Cultural competence in an HIV dedicated dental clinic: Application of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS)

This dissertation investigated perspectives on cultural competence among African-American women patients, staff, and the administrator of a dental clinic serving people living with HIV/AIDS; and evaluated the role of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) in advancing the provision of culturally competent care in the clinic. ^ The study was qualitative with data collection via focus groups and individual interviews with a sample of African-American women patients, and individual interviews with a sample of staff and the clinic administrator. Transcripts were coded and themes identified using the software program ATLAS.ti. A cultural audit template was developed and applied to evaluate cultural competency. ^ Among attitudes and behaviors that contributed to the provision of culturally competent care at the clinic were respect and empathic communication. Formal cultural competency was not featured strongly in the methods by which the staff learned to work with diverse populations. Instead cultural competence among the staff was based on thoughtful hiring practices, natural aptitude and a climate that encouraged learning through informal sharing of experiences. The staff and administrator felt that an African-American dentist would be an asset in improving culturally competent care at the clinic. Previous research and national policy also promote the provider-patient racial/ethnic concordance to improve care. In this study, however, the patients were happy with the care provided regardless of the race/ethnicity of the staff, probably reflecting the well developed cultural competence skills of clinic staff overall. ^ The clinic administrator was unaware of the CLAS standards although the clinic was implicitly operated under their mandates. This occurred because the clinic is supported by federal funding and the CLAS standards were incorporated into the requirements. Incorporation into and monitoring of the CLAS standards in federally funded programs therefore appears to be an effective means for ensuring that they are implemented. ^ This study illustrates that cultural competence, though not universally understood, can be systematically investigated to identify what constitutes appropriate care and the factors that support or inhibit it. Among important elements of culturally competent care are respect and empathic communication. ^

Policy analysis of the Americans with Disabilities Act of 1990 and federal funding concerning barrier-free playgrounds

The Americans with Disabilities Act (ADA) of 1990 was created to prohibit discrimination against disabled persons in our society. The goal of the ADA as a comprehensive civil rights law is to "ensure equal opportunity and complete participation, independent living and economic self-sufficiency" for disabled persons (U.S. Department of Justice, 2008). As part of Title II and III of the ADA, states and local governments are required to provide people with disabilities the same chance to engage in and benefit from all programs and services including recreational facilities and activities as every other citizen. Recreational facilities and related structures must comply with accessibility standards when creating new structures or renovating existing ones. Through a systematic literature review of articles accessed through online databases, articles relating to children with disabilities, their quality of life and their experience gained through play were reviewed, analyzed and synthesized. Additionally, the ADA's Final Rule regarding accessible playgrounds was evaluated through a descriptive analysis which yielded the following five components relating the importance of barrier-free playgrounds to children with disabilities: appropriate dimensions for children, integration of the play area, variety of activity and stimulation, availability of accessible play structures to communities, and financial feasibility. These components were used as evaluation criteria to investigate the degree to which the ADA's Final Rule document met these criteria. An evaluation of two federal funding sources, the Urban Parks and Recreation Renewal Program (UPARR) and the Land and Water Conservation Fund (LWCF), was also conducted which revealed three components relating the two programs' ability to support the realization of the ADA's Final Rule which included: current budget for the program, ability of local communities to attain funds, and level of ADA compliance required to receive funding. Majority of the evaluation of the Final Rule concluded it be adequate in development of barrier-free playgrounds although there are some portions of the guidelines that would benefit from further elucidation. Both funding programs were concluded to not adequately support the development of barrier-free playgrounds and therefore it was recommended that their funding be re-instated or increased as necessary. ^

An empirical model to estimate the demand for primary care in urban settings

Objective. To measure the demand for primary care and its associated factors by building and estimating a demand model of primary care in urban settings.^ Data source. Secondary data from 2005 California Health Interview Survey (CHIS 2005), a population-based random-digit dial telephone survey, conducted by the UCLA Center for Health Policy Research in collaboration with the California Department of Health Services, and the Public Health Institute between July 2005 and April 2006.^ Study design. A literature review was done to specify the demand model by identifying relevant predictors and indicators. CHIS 2005 data was utilized for demand estimation.^ Analytical methods. The probit regression was used to estimate the use/non-use equation and the negative binomial regression was applied to the utilization equation with the non-negative integer dependent variable.^ Results. The model included two equations in which the use/non-use equation explained the probability of making a doctor visit in the past twelve months, and the utilization equation estimated the demand for primary conditional on at least one visit. Among independent variables, wage rate and income did not affect the primary care demand whereas age had a negative effect on demand. People with college and graduate educational level were associated with 1.03 (p < 0.05) and 1.58 (p < 0.01) more visits, respectively, compared to those with no formal education. Insurance was significantly and positively related to the demand for primary care (p < 0.01). Need for care variables exhibited positive effects on demand (p < 0.01). Existence of chronic disease was associated with 0.63 more visits, disability status was associated with 1.05 more visits, and people with poor health status had 4.24 more visits than those with excellent health status. ^ Conclusions. The average probability of visiting doctors in the past twelve months was 85% and the average number of visits was 3.45. The study emphasized the importance of need variables in explaining healthcare utilization, as well as the impact of insurance, employment and education on demand. The two-equation model of decision-making, and the probit and negative binomial regression methods, was a useful approach to demand estimation for primary care in urban settings.^

