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J Dent Hyg ; 95(2): 14-20, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33875525


Purpose: The profession of dental hygiene is lacking in racial and ethnic diversity, a contributory factor to providing culturally competent patient care. The purpose of the study was to determine the cultural competence (CC) of licensed dental hygienists (DHs) in a region of low racial and ethnic diversity and explore the contributory factors.Methods: modified version of the Cultural Competency Assessment (CCA), a survey developed using the 3-D Model of Culturally Congruent Care was used to identify the levels of (CC) of DHs practicing in a area of low diversity. Utah was identified as a region of low racial and ethnic diversity. DHs holding a license to practice in the state of Utah were invited to participate in the 35-item, electronically delivered survey. Multiple regression was used to analyze associations between cultural competence and salient participant characteristics.Results: Of the 3,231 RDHs invited to participate, 673 responses were included for analysis, for a 20% response rate. The mean score was 10.153 (SD=1.3), indicating moderate cultural competence, unequally distributed between cultural awareness and sensitivity and culturally competent behavior scores. Possessing a graduate degree, cultural education during dental hygiene school, cultural continuing education, and employment in public health, significantly predicted CC. The regression model was significant F(8,664)=8.616 (p<0.0005) with a small effect size (R 2=0.094).Conclusion: Education and types of practice experiences were predictors of CC. Specific educational interventions that may influence the various components of cultural competency were not determined. Dental hygiene providers possessed moderate CC however there was a disconnect in translating awareness into behavior, possibly reinforced by environments lacking racial and ethnic diversity with limited opportunities to develop and exercise CC.

Competencia Cultural , Higienistas Dentales , Diversidad Cultural , Asistencia Sanitaria Culturalmente Competente , Humanos , Utah
BMC Med Educ ; 21(1): 218, 2021 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-33874946


BACKGROUND: There is an increasing shortage of primary care physicians in the U.S. The difficult task of addressing patients' sociocultural needs is one reason residents do not pursue primary care. However, associations between residents' perceived barriers to cross-cultural care provision and career interest in primary care have not been investigated. OBJECTIVE: We examined residents' career interest in primary care and associations with resident characteristics and their perceived barriers in providing cross-cultural care. METHODS: We conducted a cross-sectional analysis of a resident survey from the 2018-2019 academic year. We first described residents' sociodemographic characteristics based on their career interest in primary care (Chi-square test). Our primary outcome was high career interest in primary care. We further examined associations between residents' characteristics and perceived barriers to cross-cultural care. RESULTS: The study included 155 family medicine, pediatrics, and internal medicine residents (response rate 68.2%), with 17 expressing high career interest in primary care. There were significant differences in high career interest by race/ethnicity, as Non-White race was associated with high career interest in primary care (p < 0.01). Resident characteristics associated with identifying multiple barriers to cross-cultural care included disadvantaged background, multilingualism, and foreign-born parents (all p-values< 0.05). There were no significant associations between high career interest in primary care and barriers to cross-cultural care. CONCLUSION: Residents from diverse racial/ethnic and socioeconomic backgrounds demonstrated higher career interest in primary care and perceived more barriers to cross-cultural care, underscoring the importance of increasing physician workforce diversity to address the primary care shortage and to improve cross-cultural care.

Selección de Profesión , Asistencia Sanitaria Culturalmente Competente , Internado y Residencia , Atención Primaria de Salud , Actitud del Personal de Salud , Estudios Transversales , Femenino , Humanos , Masculino
BMC Med Educ ; 21(1): 150, 2021 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-33685439


During the COVID-19 pandemic, despite many widespread calls for social distancing, recommendations have not been followed by some people and the high rate of non-compliance has significantly affected lives all around the world. It seems that the rate of non-compliance with the recommendations among medical students has been as high as the rest of the other youth. In the time that students are removed from clinical environments and most physician teachers are strained in providing services to patients, medical students can be trained in interdisciplinary behavior change counseling programs and they can be employed in delivering virtual consultations to the patients referred to medical centers.In this quick review, we provide an argument regarding the importance of integrating the topic of patients' social history into the undergraduate medical curriculum and the necessity of teaching theories of behavior change to medical students. Hypotheses are proposed that focus on the importance of integrating behavioral and social sciences into the medical curriculum and to teach theories or models of behavior change to students. Health professions educators can design and implement interventions to teach hypothesized models of behavioral change to medical students and evaluate the effectiveness of those interventions. The impacts of such educational interventions on increasing people's compliance with recommendations to improve public health can be evaluated as well.

