Autobiographie et engagement : l’ambiguïté du genre et le discours politique de L’Amérique au jour le jour comme laboratoire scripturaire dans l’œuvre de Simone de Beauvoir

L’objet de ce mémoire est d’explorer le lien étroit qui existe entre la pratique de l’autobiographie et l’écriture comme forme d’engagement dans l’œuvre de Simone de Beauvoir, grâce à une analyse du genre ambigu de L’Amérique au jour le jour et des discours politiques qu’il renferme. Bien que L’Amérique au jour le jour constitue le corpus principal de ce mémoire, nous utiliserons aussi des textes contemporains à la rédaction du journal de voyage américain pour guider notre classification générique, dont les Lettres à Nelson Algren, les Lettres à Sartre et Les Mandarins, ainsi que les volumes de l’ensemble autobiographique beauvoirien qui portent sur l’après-guerre, même si ceux-ci sont postérieurs à la rédaction du journal. À l’aide de concepts issus de la poétique des genres, comme les questions de hiérarchie, de proportion, d’intention et de programme, et de l’éthique de l’engagement de l’écrivain telle que définie par la notion sartrienne de l’engagement, nous tenterons de démontrer que l’ambiguïté générique de L’Amérique au jour le jour relève d’une action délibérée de l’auteure visant à mettre en péril son capital symbolique pour assurer la crédibilité de son engagement intellectuel. Une fois les concepts précités définis, le deuxième chapitre de notre mémoire s’attardera à explorer toutes les facettes de l’ambiguïté générique du journal américain, alors que le troisième chapitre démontrera le lien entre les écritures intimes et l’engagement, tout en explorant les formes que prend l’engagement dans le livre. Pour ce faire, nous analyserons trois discours politiques tenus par Beauvoir dans son œuvre : la critique du consumérisme américain, la critique de la condition des Noirs et la critique de la femme américaine. Nous conclurons notre mémoire en démontrant que L’Amérique au jour le jour est devenu une sorte de matrice dans la pratique autobiographique et scripturaire de Simone de Beauvoir, ainsi que dans son engagement.

Comparación de la severidad y extensión de la enfermedad coronaria multivaso por Syntax Score en una poblaciòn de las Antillas Holandesas vs controles nacionales

En la Enfermedad Coronaria (EC) existen factores genéticos, socioculturales, medioambientales y raciales adicionales a los factores de riesgo cardiovascular mayores que podrían influir en su presentación. Se desconoce el impacto de la raza en la severidad de la enfermedad coronaria en los pacientes extranjeros que son enviados a nuestro Servicio. Objetivos: Comparar la severidad de la EC multivaso en una población de pacientes de las Antillas y Nacionales, pareados por la escala Framingham. Metodología: Realizamos un estudio de corte transversal, comparando pacientes colombianos contra pacientes provenientes de las Antillas holandesas con similares factores de riesgo según escala de Framingham, catalogándolos por grupos de riesgo bajo, intermedio, alto y muy alto. Todos con EC severa multivaso documentada por angiografía coronaria desde enero del 2009 hasta Junio de 2011. Se excluyeron pacientes con antecedentes de intervención percutánea o quirúrgica previa. Resultados: Ingresaron 115 pacientes internacionales y 115 pacientes nacionales. La relación hombres/mujeres 3:1. La proporción de grupos de riesgo fue de bajo riesgo 2.5%, intermedio 15%, alto 19.3%, y muy alto 63.4%. El Syntax Score en pacientes nacionales fue 14.3+/-7.4 y en internacionales 22.2+/-10.5 p: 0.002. Conclusiones: En pacientes provenientes de las Antillas Holandesas, valorados en nuestra institución, se observó una mayor severidad de la enfermedad coronaria comparada con una población nacional con factores de riesgo similares. Estos hallazgos sugieren la influencia de la raza y factores genéticos en la severidad y extensión de la EC

