceptive Services

Over the past 30 years, states have expanded minors’ authority to consent to health care, including care related to sexual activity. This trend reflects U.S. Supreme Court rulings extending the constitutional right to privacy to a minor’s decision to obtain contraceptives and concluding that rights do not “come into being magically only when one attains the state-defined age of majority.” It also reflects the recognition that while parental involvement is desirable, many minors will remain sexually active but not seek services if they have to tell their parents. As a result, confidentiality is vital to ensuring minors’ access to contraceptive services. Even when a state has no relevant policy or case law, physicians may commonly provide medical care to a mature minor without parental consent, particularly if the state allows a minor to consent to related health services.

Working to improve access to safe abortion

Presentación en la 4ta. Conferencia Regional del CLACAI. Reafirmando el legado de Cairo: Aborto legal y seguro. Lima, 21 y 22 de Agosto de 2014

La observación participante como sistema de contextualización de los métodos etnográficos : La investigación de campo de Esther Hermitte en los Altos de Chiapas, 1960-1961

Este artículo analiza los alcances de la expresión "observación participante" como técnica etnográfica de recolección de datos. A través de los materiales consignados por escrito correspondientes a una investigación concreta, se ponen de relieve las distintas actividades que la antropóloga social argentina Esther Hermitte desarrolló en los Altos de Chiapas en 1960-1, y que culminaron con el descubrimiento de un sistema de gobierno sobrenatural. Estas actividades, que aparecen como complementarias y hasta periféricas de las verdaderas técnicas (entrevistas, cuestionarios, encuestas) de la investigación propiamente dicha, dan sentido a la "observación participante" como Instrumento que permite familiarizar a la investigadora con los contextos que dan sentido a cuanto ocurre en ellos, y configurar el lugar de la investigadora al modo que lo hacen los tzeltales de Pinola, sus sujetos de estudio. La observación participante, entonces, bandona el ámbito de las "técnicas" concebidas unilateralmente desde el medio académico, para constituir una expresión en que los lugareños y sus investigadores negocian los términos de su relación y, al hacerlo, producen (mutuos) comprensión y conocimiento

Una mirada sobre el acceso abierto en Iberoamérica : Entrevista realizada a la Dra. Remedios Melero

Esta contribución acerca a los lectores de la revista una charla entre Remedios Melero, una de las principales referentes en materia de acceso abierto en España e Iberoamérica, y miembros del proyecto de investigación "El acceso abierto al conocimiento científico en Argentina. Estado de la cuestión y principales tendencias" (H540). Durante la misma, se repasa el avance del movimiento de acceso abierto en el ámbito iberoamericano, sus similitudes y diferencias con España, la influencia de las legislaciones tendientes a establecer un marco propicio para su desarrollo, la perspectiva de las llamadas vías verde y dorada -repositorios y revistas de acceso abierto-, y las principales líneas de investigación existentes en el tema

Acceso abierto real y potencial a la producción científica de un país. El caso argentino

Se aporta una metodología para estimar la disponibilidad real y potencial de la producción científica de un país, según el modelo de acceso de las revistas elegidas por los investigadores para publicar sus artículos. Se estudia el caso de la producción científica argentina del período 2008-2010 en medicina, física y astronomía, agricultura y ciencias biológicas, y ciencias sociales y humanidades. La producción fue recogida de la base de datos Scopus y los modelos de acceso de las revistas, determinados a partir de la consulta a DOAJ, e-revist@s, SciELO, RedALyC, PubMed, Romeo-Sherpa y Dulcinea. Se concluye que Argentina presenta condiciones muy favorables para liberar un alto porcentaje de la literatura científica generada en el país bajo la modalidad de acceso abierto a través de repositorios; y que la metodología es reproducible para realizar comparaciones con otros países y campos temáticos. Los resultados aportan conocimiento útil a los gestores de repositorios de las instituciones académicas y de investigación de cara a promocionar su desarrollo y justificar su sostenimiento

La observación participante como sistema de contextualización de los métodos etnográficos : La investigación de campo de Esther Hermitte en los Altos de Chiapas, 1960-1961

Este artículo analiza los alcances de la expresión "observación participante" como técnica etnográfica de recolección de datos. A través de los materiales consignados por escrito correspondientes a una investigación concreta, se ponen de relieve las distintas actividades que la antropóloga social argentina Esther Hermitte desarrolló en los Altos de Chiapas en 1960-1, y que culminaron con el descubrimiento de un sistema de gobierno sobrenatural. Estas actividades, que aparecen como complementarias y hasta periféricas de las verdaderas técnicas (entrevistas, cuestionarios, encuestas) de la investigación propiamente dicha, dan sentido a la "observación participante" como Instrumento que permite familiarizar a la investigadora con los contextos que dan sentido a cuanto ocurre en ellos, y configurar el lugar de la investigadora al modo que lo hacen los tzeltales de Pinola, sus sujetos de estudio. La observación participante, entonces, bandona el ámbito de las "técnicas" concebidas unilateralmente desde el medio académico, para constituir una expresión en que los lugareños y sus investigadores negocian los términos de su relación y, al hacerlo, producen (mutuos) comprensión y conocimiento

Una mirada sobre el acceso abierto en Iberoamérica : Entrevista realizada a la Dra. Remedios Melero

Esta contribución acerca a los lectores de la revista una charla entre Remedios Melero, una de las principales referentes en materia de acceso abierto en España e Iberoamérica, y miembros del proyecto de investigación "El acceso abierto al conocimiento científico en Argentina. Estado de la cuestión y principales tendencias" (H540). Durante la misma, se repasa el avance del movimiento de acceso abierto en el ámbito iberoamericano, sus similitudes y diferencias con España, la influencia de las legislaciones tendientes a establecer un marco propicio para su desarrollo, la perspectiva de las llamadas vías verde y dorada -repositorios y revistas de acceso abierto-, y las principales líneas de investigación existentes en el tema