Terapia Conductista/educación , Consejo/educación , Curriculum , Educación de Pregrado en Medicina/métodos , Pacientes/psicología , Conducta Social , Asistencia Sanitaria Culturalmente Competente , Humanos , Pandemias , Enseñanza
South Med J ; 114(3): 133-138, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33655305


ABSTRACT: Racial minorities will account for >50% of the United States population by 2045, yet race and ethnicity persist as leading predictors of morbidity. Although minorities achieve better outcomes when treated by racially concordant providers, the number of minority physicians is disproportionately low compared with the rapidly growing minority population. This imbalance creates a cultural gap between many minority patients and their healthcare providers. Research suggests that educational initiatives addressing health inequity through a historical lens can help providers better understand the root causes of disparities; however, extensive clinical demands severely limit the time providers can dedicate to non-medical learning. OBJECTIVES: To address this gap, the University of Miami/Jackson Memorial Hospital System developed and piloted a short film about the history of Black people in South Florida, highlighting significant events that shaped the health-seeking behaviors of this population. METHODS: A 20-minute documentary exploring the sociocultural history of Black communities in Miami-Dade County was presented to 188 first-year postgraduate residents in June 2017. Residents completed pre-post surveys to measure changes in knowledge and care delivery intentions. RESULTS: Analyses performed between March and July 2018 revealed moderate improvements in the knowledge and awareness of the socioeconomic history of Miami's Black communities. Before watching the video, a majority indicated that increasing awareness of the sociocultural history of their patient population was a valuable learning activity. CONCLUSIONS: These findings suggest that brief videos focused on the history of culturally distinct populations may be a successful pedagogical strategy to introduce physicians to the communities they serve and improve provider knowledge.

Competencia Clínica , Competencia Cultural/educación , Educación de Postgrado en Medicina/métodos , Internado y Residencia/métodos , Películas Cinematográficas , Adulto , Afroamericanos/historia , Diversidad Cultural , Asistencia Sanitaria Culturalmente Competente , Femenino , Florida , Disparidades en Atención de Salud/etnología , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Masculino , Facultades de Medicina
JAMA Netw Open ; 4(3): e212816, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33688968


Importance: Data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in the United States are still emerging. Objective: To elucidate SARS-CoV-2 seroprevalence and symptom onset in a culturally linked community across 5 states in the United States. Design, Setting, and Participants: This cross-sectional study included adults (aged ≥18 years) recruited from the orthodox Jewish community across 5 states (California, Connecticut, Michigan, New Jersey, and New York) in 3 geographically distinct areas of the United States between May 13 and July 6, 2020. Participants completed an online survey and underwent SARS-CoV-2 antibody testing. Main Outcomes and Measures: Seroprevalence and date of symptom onset of SARS-CoV-2. Results: Overall, 9507 adults (mean [SD] age, 39.6 [15.0] years; 3777 [39.7%] women) completed the SARS-CoV-2 survey, of whom 6665 (70.1%) had immunoglobin G anti-SARS-CoV-2 antibody levels assessed. A high seroprevalence of SARS-CoV-2 antibodies was observed across all communities, with the highest proportion of positive testing observed in New Jersey (1080 of 3323 [32.5%]) and New York (671 of 2196 [30.6%]). Most individuals with a positive SARS-CoV-2 immunoglobin G antibody test reported a date of symptom-onset between March 9 and March 31, 2020 (California: 135 of 154 [87.7%]; Connecticut: 32 of 34 [94.1%]; Michigan: 44 of 50 [88.0%]; New Jersey: 964 of 1168 [82.5%]; New York: 571 of 677 [84.3%]). This start date was coincident with the Jewish festival of Purim, celebrated March 9 to 10, 2020, with extensive intracommunity spread in the weeks following (mean and mode of peak symptom onset, March 20, 2020), occurring in the absence of strong general and culture-specific public health directives. Conclusions and Relevance: This cross-sectional study of orthodox Jewish adults across the US found that socioculturally bound communities experienced early parallel outbreaks in discrete locations, notably prior to substantive medical and governmental directives. Further research should clarify optimal national, local, community-based, and government policies to prevent outbreaks in social and cultural communities that traditionally gather for holidays, assemblies, and festivals.

