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2.
Medicine (Baltimore) ; 99(8): e19167, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080095

RESUMEN

To verify the validity of functional health literacy scale and analyze what influences functional health literacy.Using convenience sampling method based on cross-sectional data to select 589 left-behind senior high-school students in an ethnic minority area, using the functional health literacy scale.The scale results were relatively strong, and the absolute fitness index, value-added fitness index, and simple fitness index reached the fitness standards. The overall functional health literacy score was (0.65 ±â€Š0.12), which falls within the upper middle class. Gender(t = 2.40, P < .05), ethnicity (t = 4.28, P < .001), place of residence (t =  = 4.51, P < .001), mother's education level (F = 3.608, P < .05), self-assessment of grades for 1 year (F = 25.781, P < .001), and whether the participant liked the health education content (F = 9.416, P < .001) had impacts on overall functional health literacy.The study results show that relatively satisfactory reliability and validity and can be applied further analysis for improving students functional health literacy levels.


Asunto(s)
Grupos Étnicos/estadística & datos numéricos , Alfabetización en Salud/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Encuestas y Cuestionarios/normas , Éxito Académico , Adolescente , China/epidemiología , Estudios Transversales , Femenino , Educación en Salud/estadística & datos numéricos , Humanos , Masculino , Reproducibilidad de los Resultados , República de Corea/etnología , Características de la Residencia/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Factores Sexuales
3.
JAMA Netw Open ; 3(1): e1919928, 2020 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-31995211

RESUMEN

Importance: An association between social and neighborhood characteristics and health outcomes has been reported but remains poorly understood owing to complex multidimensional factors that vary across geographic space. Objectives: To quantify social determinants of health (SDOH) as multiple dimensions across the continental United States (the 48 contiguous states and the District of Columbia) at a small-area resolution and to examine the association of SDOH with premature mortality within Chicago, Illinois. Design, Setting, and Participants: In this cross-sectional study, census tracts from the US Census Bureau from 2014 were used to develop multidimensional SDOH indices and a regional typology of the continental United States at a small-area level (n = 71 901 census tracts with approximately 312 million persons) using dimension reduction and clustering machine learning techniques (unsupervised algorithms used to reduce dimensions of multivariate data). The SDOH indices were used to estimate age-adjusted mortality rates in Chicago (n = 789 census tracts with approximately 7.5 million persons) with a spatial regression for the same period, while controlling for violent crime. Main Outcomes and Measures: Fifteen variables, measured as a 5-year mean, were selected to characterize SDOH as small-area variations for demographic characteristics of vulnerable groups, economic status, social and neighborhood characteristics, and housing and transportation availability at the census-tract level. This SDOH data matrix was reduced to 4 indices reflecting advantage, isolation, opportunity, and mixed immigrant cohesion and accessibility, which were then clustered into 7 distinct multidimensional neighborhood typologies. The association between SDOH indices and premature mortality (defined as death before age 75 years) in Chicago was measured by years of potential life lost and aggregated to a 5-year mean. Data analyses were conducted between July 1, 2018, and August 30, 2019. Results: Among the 71 901 census tracts examined across the continental United States, a median (interquartile range) of 27.2% (47.1%) of residents had minority status, 12.1% (7.5%) had disabilities, 22.9% (7.6%) were 18 years and younger, and 13.6% (8.1%) were 65 years and older. Among the 789 census tracts examined in Chicago, a median (interquartile range) of 80.4% (56.3%) of residents had minority status, 10.2% (8.2%) had disabilities, 23.2% (10.9%) were 18 years and younger, and 9.5% (7.1%) were 65 years and older. Four SDOH indices accounted for 71% of the variance across all census tracts in the continental United States in 2014. The SDOH neighborhood typology of extreme poverty, which is of greatest concern to health care practitioners and policy advocates, comprised only 9.6% of all census tracts across the continental United States but characterized small areas of known public health crises. An association was observed between all SDOH indices and age-adjusted premature mortality rates in Chicago (R2 = 0.63; P < .001), even after accounting for violent crime and spatial structures. Conclusions and Relevance: The modeling of SDOH as multivariate indices rather than as a singular deprivation index may better capture the complexity and spatial heterogeneity underlying SDOH. During a time of increased attention to SDOH, this analysis may provide actionable information for key stakeholders with respect to the focus of interventions.