Crack and powder cocaine federal legislation: A sentencing disparity and potential for policy improvement

Since its introduction into the United States in the 1980s, crack cocaine has been a harsh epidemic that has taken its toll on a countless number of people. This highly addictive, cheap and readily available drug of abuse has permeated many demographic sectors, mostly in low income, lesser educated, and urban communities. This epidemic of crack cocaine use in inner city areas across the Unites States has been described as an expression of economic marginality and “social suffering” coupled with the local and international forces of drug market economies (Agar 2003). As crack cocaine is a derivative of cocaine, it utilizes the psychoactive component of the drug, but delivers it in a much stronger, quicker, and more addictive fashion. This, coupled with its ready availability and cheap price has allowed for users to not only become very addicted very quickly, but to be subject to the stringent and sometimes unequal or inconsistent punishments for possession and distribution of crack-cocaine. ^ There are many public health and social ramifications from the abuse of crack-cocaine, and these epidemics appear to target low income and minority groups. Public health issues relating to the physical, mental, and economic strain will be addressed, as well as the direct and indirect effects of the punishments that come as a result of the disparity in penalties for cocaine and crack-cocaine possession and distribution. ^ Three new policies have recently been introduced into the United Stated Congress that actively address the disparity in sentencing for drug and criminal activities. They are, (1) Powder-Crack Cocaine Penalty Equalization Act of 2009, (HR 18, 111th Cong. 2009), (2) The Drug Sentencing Reform and Cocaine Kingpin Trafficking Act of 2009, (HR 265, 111th Cong. 2009) and (3) The Justice Integrity Act of 2009, (111th Cong. 2009). ^ Although they have only been initiated, if passed, they have potential to not only eliminate the crack-cocaine disparity, but to enact laws that help those affected by this epidemic. The final and overarching goal of this paper is to analyze and ultimately choose the ideal policy that would not only eliminate the cocaine and crack disparity regardless of current or future state statutes, but will provide the best method of rehabilitation, prevention, and justice. ^

Expanding cities and expanding waistlines: Urban sprawl and its impact on obesity, how the adoption of smart growth statutes can build healthier and more active communities

For decades, American towns and cities have expanded from their established cores into the surrounding rural areas. U.S. population has grown but the land that we use has grown at an even faster pace, and our country has now become a largely suburban nation. Americans moved and continue to move out to the suburbs in search of better lives – for clean and healthy living, for larger homes, and for better resources. In many ways and for many Americans, the suburban lifestyle has been a great success. However, there are some unintended public health consequences of urban sprawl that must be recognized. As most Americans no longer walk or bicycle, increasingly sedentary lifestyles now contribute to greater levels of obesity, diabetes and other associated chronic diseases. This thesis reviewed the impacts of urban sprawl on the public's health specifically, as sprawl relates to decreased physical activity rates and increased obesity rates. The health effects and their connection with sprawl were identified, and available evidence was reviewed. Finally, this thesis described legal and policy solutions for addressing the health effect through improving the design of our built environment and by recommending that governments adopt and implement Smart Growth statutes that incorporate a public health component and require public health involvement. ^

Understanding mental illness in Nigeria: Bringing culture and traditional medicine into mental health policy