/epidemiología , Asistencia Sanitaria Culturalmente Competente , Transmisión de Enfermedad Infecciosa , Vacaciones y Feriados , Judíos/estadística & datos numéricos , Grupos Minoritarios , Salud Pública , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , California/epidemiología , Connecticut/epidemiología , Estudios Transversales , Brotes de Enfermedades , Femenino , Humanos , Judaísmo , Masculino , Michigan/epidemiología , Persona de Mediana Edad , New Jersey/epidemiología , New York/epidemiología , Características de la Residencia , Estudios Seroepidemiológicos , Estados Unidos/epidemiología , Adulto Joven
J Nurs Adm ; 51(4): 182-184, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33734176


To meet the growing demands in the US healthcare system caused by multiculturalism and the expansion of health inequities, due diligence must be given to testing the efficacy of tools used in teaching nurses to provide culturally competent care. This project assessed the utility of a free US government-developed training module. The team found an improved trend in nurse-patient communication scores and improved willingness to ask for help with cultural issues for the intervention unit. The use of no-cost, publicly available resources may be a cost-effective option for training materials.

Competencia Cultural/educación , Asistencia Sanitaria Culturalmente Competente/organización & administración , Personal de Salud/educación , Disparidades en Atención de Salud/organización & administración , Competencia Cultural/organización & administración , Diversidad Cultural , Asistencia Sanitaria Culturalmente Competente/economía , Personal de Salud/economía , Disparidades en Atención de Salud/economía , Humanos
RECIIS (Online) ; 15(1): 249-267, jan.-mar. 2021. ilus
Artículo en Portugués | LILACS | ID: biblio-1177454


Com a globalização, os fluxos migratórios intensificaram-se e as razões financeiras são umas das principais impulsionadoras de tais eventos. As populações migrantes têm diferentes necessidades, sendo o acesso à saúde algo primordial para garantir a qualidade de vida. Assim, este estudo objetivou analisar a produção científica sobre atenção à saúde de imigrantes internacionais haitianos em diferentes contextos e países, buscando compreender quais são os desafios e as perspectivas para a atenção à saúde dessa população nos contextos investigados. Trata-se de uma Revisão Integrativa de Literatura, realizada a partir de pesquisas nas bases Sistema Online de Busca e Análise de Literatura Médica (Medline/PubMed) e Scientific Electronic Library Online (SciELO), com os descritores padronizados 'Health Care' ('Public Health'), 'Haiti' e 'Emigrants and Immigrants', combinados por meio do operador booleano AND. Selecionaram-se artigos publicados no período de 2015 a 2019 que fossem em português, inglês ou espanhol e que tratassem desse tema. A partir da análise dos artigos, identificaram-se três categorias de análise temática: Impactos das regulamentações imigratórias na integração dos imigrantes haitianos; Competência intercultural para a atenção à saúde de imigrantes haitianos; e Condições de saúde e acesso a serviços por imigrantes haitianos. Destaca-se a importância da inclusão de aspectos políticos interculturais nas políticas de saúde voltadas à atenção à saúde do imigrante.

