Latino perceptions of and barriers to preventive healthcare maintenance in the southwest United States

Between the 1990 and 2000 Censuses, the Latino population accounted for 40% of the increase in the nation’s total population. The growing population of Latinos underscores the importance for understanding factors that influence whether and how Latinos take care of their health. According to the U.S. Department of Human Health Service’s Office of Minority Health (OMH), Latinos are at greater risk for health disparities (2003). Factors such as lack of health insurance and access to preventive care play a major role in limiting Latino use of primary health care (Institute of Medicine, 2005). Other significant barriers to preventive health care maintenance behaviors have been identified in current literature such as primary care physician interaction, self-perceived health status, and socio-cultural beliefs and traditions (Rojas-Guyler, King, Montieth and 2008; Meir, Medina, and Ory, 2007; Black, 1999). Despite these studies, there remains less information regarding interpersonal perceptions, environmental dynamics and individual and cultural attitudes relevant to utilization of healthcare (Rojas-Guyler, King, Montieth and 2008; Aguirre-Molina, Molina and Zambrana, 2001). Understanding the perceptions of Latinos and the barriers to health care could directly affect healthcare delivery. Improved healthcare utilization among Latinos could reduce the long term health consequences of many preventable and manageable diseases. The purpose of this study was to explore Latino perceptions of U.S. health care and desired changes by Latinos in the U.S. healthcare system. The study had several objectives, including to explore perceived barriers to healthcare utilization and the resulting effects on health among Latinos, to describe culturally influenced attitudes about health care and use of health care services among Latinos, and to make recommendations for reducing disparities by improving healthcare and its utilization. The current study utilized data that were collected as part of a larger study to examine multidimensional, cross-cultural issues relevant to interactions between healthcare consumers and providers. Qualitative methods were used to analyze four Spanish-language focus group transcripts to interpret cultural influences on perceptions and beliefs among Latinos. Direct coding of transcript content was carried out by two reviewers, who conducted independent reviews of each transcript. Team members developed and refined thematic categories, positive and negative cases, and example text segments for each theme and sub-theme. Incongruities of interpretations were resolved through extensive discussion. Study participants included 44 self-identified Latino adults (16 male, 28 female) between age 18 and 64 years. Thirty seven (84.1%) of the participants were immigrants. The study population comprised eight ethnic subgroups. While 31% of the participants reported being employed on a full-time basis, only 18.4% had medical insurance that was private or employee sponsored. Five major themes regarding the perceptions and healthcare utilization behaviors of Latinos were consistent across all focus groups and were identified during the analysis. These were: (1) healthcare utilization, experience, and access; (2) organizational and institutional systems; (3) communication and interpersonal interactions between healthcare provider, staff, and patient; (4) Latinos’ perception of their own health status; (5) cultural influences on healthcare utilization, which included an innovation termed culturally-bound locus of control. Healthcare utilization was directly influenced by healthcare experience, access, current health status, and cultural factors and indirectly influenced by organizational systems. There was a strong interdependence among the main themes. The ability to communicate and interact effectively with healthcare providers and navigate healthcare systems (organizational and institutional access) significantly influenced the participant’s health care experience, most often (indirectly) impacting utilization negatively. ^ Research such as this can help to identify those perceptions and attitudes held by Latinos concerning utilization or underutilization of healthcare systems. These data suggest that for healthcare utilization to improve among Latinos, healthcare systems must create more culturally competent environments by providing better language services at the organizational level and more culturally sensitive providers at the interpersonal level. Better understanding of the complex interactions between these impediments can aid intervention developments, and help health providers and researchers in determining appropriate, adequate, and effective measurers of care to better increase overall health of Latinos.^

Syndromic surveillance at a long term shelter for persons displaced by hurricanes Katrina and Rita conducted by the San Antonio Metropolitan Health District