One of the major challenges in treating mental illness in Nigeria is that the health care facilities and mental health care professionals are not enough in number or well equipped to handle the burden of mental illness. There are several barriers to treatment for individual Nigerians which include the following: such as the lack of understanding of the root causes of mental illness, lack of financial support to get mental treatment, lack of social support (family, friends, neighbors), the fear of stigmatization concerning being labeled as mentally ill or being in association with the mentally ill, and the consultation of traditional native healers who may be unknowingly prolonging illness, rather than addressing and treating them due to lack of formal education and standardization of their treatments. Another barrier is the non-health nature of the mental health services in Nigeria. Traditional healers are essentially the mental health system. The elderly, women, and children are the most vulnerable groups in times of strife and hardships. Their mental well-being must be taken into account as well as their special needs in times of personal or societal crisis. ^ Nigerian mental health policy is geared toward forming a mental health system, but in actuality only a mental illness care system is the observed result of the policy. The government of Nigeria has drafted a mental health policy, yet its actual implementation into the Nigerian health infrastructure and society waits to be materialized. The limited health legislation or policy implementations tend to favor those who have access to these urban areas and the facilities' health services. Nigerians living in rural areas are at a disadvantage; many of them may not even be aware of services available to help them understand and treat mental illness. Perhaps, government driven health interventions geared toward mental illness in rural areas would reach an underserved Nigerians and Africans in general. Issues with political instability and limited infrastructure often hinder crucial financial resources and legislation from reaching the people that are truly in need of governmental leadership in regards to mental health policy.^ Traditional healers are a severely untapped resource in the treatment of mental illness within the Nigerian population. They are abundant within Nigerian communities and are meeting a real need for the mentally ill. However, much can be done to remove the barriers that prevent the integration of traditional healers within the mental health system and improve the quality of care they administer within the population. Mental illness is almost exclusively coped with through traditional medicine practices. Mobilization and education from each strata of Nigerian society and government as well as input from the medical community can improve how traditional medicine is utilized as a treatment for clinical illness and help alleviate the heavy burden of mental illness in Nigeria. Currently, there is no existing policy making structure for a working mental health system in Nigeria, and traditional healers are not taken into account in any formulation of mental health policy. Advocacy for mental illness is severely inadequate due to fear of stigmatization, with no formally recognized national of regional mental health association.^

Políticas territoriales y construcción del paisaje cultural : caso región Gran La Plata

El propósito es presentar las principales estrategias de ordenamiento territorial urbano puestas en práctica en los últimos quince años en el Gran La Plata, que han incidido en el paisaje cultural. Se observan tanto políticas de enfoques integrales como sectoriales, las que incorporan innovaciones en OT y proponen nuevos y/o renovados paisajes culturales y las políticas “centrales" desde las gestiones municipales. Se reflexiona sobre aportes y debilidades, incompatibilidades entre ellas, en el marco del desarrollo sustentable. La estrategia metodológica utilizada tiene un perfil cualitativo y de tipo exploratoria, con un diseño de naturaleza flexible. En el estudio de caso se identifican las modalidades de intervención en función de las transformaciones del paisaje resultante y su gestión. Tiene una fuerte orientación interpretativa y la estrategia general está orientada a conseguir una familiarización con hechos aun no suficientemente comprendidos para generar nuevas ideas que permitan realizar nuevas preguntas e hipótesis. En este marco, las políticas se tornan contradictorias, si bien han logrado modificar algunos microespacios. Se entienden más como el recorte y congelamiento/ restauración del paisaje previo que como la creación de otros renovados, nuevos y/o mejores y con valores sociales aggiornados. En lo ambiental, no han sido acompañadas por estrategias estructurantes como el arbolado urbano y disposición de los residuos sólidos urbanos.

El contexto cultural en la implementación de proyectos de desarrollo rural. El caso del Parque Pereyra Iraola

Productores hortícolas que viven en el Parque Pereyra Iraola (La Plata-Berazategui) han implementado desde el año 2000 un proceso de desarrollo enmarcado en la adopción de la Agroecología como modelo productivo, económico y social. Se relatan los objetivos, significados y diferentes grados y motivos de adopción del proyecto desde una perspectiva que considera el contexto cultural como parte determinante para el desarrollo y las características que asume el proceso. En esta dirección, se plantean las miradas de productores, técnicos y una posible línea reflexiva desde las ciencias sociales.

Ni crisol de razas, ni pluralismo cultural : Pluralismo social. Migraciones y pautas matrimoniales en una ciudad patagónica (Neuquén, 1960-1990)

Este trabajo pretende aproximarse al problema de la integración de los migrantes en sociedades de crecimiento explosivo. Para ello, centra sus reflexiones en un caso particular: la ciudad de Neuquén (Patagonia, Argentina) en el periodo comprendido entre 1960 y 1990. Tomando en consideración los comportamientos matrimoniales de migrantes de diferentes orígenes, tanto intra e interprovinciales como trasandinos, el texto intentará discutir los alcances de categorías como las de melting pot, pluralismo cultural y pluralismo social. El trabajo analiza un corpus documental compuesto por cerca de tres millares de actas matrimoniales extraídas del Archivo de la Dirección Provincial de Registro Civil de Neuquén