With globalization, migration flows have intensified and financial reasons are one of the main drivers of these events. Migrant populations have different needs, and access to health is essential to ensure their quality of life. Accordingly, this study aimed to analyze the scientific production on health care of international Haitian immigrants in different contexts and countries, seeking to understand what are the challenges and perspectives for the health care of this population in the investigated contexts. This is an Integrative Literature Review, performed from searches in the Medical Literature Analysis and Retrieval System Online (Medline/PubMed) and Scientific Electronic Library Online (SciELO), with the standardized descriptors 'Health Care' ('Public Health'), 'Haiti' and 'Emigrants and Immigrants', combined through the Boolean operator AND. We selected articles published in the period 2015-2019, in Portuguese, English or Spanish, that dealt with this theme. From the analysis of the articles, we identified three categories of thematic analysis: Impacts of immigration regulations on the integration of Haitian immigrants; Intercultural competency for the health care for Haitian immigrants; and Health conditions and access to services by Haitian immigrants. We should highlight the importance of including intercultural political aspects in health policies focused on the health care for immigrants.

Con la globalización, los flujos migratorios se han intensificado y las razones financieras son uno de los principales impulsores de tales eventos. Las poblaciones migrantes tienen diferentes necesidades, siendo el acceso a la salud fundamental para garantizar la calidad de vida. Así, este estudio tuvo como objetivo analizar la producción científica en salud de inmigrantes haitianos internacionales en diferentes contextos y países, buscando comprender cuáles son los desafíos y perspectivas para la atención de la salud de esta población en los contextos investigados. Se trata de una Revisión Integrativa de Literatura, realizada a partir de la investigación del Sistema de Análisis y Búsqueda de Literatura Médica en Línea (Medline / PubMed) y Biblioteca Electrónica Científica en Línea (SciELO), con los descriptores estandarizados 'Health Care' ('Salud Pública'), 'Haití' y 'Emigrantes e inmigrantes', combinados a través del operador booleano AND. Se seleccionaron artículos publicados en el período de 2015 a 2019 que estuvieran en portugués, inglés o español y abordaran este tema. Del análisis de los artículos se identificaron tres categorías de análisis temático: Impactos de las regulaciones migratorias en la integración de inmigrantes haitianos; Competencia intercultural para la atención de la salud de los inmigrantes haitianos; y Condiciones de salud y acceso a servicios de inmigrantes haitianos. Se destaca la importancia de incluir aspectos políticos interculturales en las políticas de salud dirigidas a la atención de la salud de los inmigrantes.

Humanos , Política Pública , Emigración e Inmigración , Competencia Cultural , Asistencia Sanitaria Culturalmente Competente , Haití , Literatura de Revisión como Asunto , Vulnerabilidad Social , Salud del Viajero , Necesidades y Demandas de Servicios de Salud
BMC Med Educ ; 21(1): 132, 2021 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-33632194


BACKGROUND: Cultural safety, whereby health professionals respect and promote the cultural identity of patients, could reduce intercultural tensions that hinder patient access to effective health services in Colombia. Game jams are participatory events to create educational games, a potentially engaging learning environment for Millennial medical students. We set out to determine whether medical student participation in a game jam on cultural safety is more effective than more conventional education in changing self-reported intended patient-oriented behavior and confidence in transcultural skills. METHODS: We conducted a parallel-group, two-arm randomized controlled trial with 1:1 allocation. Colombian medical students and medical interns at University of La Sabana participated in the trial. The intervention was a game jam to create an educational game on cultural safety, and the reference was a standard lesson plus an interactive workshop on cultural safety. Both sessions lasted eight hours. Stratified randomization allocated the participants to the intervention and control groups, with masked allocation until commencement. RESULTS: 531 students completed the baseline survey, 347 completed the survey immediately after the intervention, and 336 completed the survey after 6 months. After the intervention, game jam participants did not have better intentions of culturally safe behaviour than did participants in the reference group (difference in means: 0.08 95% CI - 0.05 to 0.23); both groups had an improvement in this outcome. Multivariate analysis adjusted by clusters confirmed that game jam learning was associated with higher transcultural self-efficacy immediately after the intervention (wt OR 2.03 cl adj 95% CI 1.25-3.30). CONCLUSIONS: Game jam learning improved cultural safety intentions of Colombian medical students to a similar degree as did a carefully designed lecture and interactive workshop. The game jam was also associated with positive change in participant transcultural self-efficacy. We encourage further research to explore the impact of cultural safety training on patient-related outcomes. Our experience could inform initiatives to introduce cultural safety training in other multicultural settings. TRIAL REGISTRATION: Registered on ISRCTN registry on July 18th 2019. Registration number: ISRCTN14261595 .