Actitudes hacia el VIH/SIDA, el cáncer y la enfermedad de Alzheimer

Esta revisión de la literatura tuvo como objetivo describir las actitudes hacia el VIH/SIDA, el cáncer y la Enfermedad de Alzheimer desde el modelo tripartito. Se revisaron 109 artículos publicados entre 2005 y 2015 en algunas bases de datos especializadas y herramientas de análisis de impacto. También se incluyeron fuentes secundarias ampliándose la búsqueda a los últimos 20 años (1995-2015). Los resultados mostraron que la mayoría de los estudios realizados sobre las actitudes hacia estas tres enfermedades son de tipo cuantitativo y la información se analizó con base en los componentes del modelo tripartito. Algunos aspectos sociodemográficos como el sexo y la edad están asociados con las actitudes hacia las tres enfermedades y predominan las creencias erróneas sobre ellas respecto a sus causas, curso y tratamiento. También predominan actitudes negativas hacia las tres enfermedades y las conductas e intenciones conductuales son diversas hacia cada una de ellas. No se hallaron antecedentes empíricos del estudio de la estructura de las actitudes propuesta por el modelo tripartito hacia las tres enfermedades. La Salud Pública ha liderado la investigación con base en el modelo de conocimientos, actitudes y prácticas propuesto por la OMS.

Manuela, la impensable: un diálogo entre Amor y gloria: el romance de Manuela Sáenz y el Libertador Simón Bolívar (1952), de María Jesús Alvarado, y Manuela Sáenz, la divina loca (195?), de Olga Briceño (Estudios)

En este artículo se analiza el diálogo que establecen las intelectuales latinoamericanas con la Historia oficial por medio de determinadas ficciones de archivo publicadas en la década de 1950. Al respecto, es importante tener en cuenta que tras la adquisición de derechos civiles por parte de las mujeres latinoamericanas en las décadas de 1930 y 1940 –cuando conquistaron el derecho al voto, ingresaron masivamente a las universidades y se erigieron como posibles representantes de los intereses públicos–, las intelectuales del continente demandaron la adscripción a alguna genealogía histórica que les proporcionara coherencia y profundidad identitaria. En muchas ocasiones debieron echar mano del discurso literario para negociar su existencia presente con el pasado histórico y ampliar los límites de la fundación continental con la visibilización de las voces y subjetividades femeninas. En este marco se publican los dos libros que componen el corpus: Manuela Sáenz, la divina loca (195?), de la venezolana Olga Briceño, y Amor y gloria: el romance de Manuela Sáenz y el Libertador Simón Bolívar (1952), de la peruana María Jesús Alvarado. Estas lecturas permitirán reflexionar en torno al proceso de historización de la alteridad demandado por las nuevas ciudadanas del continente, determinar sus alcances y la subjetividad resultante de este enfrentamiento.

Revolutionary insurgencies, paradigmatic cases

This essay will examine and compare the production of women's writing during and after the Nicaraguan and Cuban Revolutions, a corpus that includes novels, poetry, and testimonies, but also features considerable generic hybridity. Since both revolutions are separated by some twenty years, each must be understood in the context of the specific ideological conditions that framed women’s participation in culture and revolution, and must also be considered in light of evolving gender discourses, both national and international. As such, these texts respond to both local and transnational paradigms of feminine subjectivity, and highlight the particular problems that arise from women’s insertion into the revolution and its representation in literature. These writers also have to negotiate the evolving context of revolution itself, with its moments of euphoria and disenchantment – and it is here that the greatest contrasts can be found between the two revolutionary instances and their political features: whilst Cuba’s revolutionary process has somehow survived economic crisis and created a level of political stability and continuity (not without its own problems), the Nicaraguan case is characterised by ruptures and resentments which are clearly reflected in the work of writers before, during, and after the Sandinista revolution, and which continue to the present day. This chapter will address the work of the most prominent woman writer of the Nicaraguan revolution, Gioconda Belli, whose main work reflects her involvement in the Sandinista struggle; ex-commander Mónica Baltodano has recently compiled a four volume piece with testimonials of men and women who participated in the organization and actions led by the Frente Sandinista de Liberación Nacional, and Violeta Barrios de Chamorro, former president of Nicaragua, who has recently co-authored an autobiography. There are other women poets to consider, especially under the auspices of the Asociación de Mujeres Nicaraguenses Luisa Amanda Espinoza, such as Vidaluz Meneses, Michele Najlis and Daisy Zamora. The testimonios compiled by Margaret Randall are also important pieces to consider for both Nicaragua and Cuba. The most important voices of the Cuban revolution still resident on the island are poet Nancy Morejón and writers Mirta Yáñez and Aida Bahr, with younger writers such as Adelaida Fernández de Juan and Marilyn Bobes representing a more recent generation.