El contexto cultural en la implementación de proyectos de desarrollo rural. El caso del Parque Pereyra Iraola

Productores hortícolas que viven en el Parque Pereyra Iraola (La Plata-Berazategui) han implementado desde el año 2000 un proceso de desarrollo enmarcado en la adopción de la Agroecología como modelo productivo, económico y social. Se relatan los objetivos, significados y diferentes grados y motivos de adopción del proyecto desde una perspectiva que considera el contexto cultural como parte determinante para el desarrollo y las características que asume el proceso. En esta dirección, se plantean las miradas de productores, técnicos y una posible línea reflexiva desde las ciencias sociales.

Ni crisol de razas, ni pluralismo cultural : Pluralismo social. Migraciones y pautas matrimoniales en una ciudad patagónica (Neuquén, 1960-1990)

Este trabajo pretende aproximarse al problema de la integración de los migrantes en sociedades de crecimiento explosivo. Para ello, centra sus reflexiones en un caso particular: la ciudad de Neuquén (Patagonia, Argentina) en el periodo comprendido entre 1960 y 1990. Tomando en consideración los comportamientos matrimoniales de migrantes de diferentes orígenes, tanto intra e interprovinciales como trasandinos, el texto intentará discutir los alcances de categorías como las de melting pot, pluralismo cultural y pluralismo social. El trabajo analiza un corpus documental compuesto por cerca de tres millares de actas matrimoniales extraídas del Archivo de la Dirección Provincial de Registro Civil de Neuquén

El contexto cultural en la implementación de proyectos de desarrollo rural. El caso del Parque Pereyra Iraola

Productores hortícolas que viven en el Parque Pereyra Iraola (La Plata-Berazategui) han implementado desde el año 2000 un proceso de desarrollo enmarcado en la adopción de la Agroecología como modelo productivo, económico y social. Se relatan los objetivos, significados y diferentes grados y motivos de adopción del proyecto desde una perspectiva que considera el contexto cultural como parte determinante para el desarrollo y las características que asume el proceso. En esta dirección, se plantean las miradas de productores, técnicos y una posible línea reflexiva desde las ciencias sociales.

Ni crisol de razas, ni pluralismo cultural : Pluralismo social. Migraciones y pautas matrimoniales en una ciudad patagónica (Neuquén, 1960-1990)

Este trabajo pretende aproximarse al problema de la integración de los migrantes en sociedades de crecimiento explosivo. Para ello, centra sus reflexiones en un caso particular: la ciudad de Neuquén (Patagonia, Argentina) en el periodo comprendido entre 1960 y 1990. Tomando en consideración los comportamientos matrimoniales de migrantes de diferentes orígenes, tanto intra e interprovinciales como trasandinos, el texto intentará discutir los alcances de categorías como las de melting pot, pluralismo cultural y pluralismo social. El trabajo analiza un corpus documental compuesto por cerca de tres millares de actas matrimoniales extraídas del Archivo de la Dirección Provincial de Registro Civil de Neuquén

Economic Reforms and Income Inequality in Urban China

This paper reports the results of an analysis of changes in income inequality, and in its determinants, in urban China since the economic reforms that began in 1978. The intention is to identify new characteristics of economic inequality. It first shows that income differentials acrossand in provinces widened and that their economic rankings were becoming fixed during the period from 1988 to 1995. Second, age was the major factor in inequality in 1988, while education became the important factor in 1995. Third, education significantly contributed to increasing inequality during the period. Fourth, the higher education-level groups had less within-group inequality. These changes reflect the penetration of the market mechanism into China after the reforms. However, this will be problematic without equality of opportunity.

On Labor Complementarity, Cultural Frictions and Strategic Immigration Policies

In this paper we consider a model with two industrialized countries that face a flow of immigration from the "rest of the world." The countries differ in three characteristics: the labor complementarity between the "native" population and immigrants, the population size, and the magnitude of the cultural friction between the natives and immigrants. We consider a non-cooperative game between two countries' when their strategic instrument is the choice of an immigration quota and the world immigrant wages introduce the spill-over effect between two countries. We first show that the quota game admits unique pure strategies Nash equilibrium. We then compare the equilibrium choices of two countries and show that even though the larger country attracts more immigrants, it chooses lower quota than its smaller counterpart. It also turns out that higher degree of labor complementarity between natives and immigrants and a lower degree of cultural friction between two groups yield higher immigration quota. We also examine the welfare implications of countries choices' and argue that coordinated and harmonized immigration policies may improve the welfare of both countries.