Asistencia Sanitaria Culturalmente Competente , Educación de Pregrado en Medicina/métodos , Intención , Autoeficacia , Estudiantes de Medicina/psicología , Adolescente , Adulto , Colombia , Femenino , Humanos , Masculino , Autoinforme , Adulto Joven
South Med J ; 114(1): 17-22, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33398355


OBJECTIVES: Previous negative experiences with the medical community often leave transgender people reluctant to seek medical care. Inadequate teaching and exposure to transgender health during medical training perpetuates the health disparities experienced by this community. Although undergraduate medical education is uniquely positioned to address these disparities, curricular coverage of these topics remains inadequate. METHODS: The second-year clinical skills course at the Florida International University Herbert Wertheim College of Medicine includes a workshop consisting of a 1-hour lecture about the inclusive sexual history, followed by a 1.5-hour small group during which students interview a standardized patient playing the role of a transgender man and participate in a faculty-facilitated debriefing. To evaluate the 2019 workshop, students were provided with an optional, anonymous, pre- and postsession survey consisting of multiple choice and Likert-type questions. RESULTS: After the session, there was a statistically significant increase in students' knowledge of the components of an inclusive sexual history, in the number of students who believed that their medical training had prepared them to effectively provide care for transgender patients, and in the number who reported feeling comfortable taking a sexual history from a patient who identifies as transgender. Most students thought the standardized patient case was realistic and found the postencounter debriefing session helpful in identifying their own strengths and weaknesses. CONCLUSIONS: Our findings suggest that students found this brief, interactive sexual history workshop, which included a lecture and standardized patient case, to be an effective component of their medical training. Although our transgender patient case was acted primarily by cis-gender people, students perceived this as a realistic opportunity to actively explore the nuances of obtaining a history from a transgender patient. In addition, our findings suggest that it is possible to merge teaching on sexual history and transgender health care, which is important in time-limited undergraduate medical education curricula.

Asistencia Sanitaria Culturalmente Competente/métodos , Anamnesis/métodos , Simulación de Paciente , Enseñanza/normas , Personas Transgénero/educación , Asistencia Sanitaria Culturalmente Competente/estadística & datos numéricos , Educación/métodos , Humanos , Enseñanza/estadística & datos numéricos , Personas Transgénero/psicología
Public Health ; 190: 152-159, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33419526


OBJECTIVE: The objective of the study is to identify the barriers to UK Black, Asian and Minority Ethnic (BAME) women attending breast screening and subsequently, support the growing evidence base providing solutions to the public health problem of ethnic variation within screening attendance. STUDY DESIGN: A systematic review and thematic analysis of UK-based, qualitative studies concerning BAME women. METHODS: The methodology of this review is based on Cochrane guidelines. A search strategy was applied to Embase, PubMed and Medline. Predefined inclusion and exclusion criteria yielded 8 final articles which were appraised and thematically analysed. RESULTS: The main findings of the review revealed three overarching themes: knowledge-related, access-related and cultural-related factors. The emphasis of the importance of knowledge was highlighted by all studies identifying a lack of knowledge as a key barrier to screening attendance. CONCLUSIONS: BAME women have disproportionally lower breast screening attendance and a lack of knowledge is an essential barrier to overcome when addressing this health inequality.