Background. Beginning September 2, 2005, San Antonio area shelters received approximately 12,700 evacuees from Hurricane Katrina. Two weeks later, another 12,000 evacuees from Hurricane Rita arrived. By mid-October, 2005, the in-shelter population was 1,000 people. There was concern regarding the potential for spread of infectious diseases in the shelter. San Antonio Metropolitan Health District (SAMHD) established a syndromic surveillance system with Comprehensive Health Services (CHS) who provided on-site health care. CHS was in daily contact with SAMHD to report symptoms of concern until the shelter closed December 23, 2005. ^ Study type. The objective of this study was to assess the methods used and describe the practical considerations involved in establishing and managing a syndromic surveillance system, as established by the SAMHD in the long-term shelter clinic maintained by CHS for the hurricane evacuees. ^ Methods. Information and descriptive data used in this study was collected from multiple sources, primarily from the San Antonio Metropolitan Health District’s 2006 Report on Syndromic Surveillance of a Long-Term Shelter by Hausler & Rohr-Allegrini. SAMHD and CHS staff ensured that each clinic visit was recorded by date, demographic information, chief complaint and medical disposition. Logs were obtained daily and subsequently entered into a Microsoft Access database and analyzed in Excel. ^ Results. During a nine week period, 4,913 clinic visits were recorded, reviewed and later analyzed. Repeat visits comprised 93.0% of encounters. Chronic illnesses contributed to 21.7% of the visits. Approximately 54.0% were acute care encounters. Of all encounters, 17.3% had infectious disease potential as primarily gastrointestinal and respiratory syndromes. Evacuees accounted for 86% and staff 14% of all visits to the shelter clinic. There were 782 unduplicated individuals who sought services at the clinic, comprised of 63% (496) evacuees and 36% (278) staff members. Staff were more likely to frequent the clinic but for fewer visits each. ^ Conclusion. The presence of health care services and syndromic surveillance provided the opportunity to recognize, document and intervene in any disease outbreak at this long-term shelter. Constant vigilance allowed SAMHD to inform and reassure concerned people living and working in the shelter and living outside the shelter.^

Effective interventions for lowering HbA1C in African Americans with type 2 diabetes: A review

This synthesis of the literature provides descriptive analysis and outlines current self-management interventions for African Americans with type 2 diabetes. Specifically, this study describes and explores the design of those studies whose interventions have been shown to lower HbA1C levels in this population by at least 0.5% points, an improvement that provides approximately 10% reduction in long term complications from this disease.^ Results. In total, 37 articles were reviewed and 17 articles met inclusion criteria for analysis. Analysis of each study's methodology and results was performed and selected studies with interventions that resulted in improvements in HbA1C outcomes equal to 0.5% or greater for both group 1 and 2 were summarized by intervention type in table format. Descriptive analysis, outlining the number and characteristics of proximal and distal mediating components addressed in Group 1 studies, was performed in order to determine whether mediating components may have had some relation to effectiveness of intervention on outcome HbA1C. Descriptive analysis revealed that no particular design is substantially more effective than another among Behavioral studies although, there may be an advantage in using culturally sensitive, group interventions that address greater numbers of distal mediating components. Among Process studies, structured approaches (i.e. algorithm care and scheduled follow up), as well as utilization of specialty and group care are represented as effective for African American populations. ^ Conclusions. It may be summarized that by targeting behavior and addressing provider delivery (i.e. algorithm use, group care, home care, and provider follow up) in this population, a greater yield in outcome improvements may be accomplished. However, many gaps exist in a review process that stratifies results and focuses on identifying group specific intervention successes and failures. Further research in different populations will aid researchers and practitioners in discovering the best evidence, and identifying models that could be utilized in practice to achieve the best diabetes management for at risk groups.^

Utilization behavior of the elderly in an HMO: A causal analysis

Planning and providing health care services for the elderly represents a major challenge to the health care system. One part of that challenge is the identification of those factors which determine the utilization of services by this population. The purpose of this study is to explain the use of health care services by elderly subscribers in a prepaid group health plan, using the theoretical framework developed by Andersen and Aday. The impact of the predisposing, enabling and need factors on utilization was modelled through a structural equation approach using LISREL. The data were derived from Kaiser-Permanente's Medicare Prospective Payment Project, August 1980-December 1982. Need factors, in general, were the most significant determinants of utilization, with the predisposing and enabling factors found to be secondary but necessary links in the causal chain. The model was fitted to the data from the youngest age group (65-74 years) and then evaluated for goodness of fit in the two older groups (75-84 and 85+ years). Implications of the study's findings and suggestions for further modelling the utilization behavior of the elderly are discussed. ^