Beyond difference: female participation in the Brazilian film revival of the 1990s

In this chapter, I will focus on the female participation in what became known as ‘The Retomada do Cinema Brasileiro’, or the Brazilian Film Revival, by thinking beyond differences of gender, class, age and ethnicity. I will first re-consider the Retomada phenomenon against the backdrop of its historical time, so as to evaluate whether the production boom of the period translated into a creative peak, and, if so, how much of this carried onto the present day. I will then look at the female participation in this phenomenon not just in terms of numerical growth of women film directors, admittedly impressive, but only partially reflective of the drastic changes in the modes of production and address effected by the neoliberal policies introduced in the country in the mid 1990s. I will argue that the most decisive contribution brought about by the rise of women in Brazilian filmmaking has been the spread of team work and shared authorship, as opposed to a mere aspiration to the auteur pantheon, as determined by a notoriously male-oriented tradition. Granted, films focusing on female victimisation were rife during the Retomada period and persist to this day, and they have been, and continue to be, invaluable for the understanding of women’s struggles in the country. However, rather than resorting to feminist readings of representational strategies in these films, I will draw attention to other, presentational aesthetic experiments, open to the documentary contingent and the unpredictable real, which, I argue, suspend the pedagogical character of representational narratives. In order to demonstrate that new theoretical tools are needed to understand the gender powers at play in contemporary world cinema, I will, to conclude, analyse an excerpt of the film, Delicate Crime (Crime delicado, Beto Brant, 2006), where team work comes out as a particularly effective female, and feminist, procedure.

Da libertinagem no Brasil colonial: a construção da imagem amoral das mulheres na literatura de viagem (1611-1808)

Pós-graduação em História - FCHS

Juanita H. Neely Papers - Accession 6

The Juanita H. Neely Papers consist of correspondence, autobiographical and biographical data, speeches, radio talks, clippings, photographs, and articles mainly relating to her work with the South Carolina Home Demonstration Extension Service. There is also family history material relating to the Neely family. This collection is a good source of information concerning the South Carolina Home Economics Extension program in the first half of the twentieth century. While the papers range from 1911 to about 1970, the more valuable and greater part of the collection extends from the mid-1920s to 1957, when Juanita Neely rose from a county home economics extension agent to the State Demonstration Agent. The collection contains many of her speeches, radio talks and articles made during this period; the reference material that she used for her speeches; letters of appreciation from agents and others upon her retirement; and materials relating to the Winthrop-Clemson controversy in 1955 concerning the location of the Home Economics Extension Program. There is also biographical material, award notices, and some correspondence dating after Juanita Neely's retirement from the Home Economics Extension Program. Additional Neely information may be found by referring to the Winthrop Archives, record group 412, and the 1958-1959 edition of Who’s Who of American Women.