Neoplasias de la Mama/psicología , Asistencia Sanitaria Culturalmente Competente , Grupos Étnicos/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud/etnología , Promoción de la Salud/métodos , Accesibilidad a los Servicios de Salud , Disparidades en el Estado de Salud , Mamografía/psicología , Adulto , Afroamericanos , Grupo de Ascendencia Continental Africana , Grupo de Ascendencia Continental Asiática , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/etnología , Cultura , Detección Precoz del Cáncer , Grupos Étnicos/psicología , Femenino , Humanos , Aceptación de la Atención de Salud/etnología
Z Evid Fortbild Qual Gesundhwes ; 160: 55-61, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33461903


BACKGROUND: The number of patients with an immigration background in geriatric healthcare institutions in Germany is growing continuously. The number of medical staff with a migration background is also increasing because of the shortage of qualified employees in the healthcare sector. Therefore, the ability to act culturally sensitive is essential. A training course for employees caring for chronically ill elderly patients with a migration background was developed, tested and evaluated. METHODS: The training was developed on the basis of interviews with experts and research literature and took place over half a day. It was then tested in a pilot study in three hospitals (geriatric, orthopaedic, cardiologic clinics) and evaluated with respect to content and implementation using both guided interviews, which were subjected to content analysis, and a questionnaire. RESULTS: The training was feasible and well received by the participants, and a high demand for interventions on cultural sensitivity could be derived from the interviews. Improvements were achieved on the dimensions of self-reflection (recognizing one's own and others' cultural imprint), communication with patients and their relatives, and teamwork. DISCUSSION: The participants asked for a more extensive and broader training. A multiplier training should be considered in order to implement the contents nationwide and sustainably in clinics. A randomized controlled design is necessary to verify the assumed effects. CONCLUSION: Based on the results and the need for culture-sensitive training, the training should be carried out within a wider timeframe and in a bigger population.

Asistencia Sanitaria Culturalmente Competente , Prestación de Atención de Salud , Medicina , Anciano , Emigración e Inmigración , Alemania , Hospitales , Humanos , Proyectos Piloto
Rev. enferm. UFPE on line ; 15(1): [1-20], jan. 2021. ilus, tab, graf
Artículo en Portugués | BDENF - Enfermería | ID: biblio-1147315


Objetivo: conhecer as evidências científicas na literatura nacional sobre a saúde indígena no contexto da Amazônia Legal. Método: trata-se de um estudo bibliográfico, descritivo, tipo revisão integrativa de literatura. Encontraram-se, após a pesquisa nas bases de dados LILACS e BDENF e na Biblioteca Virtual SciELO, 99 artigos, dos quais dez atenderam aos critérios de inclusão. Utilizaramse os descritores 'saúde das populações indígenas', 'serviço de saúde indígena' e 'assistência aos índios', além do cruzamento dos Descritores em Ciências da Saúde combinados com o uso do operador booleano AND: "saúde indígena" AND "Amazônia" e "comunidade indígena" AND "saúde". Resultados: destacaram-se, na análise, os estados do Amazonas e Mato Grosso em relação aos estudos selecionados de abordagem quantitativa. Publicou-se a maioria na revista Caderno Saúde Pública, sendo 26 com autoria de doutores. Conclusão: constatou-se a necessidade de novos estudos sobre a saúde indígena na Amazônia Legal com o intuito de se conhecer as adversidades enfrentadas por essas populações.(AU)

Objective: to know the scientific evidence on indigenous health in the Brazilian literature in the context of the Legal Amazon. Method: this is a bibliographic, descriptive, integrative literature review type study. After searching the LILACS and BDENF databases, as well as the SciELO Virtual Library, 99 articles were found, ten of which met the inclusion criteria. The descriptors 'health of indigenous populations', 'indigenous health service' and 'assistance to indians' were used, in addition to the crossover of the Descriptors in Health Sciences combined with the use of the Boolean operator AND: "indigenous health" AND "Amazon" and "indigenous community" AND "health". Results: in the analysis, the states of Amazonas and Mato Grosso stood out in relation to the quantitative approach selected studies, most of which were published in the Caderno Saúde Pública journal, with 26 authored by PhDs. Conclusion: the need for new studies on indigenous health in the Legal Amazon was verified in order to know the adversities faced by these populations.(AU)