A proposed application of the attributable risk technique in the assessment of unmet need among newly organized populations

In the midst of health care reform, and as health care organizations reorganize to provide more cost-effective healthcare, the population is being shifted into new healthcare delivery systems such as health insurance purchasing alliances, and health maintenance organizations. These new models of delivery are usually organized within resource restricted and data limited environments. Health care planners are faced with the challenge of identifying priorities for preventive and primary care services within these newly organized populations (Medicare HMO, Medicaid HMO, etc.). The author proposes a technique usually employed in epidemiology--attributable risk estimation--as a planning methodology to establish preventive health priorities within newly organized populations. Illustrations of the methodology are provided utilizing the Texas 1992 population. ^

Increasing awareness of colorectal cancer screening through targeted exam room based video messages

Colorectal cancer (CRC) is the third largest cause of cancer death in the United States. While the disease burden is high, there are proven methods to screen for CRC and detect it at a stage that is amenable to cure. Patients with low health literacy have difficulty navigating the health care system and are at increased risk to not receive preventive care services such as colorectal cancer screening (CRCS). To address this need, an exam-room based video was developed to be played for patients in the privacy of the exam room, while they are waiting to be seen by their medical provider. In roughly 2 minutes, the video informs the patient about CRC and CRCS and how they can successfully complete CRCS. One of the key barriers to completing CRCS is the need to increase patients' knowledge and improve attitudes surrounding CRCS. This study examines the impact of the video on patients' knowledge and attitudes about CRC and CRCS in a medically underserved patient population in Houston, Texas. ^ Sixty-one patients presenting for routine medical care were enrolled in the study. Depending on their randomization, the patients either received routine information about CRC and CRCS or they watched the video. We found that the patients who did watch the video did have improvements in their knowledge and improved attitudes about CRC and CRCS. Future studies will be needed to examine whether the video improves the patients' completion of CRCS.^

A systematic review of telemedicine interventions for type 2 diabetes patients

Telemedicine is the use of telecommunications to support health care services and it incorporates a wide range of technology and devices. This systematic review seeks to determine which types of telemedicine technologies have been the most effective at improving the major health factors of subjects with type 2 diabetes. The major health factors identified were blood glucose, systolic and diastolic blood pressure, LDL cholesterol, weight, BMI, triglyceride levels, and waist circumference. A literature search was performed using peer reviewed, scholarly articles focused on the health outcomes of type 2 diabetes patients served by various telemedicine interventions. A total of 15 articles met the search criteria and were then analyzed to determine the significant health outcomes of each telemedicine interventions for type 2 diabetes patients. Results showed that telemedicine interventions using videoconferencing technology resulted in significant improvements in five health factor outcomes (total body weight, BMI, blood glucose, LDL cholesterol, and blood pressure), while telemedicine interventions using web applications and health monitors/modems only produced significant improvements in blood glucose. Future research should focus on examining the costs and benefits of videoconferencing and other telemedicine technologies for type 2 diabetes patients.^

Evaluation of CHIP perinatal program outcomes in Harris County, Texas

This study compared initial year trends in prenatal care and birth outcomes of women enrolled in the Texas Children's Health Insurance Program (CHIP) Perinatal program to trends in Medicaid program women. The study utilized claims data from Community Health Choice (CHC), a health plan in Harris County, Texas that provides coverage to both populations. Quarterly data was analyzed and compared for the first two years of the CHIP Perinatal program (2007-2008) to determine if outcome trends for the CHIP program improved over the outcome trends seen with those enrolled in Medicaid. Study findings indicate an increase in the quarterly prenatal care utilization for the CHIP Perinatal population from 2007 to 2008 and the associated birth weights of babies delivered also had marginal improvements during the same timeframe. Enrollees in Medicaid continued to have overall better outcomes than those enrolled within the CHIP Perinatal program. However, the study showed that the rate of improvement in both prenatal care utilization and birth outcomes were greater for the CHIP Perinatal enrollees than those enrolled in Medicaid. ^ The majority of these improvements were significant when comparing each coverage program and from year to year. Lastly, the study showed that there was a correlation between prenatal care utilization and birth outcomes. However, further analysis of the data could not conclusively indicate that access to prenatal care services provided by the CHIP Perinatal program contributed to the increases observed in utilization and birth outcomes for the study's sample population.^