Asunto(s)
Estado de Salud , Grupos Minoritarios/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Determinantes Sociales de la Salud/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adulto , Anciano , Chicago , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Calidad de Vida , Factores de Riesgo , Factores Socioeconómicos , Adulto Joven
4.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 56-63, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31123058

RESUMEN

OBJECTIVE: To describe ethnic and socioeconomic variation in cause-specific infant mortality of preterm babies by gestational age at birth. DESIGN: National birth cohort study. SETTING: England and Wales 2006-2012. SUBJECTS: Singleton live births at 24-36 completed weeks' gestation (n=256 142). OUTCOME MEASURES: Adjusted rate ratios for death in infancy by cause (three groups), within categories of gestational age at birth (24-27, 28-31, 32-36 weeks), by baby's ethnicity (nine groups) or area deprivation score (Index of Multiple Deprivation quintiles). RESULTS: Among 24-27 week births (5% of subjects; 47% of those who died in infancy), all minority ethnic groups had lower risk of immaturity-related death than White British, the lowest rate ratios being 0.63 (95% CI 0.49 to 0.80) for Black Caribbean, 0.74 (0.64 to 0.85) for Black African and 0.75 (0.60 to 0.94) for Indian. Among 32-36 week births, all minority groups had higher risk of death from congenital anomalies than White British, the highest rate ratios being 4.50 (3.78 to 5.37) for Pakistani, 2.89 (2.10 to 3.97) for Bangladeshi and 2.06 (1.59 to 2.68) for Black African; risks of death from congenital anomalies and combined rarer causes (infection, intrapartum conditions, SIDS and unclassified) increased with deprivation, the rate ratios comparing the most with the least deprived quintile being, respectively, 1.54 (1.22 to 1.93) and 2.05 (1.55 to 2.72). There was no evidence of socioeconomic variation in deaths from immaturity-related conditions. CONCLUSIONS: Gestation-specific preterm infant mortality shows contrasting ethnic patterns of death from immaturity-related conditions in extremely-preterm babies, and congenital anomalies in moderate/late-preterm babies. Socioeconomic variation derives from congenital anomalies and rarer causes in moderate/late-preterm babies. Future research should examine biological origins of extremely preterm birth.


Asunto(s)
Grupos de Población Continentales/estadística & datos numéricos , Mortalidad Infantil/etnología , Recien Nacido Prematuro , Grupos Minoritarios/estadística & datos numéricos , Pobreza , Causas de Muerte , Estudios de Cohortes , Anomalías Congénitas/mortalidad , Inglaterra/epidemiología , Edad Gestacional , Humanos , Lactante , Recién Nacido , Enfermedades del Prematuro/mortalidad , Gales/epidemiología
5.
Gastroenterology ; 158(2): 354-367, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31682851

RESUMEN

Colorectal cancer (CRC) disproportionately affects people from low socioeconomic backgrounds and some racial minorities. Disparities in CRC incidence and outcomes might result from differences in exposure to risk factors such as unhealthy diet and sedentary lifestyle; limited access to risk-reducing behaviors such as chemoprevention, screening, and follow-up of abnormal test results; or lack of access to high-quality treatment resources. These factors operate at the individual, provider, health system, community, and policy levels to perpetuate CRC disparities. However, CRC disparities can be eliminated. Addressing the complex factors that contribute to development and progression of CRC with multicomponent, adaptive interventions, at multiple levels of the care continuum, can reduce gaps in mortality. These might be addressed with a combination of health care and community-based interventions and policy changes that promote healthy behaviors and ensure access to high-quality and effective measures for CRC prevention, diagnosis, and treatment. Improving resources and coordinating efforts in communities where people of low socioeconomic status live and work would increase access to evidence-based interventions. Research is also needed to understand the role and potential mechanisms by which factors in diet, intestinal microbiome, and/or inflammation contribute to differences in colorectal carcinogenesis. Studies of large cohorts with diverse populations are needed to identify epidemiologic and molecular factors that contribute to CRC development in different populations.


Asunto(s)
Neoplasias Colorrectales/epidemiología , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Factores Socioeconómicos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/prevención & control , Detección Precoz del Cáncer/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Estilo de Vida Saludable , Humanos , Incidencia , Tamizaje Masivo/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Factores de Riesgo
7.
Public Health Rep ; 135(1): 74-81, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31747339

RESUMEN

OBJECTIVE: This study is a follow-up to an examination of the racial/ethnic composition of public health students (1996) and faculty (1997) at schools of public health that was conducted 20 years ago. We examined data on the race/ethnicity of students, graduates, and faculty among Association of Schools and Programs of Public Health (ASPPH)-member institutions during 2016-2017 and how these data have changed in the past 20 years. METHODS: We obtained data on the race/ethnicity of students (in 1996 and 2016), graduates (in 1996 and 2016), and faculty (in 1997 and 2017) at ASPPH-member institutions from the ASPPH Data Center. We tabulated frequencies, percentages, and 20-year percentage-point changes by race/ethnicity. We examined data for all current ASPPH-member institutions and for comparable subcohorts of 1996 and 1997 member institutions that are current ASPPH members. RESULTS: In graduate student enrollment, the 20-year increase in each nonwhite racial/ethnic subgroup was ≤5 percentage points. Among tenured faculty, the 20-year increase was greatest among Asians (8 percentage points) but was <3 percentage points for black, Hispanic, and Native American faculty. CONCLUSIONS: The increasing racial/ethnic diversity among students, graduates, and faculty in schools and programs of public health contributes to parallel increases in racial/ethnic diversity in the public health workforce. Schools and programs of public health should recruit clusters of racial/ethnic minority students using holistic application review processes, provide enrolled students with racially/ethnically diverse role models and mentors, and dedicate staffing to ensure a student-centered approach. In addition, those who mentor racially/ethnically diverse students and junior faculty should be rewarded.