Objetivo: conocer la evidencia científica en la literatura nacional sobre la salud indígena en el contexto de la Amazonía Legal. Método: se trata de una revisión bibliográfica, descriptiva e integradora de la literatura. Después de buscar en las bases de datos LILACS y BDENF y en la Biblioteca Virtual SciELO, se encontraron 99 artículos, de los cuales diez cumplieron con los criterios de inclusión. Se utilizaron los descriptores 'salud de poblaciones indígenas', 'servicio de salud indígena' y 'asistencia a indígenas', además del cruce de Descriptores de Ciencias de la Salud combinado con el uso del operador booleano AND: "salud indígena" AND "Amazonia "y" comunidad indígena "AND" salud ". Resultados: los estados de Amazonas y Mato Grosso se destacaron en el análisis en relación a los estudios seleccionados con enfoque cuantitativo. La mayoría fue publicada en la revista Caderno Saúde Pública, 26 de las cuales fueron escritas por médicos. Conclusión: era necesario realizar más estudios sobre la salud indígena en la Amazonia Legal para comprender las adversidades que enfrentan estas poblaciones.(AU)

Humanos , Masculino , Femenino , Perfil de Salud , Ecosistema Amazónico , Salud de Poblaciones Indígenas , Asistencia Sanitaria Culturalmente Competente , Servicios de Salud del Indígena , Epidemiología Descriptiva , LILACS
J Plast Reconstr Aesthet Surg ; 74(3): 463-474, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33309318


INTRODUCTION: Post-mastectomy breast reconstruction (PMBR) is an important component of the multidisciplinary care of breast cancer patients. Despite the improved quality of life, significant racial disparities exist in the receipt of PMBR. Given the increasing population of Black, Asian and minority ethnic (BAME) women in UK, it is important to address this disparity. Our review aims to identify the barriers and facilitators influencing the uptake of PMBR in BAME women and raise awareness for physicians on interventions that could improve uptake of PMBR in BAME women. METHODS: The methodology outlined by the Cochrane guidelines was used to structure this systematic review. Systematic searches for qualitative studies on barriers and/or facilitators to PMBR in ethnic women published in English were conducted. The following databases were searched from their inception up to June 2019: MEDLINE, EMBASE, PubMed, Cochrane Library, Google Scholar and Scopus. Reference lists of all included articles and relevant systematic reviews were also hand-searched for possible additional publications. Publication year or status restrictions were not applied. Only full text articles published in English and by peer reviewed journals are included. Exclusion criteria were as follows: quantitative studies on barriers and/or facilitators to PMBR, abstracts, conference proceedings, non-English language and non-specific to BAME women. A thematic synthesis approach was used through the development of sub-themes and themes from the findings of the included qualitative studies. RESULTS: Five studies satisfied the inclusion and exclusion criteria. Three overarching themes emerged from our review: physician-associated factors (physician recommendations), patient-associated factors (knowledge, language, community and cultural, emotions, logistics, patient characteristics) and system-associated factors (insurance coverage, income status). CONCLUSION: Our systematic review suggests that there is a paucity of data in the literature on the barriers and facilitators to PMBR in BAME women. Considering the expanding population of BAME women and increasing breast cancer incidence, it is imperative that future research in this field is carried out. Physician and patient-associated factors were identified as the most important yet modifiable factors. Adopting a combination of culturally tailored interventions targeting these factors may help improve the access of PMBR in BAME women. REGISTRATION: Prospero ID: CRD42019133233.

Neoplasias de la Mama , Asistencia Sanitaria Culturalmente Competente/etnología , Mamoplastia , Aceptación de la Atención de Salud/etnología , Calidad de Vida , Neoplasias de la Mama/etnología , Neoplasias de la Mama/psicología , Neoplasias de la Mama/cirugía , Grupos Étnicos , Femenino , Humanos , Mamoplastia/métodos , Mamoplastia/psicología , Mastectomía/métodos
JAMA Netw Open ; 3(12): e2027744, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33337491