Facets of Gender : Analyses of the Family and the Labour Market

This thesis contains four different studies on the dynamics of gender in households and workplaces. The relationship between family life and work life is in focus, particularly in the paper on labour market outcomes after divorce. In the introductory chapter, the Swedish context is briefly described. The description focuses on gender differences in the labour market and in the home. Theories concerning the division of work in the household are discussed, as are two theories on labour market discrimination, viz. taste discrimination and statistical discrimination. The theory part is concluded with a discussion of social closure processes and gendered organizational structures. The Reproduction of Gender. Housework and Attitudes Towards Gender Equality in the Home Among Swedish Boys and Girls. The housework boys and girls age 10 to 18 do, and their attitudes towards gender equality in the home are studied. One aim is to see whether the work children do is gendered and if so, whether they follow their parents’, often gendered, pattern in housework. A second aim is to see whether parents’ division of work is related to the children’s attitude towards gender equality in the home. The data used are taken from the Swedish Child Level of Living Survey (Child-LNU) 2000. Results indicate that girls and boys in two-parent families are more prone to engage in gender-atypical work the more their parent of the same sex engages in this kind of work. The fact that girls still do more housework than boys indicates that housework is gendered work also among children. No relation between parents’ division of work and the child’s attitude towards gender equality in the home was found. Dependence within Families and the Household Division of Labor – A Comparison between Sweden and the United States. This paper assesses the relative explanatory value of the resource-bargaining perspective and the doing-gender approach in analysing the division of housework in the United States and Sweden from the mid-1970s to 2000. Data from the Swedish Level of Living Survey (LNU) and the Panel Study of Income Dynamics (PSID) were used. Overall results indicate that housework is truly gendered work in both countries during the entire period. Even so, the results also indicate that gender deviance neutralization is more pronounced in the United States than in Sweden. Unlike Swedish women, American women seem to increase their time spent in housework when their husbands are to some extent economically dependent on them, as if to neutralize the presumed gender deviance. Divorce and Labour Market Outcomes. Do Women Suffer or Gain? In this paper, the interconnected nature of work and family is studied by looking at labour market outcomes after divorce. The data used are retrospective work and family histories collected in LNU 1991. A hazard regression model with competing risks reveals that women’s chances of improving their occupational prestige appear to be better after divorce compared to before. Increased working hours and perhaps also increased energy invested in the job may pay off in better occupational opportunities. Worth noting, however, is that the outcome among women with a less firm labour market attachment is more often to a job of lower prestige than one of higher prestige. Hence, the labour market outcome for women after divorce is to some extent conditioned by their labour market attachment at the time of divorce. Men, on the other hand, in most cases seem to suffer occupationally from divorce. For separated men the risk of negative changes in occupational prestige is greater than for cohabiting men. Formal On-the-job Training. A Gender-Typed Experience and Wage- Related Advantage? Formal on-the-job training (FOJT) can have a positive impact on wages and on promotion opportunities. According to theory and earlier research, a two-step model of gender inequality in FOJT is predicted: First, women are less likely than men to take part in FOJT and, second, once women do get the more remunerative training, they are not rewarded for their new skills to the same extent as men are. Pooled cross-sectional data from the Swedish Survey of Living Conditions (ULF) in the mid-nineties were used. Results show that women are significantly less likely than men to take part in FOJT. Among those who do receive training, women are more likely to take part in industry-specific training, whereas men are more likely to participate in general training and training that increases promotion opportunities. The two latter forms of training significantly raise a man’s annual earnings but not a woman’s. Hence, the theoretical model is supported and it is argued that this gender inequality is partly due to employers’ discriminatory practices.

Incident malignancies among older long-term breast cancer survivors and an age-matched and site-matched nonbreast cancer comparison group over 10 years of follow-up

BACKGROUND Of the approximately 2.4 million American women with a history of breast cancer, 43% are aged ≥ 65 years and are at risk for developing subsequent malignancies. METHODS Women from 6 geographically diverse sites included 5-year breast cancer survivors (N = 1361) who were diagnosed between 1990 and 1994 at age ≥ 65 years with stage I or II disease and a comparison group of women without breast cancer (N = 1361). Women in the comparison group were age-matched and site-matched to breast cancer survivors on the date of breast cancer diagnosis. Follow-up began 5 years after the index date (survivor diagnosis date or comparison enrollment date) until death, disenrollment, or through 15 years after the index date. Data were collected from medical records and electronic sources (cancer registry, administrative, clinical, National Death Index). Analyses included descriptive statistics, crude incidence rates, and Cox proportional hazards regression models for estimating the risk of incident malignancy and were adjusted for death as a competing risk. RESULTS Survivors and women in the comparison group were similar: >82% were white, 55% had a Charlson Comorbidity Index of 0, and ≥ 73% had a body mass index ≤ 30 kg/m(2) . Of all 306 women (N = 160 in the survivor group, N = 146 in the comparison group) who developed a first incident malignancy during follow-up, the mean time to malignancy was similar (4.37 ± 2.81 years vs 4.03 ± 2.76 years, respectively; P = .28), whereas unadjusted incidence rates were slightly higher in survivors (1882 vs 1620 per 100,000 person years). The adjusted hazard of developing a first incident malignancy was slightly elevated in survivors in relation to women in the comparison group, but it was not statistically significant (hazard ratio, 1.17; 95% confidence interval, 0.94-1.47). CONCLUSIONS Older women who survived 5 years after an early stage breast cancer diagnosis were not at an elevated risk for developing subsequent incident malignancies up to 15 years after their breast cancer diagnosis.