Asunto(s)
Educación de Postgrado/estadística & datos numéricos , Educación en Salud Pública Profesional/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Docentes/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Estudiantes/estadística & datos numéricos , Diversidad Cultural , Humanos , Estados Unidos
8.
J Surg Res ; 245: 198-204, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31421362

RESUMEN

BACKGROUND: Race and insurance status have been shown to predict outcomes in pediatric bicycle traumas. It is unknown how these factors influence outcomes in adult bicycle traumas. This study aims to evaluate the association, if any, between race and insurance status with mortality in adults. METHODS: This retrospective cohort study used the National Trauma Data Bank Research Data Set for the years 2013-2015. Multivariate logistic regression models were used to determine the independent association between patient race and insurance status on helmet use and on outcomes after hospitalization for bicycle-related injury. These models adjusted for demographic factors and comorbid variables. When examining the association between race and insurance status with outcomes after hospitalization, injury characteristics were also included. RESULTS: A study population of 45,063 met the inclusion and exclusion criteria. Multivariate regression demonstrated that black adults and Hispanic adults were significantly less likely to be helmeted at the time of injury than white adults [adjusted odds ratio of helmet use for blacks 0.25 (95% CI 0.22-0.28) and for Hispanics 0.33 (95% CI 0.30-0.36) versus whites]. Helmet usage was also independently associated with insurance status, with Medicare-insured patients [AOR 0.51 (95% CI 0.47-0.56) versus private-insured patients], Medicaid-insured patients [AOR 0.18 (95% CI 0.17-0.20)], and uninsured patients [AOR 0.29 (95% CI 0.27-0.32)] being significantly less likely to be wearing a helmet at the time of injury compared with private-insured patients. Although patient race was not independently associated with hospital mortality among adult bicyclists, we found that uninsured patients had significantly higher odds of mortality [AOR 2.02 (AOR 1.31-3.12)] compared with private-insured patients. CONCLUSIONS: Minorities and underinsured patients are significantly less likely to be helmeted at the time of bicycle-related trauma when compared with white patients and those with private insurance. Public health efforts to improve the utilization of helmets during bicycling should target these subpopulations.


Asunto(s)
Ciclismo/lesiones , Disparidades en Atención de Salud/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Heridas y Traumatismos/mortalidad , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Conjuntos de Datos como Asunto , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Dispositivos de Protección de la Cabeza/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Puntaje de Gravedad del Traumatismo , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Estados Unidos/epidemiología , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/terapia , Adulto Joven
9.
Health Psychol ; 39(3): 230-239, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31868376

RESUMEN

OBJECTIVE: For minority students from socioeconomically disadvantaged backgrounds, attending university and succeeding despite social and academic stressors is often considered the ultimate marker of resilience. However, a growing body of work suggests that there may be health costs to upward mobility for such students. This study investigated whether believing that the social system is fair simultaneously promotes psychological health while undermining the physical health of Latinx students experiencing frequent discrimination. METHOD: Two hundred thirty-three low-income and/or first-generation Latinx college students were followed through their first year at university. Discrimination experiences, psychological health, and physical health risk (a suite of inflammatory, biomorphic, and cardiovascular risk markers) were assessed upon entering university and at the end of the academic year. RESULTS: Regardless of discrimination experiences, believing in system fairness predicted higher end-of-year psychological health (controlling for initial psychological health). However, for students who experienced substantial discrimination at university, believing in system fairness also led to higher end-of-year physical health risk (controlling for baseline levels of discrimination and physical health risk). CONCLUSIONS: Beliefs that allow socioeconomically disadvantaged minority students to thrive psychologically may also put them at physical health risk when facing frequent discrimination. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Análisis Costo-Beneficio/tendencias , Grupos Minoritarios/estadística & datos numéricos , Discriminación Social/tendencias , Adulto , Femenino , Humanos , Masculino , Adulto Joven
10.
BMC Public Health ; 19(1): 1722, 2019 Dec 23.
Artículo en Inglés | MEDLINE | ID: mdl-31870346