Importance: Identifying effective weight loss interventions for Latino adults at risk of diabetes is of critical public health importance. Objective: To determine whether a culturally adapted behavioral intervention for Latino adults was more effective than usual care for weight loss over 24 months. Design, Setting, and Participants: In this randomized clinical trial, Latino adults with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 24 or greater and a high risk for type 2 diabetes were recruited in primary care practices in the San Francisco, California, area, randomized to receive the Vida Sana intervention or usual care, and followed up for 24 months. The study was conducted from November 2015 to May 2019, and data were analyzed from July 2019 to Septmeber 2020. Interventions: The treatment group received Vida Sana, a culturally adapted lifestyle intervention that included a family-based orientation session and 22 group sessions over 12 months. Participants were encouraged to use a wearable activity tracker and mobile applications to track their physical activity and dietary intake. Participants received monthly email messages for an additional 12 months. The control group received usual care. Main Outcomes and Measures: The primary outcome was weight loss at 24 months. Secondary outcomes included weight loss at 12 months and achieving at least 5% weight loss at 12 and 24 months. Associations of baseline characteristics and intervention adherence with weight loss outcomes were also examined. Results: Among 191 participants (mean [SD] age, 50.2 [12.2] years; 118 [61.8%] women; 107 participants [57.2%] of Mexican origin; mean [SD] baseline BMI, 32.4 [5.7]) randomized, 92 participants were randomized to the intervention and 99 participants were randomized to usual care. Of these, 185 participants (96.9%) completed 24-month follow-up. Mean (SD) weight loss did not differ significantly by group at 24 months (intervention: -1.1 [5.7] kg; control: -1.1 [7.1] kg; P = .93). However, mean (SD) weight loss was significantly greater in the intervention group (-2.6 [6.0] kg) than the control group (-0.3 [4.2] kg) at 12 months (mean difference, -2.1 [95% CI, -3.6 to -0.7] kg; P = .005). Intervention participants were more likely to achieve at least 5% weight loss than control participants at 12 months (22 participants [25.9%] vs 9 participants [9.2%]; P = .003), and participants who achieved at least 5% weight loss attended more intervention sessions than those who did not (mean [SD], 16.6 [7.6] sessions vs 12.4 [7.5] sessions; P = .03). Conclusions and Relevance: These findings suggest that among Latino adults with high diabetes risk, a culturally adapted behavioral lifestyle intervention was effective for weight loss over 12 months but not 24 months. Trial Registration: Identifier: NCT02459691.

Terapia Conductista/métodos , Asistencia Sanitaria Culturalmente Competente/métodos , Diabetes Mellitus Tipo 2/prevención & control , Sobrepeso/terapia , Programas de Reducción de Peso/métodos , Adulto , Índice de Masa Corporal , Diabetes Mellitus Tipo 2/etnología , Diabetes Mellitus Tipo 2/etiología , Femenino , Hispanoamericanos , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Sobrepeso/complicaciones , Sobrepeso/etnología , San Francisco , Resultado del Tratamiento , Pérdida de Peso
Artículo en Inglés | MEDLINE | ID: mdl-33374701


With tobacco commonly used for stress relief, smoking cessation during pregnancy can present challenges for women facing stressful circumstances. This can be pronounced for Aboriginal and Torres Strait Islander women who experience disproportionately high smoking rates during pregnancy and also have a greater intersection of stressors from social disadvantage, institutional racism and trauma. To contribute understandings into how women can be best supported at this time, this study identified the features of value of an Aboriginal and Torres Strait Islander pregnancy smoking cessation program that addressed the contexts of women's lives in culturally affirming and strength-based ways. A narrative methodology using a yarning approach was used to interview 7 pregnant women, 6 significant others, 3 case managers, and 4 healthcare professionals. Data were analyzed using thematic analysis, guided by an Indigenist research practice of deep and reflexive researcher listening. Features of value included: relationship-based care, holistic wraparound care, flexibility, individualized care, and culturally orientated care. Combined, they enabled highly relevant and responsive women-centered, trauma-informed, and harm-reducing smoking cessation support that was well received by participants, who achieved promising smoking changes, including cessation. This approach strongly departs from standard practices and provides a blueprint for meaningful support for pregnant women experiencing vulnerabilities.

Asistencia Sanitaria Culturalmente Competente , Grupo de Ascendencia Oceánica , Mujeres Embarazadas , Cese del Hábito de Fumar , Prestación de Atención de Salud , Femenino , Humanos , Embarazo , Queensland , Fumar