Neural tube defects in Mexican-Americans living on the US-Mexico border: The effects of folic acid and dietary folate

Neural tube defects (NTDs) are malformations of the developing brain and spinal cord; the most common are anencephaly and spina bifida. Evidence from many populations suggests that 50% of NTDs can be prevented through daily consumption of folic acid. A recent study has reported that folic acid may not protect populations of Mexican descent. This finding has serious implications for women living along the US-Mexico border. Not only is risk high in these Mexican American women compared with other US women; they also differ markedly in supplemental folic acid and dietary folate consumption, and in NTD-related risks (e.g., obesity, diabetes). This case-control study investigated whether folic acid supplements and dietary folate reduces NTDs in Mexican Americans. Cases included liveborn, stillborn, electively and spontaneously aborted NTD-affected fetuses and infants occurring in the 14-county Texas-Mexico border. Controls were randomly selected from unaffected live births, frequency matched to cases by hospital and year. An in-person interview of 110 case and 113 control mothers solicited data on folic acid supplements, dietary folate, and other covariates. Consumption of folic acid-containing vitamins before conception was only 5% for both case and control women. Taking vitamins the trimester before conception had no apparent effect, after adjusting for covariates [odds ratio (OR) = 1.0, 95% confidence interval (CI) = 0.3–3.4]. Combining folate from vitamins and diet showed a 20% risk reduction for women consuming at least 400 μg of folate daily [OR = 0.8, 95% CI = 0.5–1.5]; however, this estimate is statistically indistinguishable from the null. Although consistent with an inherent ineffectiveness of supplemental folic acid, that so few women consumed multivitamins during the critical time severely limited the assessment of folic acid in this population. A reduced folate response in Mexican descent women may be due to a genetic heterogeneity for metabolizing folate. Alternatively, folate intakes may be insufficient to overcome other underlying risk factors. In conclusion, determining whether folic acid reduces NTD risk in Mexican American women requires further study in populations with higher folic acid exposures. Meanwhile, we should pursue all recommended prevention strategies to reduce risk, including motivating Mexican American women of childbearing age to take folic acid routinely. ^

Case-control study of association of maternal recall of diarrhea or use of antimicrobials in the periconceptional period and neural tube defects

In June 1995 a case-control study was initiated by the Texas Department of Health among Mexican American women residing in the fourteen counties of the Texas-Mexico border. Case-women had carried infants with neural tube defect. Control-women had given birth to infants without neural tube defects. The case-control protocol included a general questionnaire which elicited information regarding illnesses experienced and antibiotics taken from three months prior to conception to three months after conception. An assessment of the associations between periconceptional diarrhea and the risk of neural tube defects indicated that the unadjusted association of diarrhea and risk of neural tube defect was significant (OR = 3.3, CI = 1.4–7.6). The unadjusted association of use of oral antimicrobials and risk of neural tube defect was also significant (OR = 3.4, CI = 1.6–7.3). These associations persisted among women who had no fever during the periconceptional period and were present irrespective of folate intake. Diarrhea was associated with an increased risk of NTD independent of use of antimicrobials. The converse was also true; antimicrobials were associated with an increased risk of NTD independent of diarrhea. Further research regarding these potentially modifiable risk factors is warranted. Replication of these findings could result in interventions in addition to folate supplementation. ^

Changes in serum lipids with change and fluctuation in body mass index and body fat distribution in Mexican Americans with type 2 diabetes

This dissertation was written in the format of three journal articles. Paper 1 examined the influence of change and fluctuation in body mass index (BMI) over an eleven-year period, on changes in serum lipid levels (total, HDL, and LDL cholesterol, triglyceride) in a population of Mexican Americans with type 2 diabetes. Linear regression models containing initial lipid value, BMI and age, BMI change (slope of BMI), and BMI fluctuation (root mean square error) were used to investigate associations of these variables with change in lipids over time. Increasing BMI over time was associated with gains in total and LDL cholesterol and triglyceride levels in women. Fluctuation of BMI was not associated with detrimental lipid profiles. These effects were independent of age and were not statistically significant in men. In Mexican-American women with type 2 diabetes, weight reduction is likely to result in more favorable levels of total and LDL cholesterol and triglyceride, without concern for possible detrimental effects of weight fluctuation. Weight reduction may not be as effective in men, but does not appear to be harmful either. ^ Paper 2 examined the associations of upper and total body fat with total cholesterol, HDL and LDL cholesterol, and triglyceride levels in the same population. Multilevel analysis was used to predict serum lipid levels from total body fat (BMI and triceps skinfold) and upper body fat (subscapular skinfold), while controlling for the effects of sex, age and self-correlations across time. Body fat was not strikingly associated with trends in serum lipid levels. However, upper body fat was strongly associated with triglyceride levels. This suggests that loss of upper body fat may be more important than weight loss in management of the hypertriglyceridemia commonly seen in type 2 diabetes. ^ Paper 3 was a review of the literature reporting associations between weight fluctuation and lipid levels. Few studies have reported associations between weight fluctuation and total, LDL, and HDL cholesterol and triglyceride levels. The body of evidence to date suggests that weight fluctuation does not strongly influence levels of total, LDL and HDL cholesterol and triglyceride. ^