Promoting Family Continuity - Perspectives from Italy

In this essay I review a recent research study from Italy, “Le Radici nel Futuro – La Continuita’ della Relazione Genitoriale oltre la Crisi Familiare,” edited by Paola Dallanegra (2005). The contributors focus on “Spazio Neutro,” a multi-purpose child welfare agency in southern Italy that facilitates parent-child visiting and relationships between children placed in out-of-home care and their families. They delineate and illustrate, through comments from family members, selected principles and strategies for maintaining such continuity throughout the out-of-home placement.

Régimen de bienestar y reproducción social : las organizaciones comunitarias proveedoras de cuidado en contextos de pobreza

El artículo analiza el rol protagónico que vienen desempeñando las organizaciones sociales en materia de provisión de cuidado y otras actividades de reproducción social en contextos de pobreza. Estas organizaciones comunitarias y sociales (OSyC) revisten de un carácter heterogéneo y diverso, tanto en lo que refiere a su génesis como a su desarrollo. Más particularmente, el artículo analiza la modalidad bajo la cual estas OSyC proveen de servicios de cuidado a amplios sectores de la población. Finalmente, se explora cómo las mujeres cuidadoras experimentan diferentes aspectos relativos al cuidado infantil que efectúan.

¿Cómo mejorar la bioseguridad en hospitales y servicios de salud?

Bioseguridad en un sentido amplio es definida como: vida libre de peligros. Medidas de bioseguridad son acciones que contribuyen para la seguridad de la vida, en el dia a dia de las personas (ej. Cinturon de seguridad, senda peatonal). Las normas de bioseguridad engloban todas las medidas que buscan evitar riesgos fisicos (radiacion o temperatura), ergonomicos (posturales), quimicos (sustancias toxicas), biologicos (agentes infecciosos) y psicologicos (como el estres). Cada tanto, cuando hay conflictos gremiales, aparecen en las noticias hospitales que tienen ratas o cucarachas, y recien ahi se toman algunas medidas correctivas, per0 la mayoria de las instalaciones de servicios de salud no cuentan con servicios de control de plagas, o si 10s tienen no son efectivos, mas por causas administrativas que tecnicas. Es inadmisible la presencia de invertebrados y vertebrados (no humanos) en hospitales y centros de salud. Se proponen algunas medidas para mejorar la bioseguridad en esas instalaciones.

Mejora del autocuidado de pacientes diabéticos en zonas rurales de Panamá a través de tecnologías tic