Na 1 Nachlass Max Horkheimer, 1 - Korrespondenzen u.a. mit Franz Alexander (p. I 1, 1-205)

1 Brief von Max Horkheimer an Abel, 16.03.1936; 3 Briefe zwischen Hubert Abrahamsohn und Max Horkheimer, 1935-1936, 21.12.1936; 2 Briefe zwischen Emanuel Adler und Max Horkheimer, 12.04.1946, 26.04.1946; 2 Briefe zwischen Max Adler und Max Horkheimer, 16.03.1935, 29.03.1935; 1 Brief von Eva Ahamson an Max Horkheimer, 01.11.1944; 2 Briefe der Aircraft Warning Service Brentwood an Max Horkheimer, Mai 1942; 6 Briefe zwischen Librairie Félix Alcan und Max Horkheimer, 1935, 18.12.1935; 11 Briefe zwischen Franz Alexander und Max Horkheimer, 1938-1940; 2 Briefe zwischen der American Historical Review New York und Max Horkheimer, 01.04.1941, 07.04.1941; 1 Brief von Paul Reiwald an Max Horkheimer, 18.10.1940; 2 Briefe zwischen Helen Manice Alexander und Max Horkheimer, 1936; 2 Briefe zwischen Bernardine Allen und Max Horkheimer, 17.06.1938, 24.06.1938; 1 Brief der Alumni Federation of Columbia University an Max Horkheimer, 21.07.1942; 1 Brief der American Friends Service Comittee an Max Horkheimer, 10.12.1940; 3 Briefe zwischen der American Academy of Political and Social Science Philadelphia und Max Horkheimer, 1939,1940, 16.01.1939; 1 Brief der American Automobile Association Washington an Max Horkheimer, 22.03.1938; 1 Brief der American Association for the Advancement of Science Washington an Max Horkheimer, 16.08.1937; 2 Briefe von Max Horkheimer an den American Consulate General Berlin, 1939; 1 Brief von Max Horkheimer an den American Consulate General Havana, 03.03.1941; 4 Briefe von Max Horkheimer an den American Consul London, 1939-1941; 2 Briefe von Max Horkheimer an den American Consulate General Stuttgart, 1939-1941; 1 Brief von Max Horkheimer an den American Consul Zürich, 1939; 1 Brief von Friedrich Pollock an den American Council of Learned Society, Washington, 27.06.1941; 2 Briefe von Max Horkheimer an die American Friends of German Freedom New York, 1941; 4 Briefe der American Historical Association Washington an Max Horkheimer, 1937-1938; 1 Brief von Max Horkheimer an den American Red Cross Westwood Office, 21.06.1943; 18 Briefe zwschen der American Society for the Prevention of Cruelty to Animals New York und Max Horkheimer, 1936-1941; 1 Brief von Max Horkheimer an die American Women's Volunteer Service Pacific Palisades, 27.07.1942; 23 Briefe zwischen Eugene Anderson und Max Horkheimer, 1937-1941; 2 Briefe zwischen Norah Andreae und Max Horkheimer, 27.10.1944, 09.09.1946; 1 Brief von Rosa Nebel-Schenk, 04.03.1946; 1 Brief von der National Catholic Welfare Conference, 14.08.1944; 12 Briefe zwischen Werner Andreae und Max Horkheimer, 1945-1954; 1 Brief von Julius Marx an Werner Andreae, 10.05.1946, 11.05.1950; 2 Briefe von Josef Messinger an Werner Andreae, 23.10.1946, ohne Datum; 3 Briefe zwischen dem Advokatenbüro Hodler und Max Horkheimer, 1946, 09.05.1946;

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. ^