Durante años, los países de América Latina y en especial Panamá han sufrido grandes cambios sociales, demográficos y epidemiológicos que han provocado un crecimiento de la incidencia y prevalencia de varias enfermedades crónicas no transmisibles como: las cardiopatías, el cáncer y la diabetes. Actualmente, la suma de estas afecciones causa la mayoría de las muertes y discapacidades en la región. Las necesidades de salud varían de un país a otro, inclusive en el interior de un mismo país o de una misma región debido a factores demográficos, socioculturales, económicos y políticos propios de la región, lo cual favorece la desigualdad en el acceso a los servicios de salud. Este hecho pone de manifiesto un aspecto importante de esta tesis de doctorado, que es facilitar el autocuidado de los pacientes diabéticos en tres zonas rurales de Panamá, contribuyendo de esta manera a la planeación e implantación de nuevos servicios TIC en salud para los pacientes diabéticos de tres zonas rurales de Panamá. El objetivo principal de esta tesis doctoral es desarrollar una contextualización del paciente diabético en zonas rurales de Panamá y modelar su autocuidado mediante el uso de las TIC. A través del modelo se busca mejorar la calidad de vida de los pacientes y propiciar estados de equidad en salud. Se continúa con la implementación del modelo en tres zonas rurales diferentes de Panamá. Se concluye con una fase de validación en la que se demuestra que el enfermo de diabetes aumenta la conciencia de la importancia de su tratamiento mejorando su estado de salud y su calidad de vida. La demostración clínica de este resultado está fuera del ámbito de la tesis doctoral. Abstract Through the years, countries of Latin America, Panama in particular have endured great social, demographic and epidemiologic changes, which in turn caused an increase in the occurrence and prevalence of chronic non transmissible diseases, such as: cardiopathy, cancer and diabetes. The sum of these afflictions causes most of the deaths and disabilities in the region nowadays. The healthcare needs vary from one country to another, furthermore the healthcare needs are different from one rural area to another in a given country or region, due demographic, sociocultural, economic and political factors, this favors the inequality in access to health care services. This facts shows one important aspect of this Ph. D. thesis, which is to facilitate the self-care of diabetic patients in three rural areas of Panama, contributing to the planning and implementation of new ICT services in healthcare for diabetic patients in rural areas of Panama. The primary goal of this Ph.D thesis is to develop a contextualization of the diabetic patient in country side of Panama and to model its self-care by means of the use of the ICT. Through model one looks for to improve the quality of life of the patients and to cause states of fairness in health. It continues with the implementation of ICT through a conceptualized model in three different rural areas of Panama. It concludes with a validation phase which shows how the awareness of the diabetes patient increases, about the importance of his/her treatment for the improvement of health and quality of life. The clinic demonstration of this result is not part of this thesis.

Metodología y criterios para evaluar la influencia de la domótica y su preinstalación en los edificios en función de los condicionantes constructivos y de la envolvente interior

La introducción de la automatización de servicios en los edificios de vivienda comenzó a implementarse a finales del siglo XX. Desde entonces, los edificios que incluyen instalaciones completas de automatización suelen conocerse como edificios domotizados o edificios inteligentes e implican la introducción en la arquitectura de tecnologías que hasta la fecha eran ajenas a ésta. El diseño de estos nuevos edificios de viviendas implica cada vez más el trabajo de equipos multidisciplinares y exige por parte del arquitecto la adquisición de nuevos conocimientos y herramientas proyectuales que aseguren la viabilidad constructiva de dichos servicios de automatización doméstica. La presente tesis tiene como objetivo determinar la influencia de la automatización de servicios domésticos en la fase de proyecto constructivo de los edificios para finalmente ofrecer al arquitecto herramientas, criterios y una metodología que le ayude a proyectar estos edificios satisfactoriamente. Esta influencia se evalúa y determina en función de los condicionantes constructivos, que se definen como aquellas consideraciones que el proyectista puede tener en cuenta en la fase de diseño o de concepción de un edificio. La metodología utilizada en esta investigación incluye el análisis conceptual y de contenidos de documentos normativos, técnicos, y de investigación así como un estudio de mercado de las aplicaciones más habituales en domótica. Finalmente la investigación se centra en la envolvente interior del edificio para determinar la influencia de los servicios de domotización no convencionales en el proyecto arquitectónico. Al margen de las aportaciones teóricas de esta investigación, las cuales se han propuesto para afianzar el marco teórico de la disciplina, los resultados obtenidos constatan que dicha influencia en la fase de proyecto existe y que es posible detectar qué condicionantes constructivos se derivan de la normativa de aplicación en este tipo de proyectos, de las nuevas tecnologías implicadas en las instalaciones de automatización y de los esfuerzos de estandarización de las asociaciones de empresas en el campo de la domótica. ABSTRACT The automation of services in residential buildings (also called home automation) began to be implemented in the late twentieth century. Since then, those buildings with full automation services are often known as intelligent buildings or smart buildings, and they imply the introduction into the architecture of technologies that where foreign to the field until then. The design of these new residential buildings increasingly involves the need of multidisciplinary teams and requires the architect to acquire new knowledge and project tools in order to ensure the constructability of such home automation services. This thesis pretends to determine the impact and influence of the introduction of home automation services in the design stage of residential buildings in order to, finally, provide the architect with the tools, criteria and methodology to help him design such projects successfully. This impact is evaluated and determined by the constructive constraints or factors implied, which are defined as those considerations that the designer may take into account in the conception and design stage of the project. The methodology used in this research includes conceptual and content analysis applied to normative and technical documents, regulatory standards and research papers, as well as a market survey of the most common applications and services in home automation. Finally, the investigation focuses on the inner partitions of the building to determine the influence of unconventional domotics services in the architectural design. Besides the theoretical contributions of this research, which have been proposed to strengthen the theoretical framework of the discipline, the achieved results find that such influence in the design stage exists and that it is possible to detect which constructive constraints are derived from the application of building regulations, from the new technologies involved in home automation facilities or from the standardization efforts of the joint ventures in the field of home automation.

MULHERES IDEAIS: UMA ANÁLISE DO PROCESSO DE CONSTRUÇÃO E DE MANUTENÇÃO DAS REPRESENTAÇÕES SOCIAIS DAS ESPOSAS DE PASTORES BATISTAS DE CURITIBA, PR.

Entre instituições e atividades ligadas à igreja como reuniões de oração, cultos, ensaios de corais, ministério infantil, casa, filhos, vida conjugal, etc. está presente uma figura ainda não estudada pelas Ciências da Religião, a da esposa do pastor batista. O objetivo principal desta pesquisa foi o de analisar o processo de construção e de manutenção das representações sociais dessas mulheres. Para isso, no primeiro capítulo identificamos e analisamos as representações de gênero presentes na estrutura e no cotidiano eclesiástico da denominação e seus reflexos na elaboração e na conservação do perfil das esposas de pastores. No segundo capítulo realizamos uma análise do poder e do papel das instituições de formação teológica e ministerial da denominação batista como formas de idealização, de construção e de manutenção das representações sociais das esposas de pastores. Investigamos no terceiro capítulo as formas do trânsito das esposas de pastores entre os espaços públicos e privados - imbricados um no outro, e as formas em que o poder institucional atua nestes lugares. Para este fim, utilizamos o método etnográfico, observando as igrejas batistas selecionadas, aplicando questionários aos membros das igrejas, líderes institucionais e estudantes da Faculdade Teológica Batista do Paraná FTBP e realizando entrevistas semi-estruturadas com os pastores e suas esposas. As teorias das Ciências da Religião e Sociais nos proporcionaram o suporte teórico necessário para o desenvolvimento do texto e para a análise dos dados empíricos. (AU)

MULHERES IDEAIS: UMA ANÁLISE DO PROCESSO DE CONSTRUÇÃO E DE MANUTENÇÃO DAS REPRESENTAÇÕES SOCIAIS DAS ESPOSAS DE PASTORES BATISTAS DE CURITIBA, PR.

Entre instituições e atividades ligadas à igreja como reuniões de oração, cultos, ensaios de corais, ministério infantil, casa, filhos, vida conjugal, etc. está presente uma figura ainda não estudada pelas Ciências da Religião, a da esposa do pastor batista. O objetivo principal desta pesquisa foi o de analisar o processo de construção e de manutenção das representações sociais dessas mulheres. Para isso, no primeiro capítulo identificamos e analisamos as representações de gênero presentes na estrutura e no cotidiano eclesiástico da denominação e seus reflexos na elaboração e na conservação do perfil das esposas de pastores. No segundo capítulo realizamos uma análise do poder e do papel das instituições de formação teológica e ministerial da denominação batista como formas de idealização, de construção e de manutenção das representações sociais das esposas de pastores. Investigamos no terceiro capítulo as formas do trânsito das esposas de pastores entre os espaços públicos e privados - imbricados um no outro, e as formas em que o poder institucional atua nestes lugares. Para este fim, utilizamos o método etnográfico, observando as igrejas batistas selecionadas, aplicando questionários aos membros das igrejas, líderes institucionais e estudantes da Faculdade Teológica Batista do Paraná FTBP e realizando entrevistas semi-estruturadas com os pastores e suas esposas. As teorias das Ciências da Religião e Sociais nos proporcionaram o suporte teórico necessário para o desenvolvimento do texto e para a análise dos dados empíricos. (AU)