RESUMEN

BACKGROUND: To reveal the ethnic disparity in the pneumonia-specific mortality rates of children under the age of 5 years (PU5MRs) and provide suggestions regarding priority interventions to reduce preventable under-five-years-of-age deaths. METHODS: Data were obtained from the Direct Report System of Maternal and Child Health in Sichuan. The Cochran-Armitage trend test was used to assess the time trend. The Cochran-Mantel-Haenszel test and Chi-square test were used to examine the differences in the PU5MRs among different groups. RESULTS: The PU5MRs in the minority and nonminority counties decreased by 53.7 and 42.3% from 2010 to 2017, respectively. The PU5MRs of the minority counties were 4.81 times higher than those of the nonminority counties in 2017. The proportion of pneumonia deaths to total deaths in Sichuan Province increased from 11.7% in 2010 to 15.5% in 2017. The pneumonia-specific mortality rates of children in the categories of 0-28 days, 29 days-11 months, and 12-59 months were reduced by 55.1, 38.8, and 65.5%, respectively, in the minority counties and by 35.5, 43.1, and 43.7%, respectively, in the nonminority counties. CONCLUSIONS: PU5MRs declined in Sichuan, especially in the minority counties, while ethnic disparity still exists. Although the PU5MRs decreased more for the minority counties as a fraction of all mortality, the absolute number of such deaths were higher, and therefore more children in these counties continue to die from pneumonia than from the non-minority counties. Priority should be given to strategies for preventing and controlling child pneumonia, especially for postneonates, in the minority counties.


Asunto(s)
Grupos Étnicos/estadística & datos numéricos , Disparidades en el Estado de Salud , Grupos Minoritarios/estadística & datos numéricos , Neumonía/etnología , Neumonía/mortalidad , Distribución de Chi-Cuadrado , Preescolar , China/epidemiología , Humanos , Lactante , Recién Nacido
11.
BMC Public Health ; 19(1): 1741, 2019 Dec 27.
Artículo en Inglés | MEDLINE | ID: mdl-31881953

RESUMEN

BACKGROUND: While discrimination takes multiple forms, racial or ethnic discrimination is a root cause of this health-damaging social phenomenon. We drew on intersectionality theory, which offers an account of discrimination's multiple effects, to consider associations between women's experiences of discrimination and postpartum depression (PPD) using four measures: single forms of discrimination (SFD); multiple forms of discrimination (MFD); ethnic discrimination combined with MFD (E-MFD); and a composite MFD that interacted with women's identity (C-MFD). METHODS: We interviewed a stratified sample of 1128 mothers face to face in 2014-2015 during mothers' visits to maternal and child health clinics. The mothers belonged to three groups in Israel: Palestinian-Arab minority, Jewish immigrant, and non-immigrant Jewish. We conducted unadjusted and adjusted logistic regressions for PPD, measured on the Edinburgh Postnatal Depression Scale, in associations with SFD (experiencing discrimination based on any of the following: age, sex, class, ethno-national identity, religiosity level and skin color); MFD (experiencing 0,1, 2 or ≥ 3 of SFD); E-MFD (ethnic discrimination combined with other MFD); and finally, C-MFD (interaction between MFD and women's identity). RESULTS: Palestinian-Arab mothers had higher PPD and reported higher SFD (based on ethnicity, religiosity level, and socioeconomic status), as well as higher MFD and E-MFD. This was followed by Jewish immigrant mothers, and lastly by non-immigrant Jewish mothers. However, both MFD and E-MFD had a strong association with PPD among non-immigrant Jewish mothers reporting 2MFD and ≥ 3MFD, and Palestinian-Arab mothers reporting ≥3MFD, but no significant association among immigrant Jewish mothers. When we used C-MFD, we found a dose-response association in which Palestinian-Arab mothers experiencing more MFD (2MFD and ≥ 3MFD) were more likely to experience PPD. This was followed by immigrant Jewish mothers (reporting 2MFD and ≥ 3MFD), and lastly by non-immigrant Jewish mothers. CONCLUSIONS: MFD should be considered in relation to women's identity (being part of a minority, immigrant, or non-immigrant majority group) in maternal mental health research and practice. Otherwise, we risk underestimating the effects of MFD on PPD, especially in minority and immigrant mothers, who are more likely to face interlocking forms of discrimination.


Asunto(s)
Árabes/psicología , Depresión Posparto/etnología , Emigrantes e Inmigrantes/psicología , Judíos/psicología , Grupos Minoritarios/psicología , Madres/psicología , Prejuicio/etnología , Adolescente , Adulto , Árabes/estadística & datos numéricos , Estudios Transversales , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Humanos , Israel , Judíos/estadística & datos numéricos , Persona de Mediana Edad , Grupos Minoritarios/estadística & datos numéricos , Madres/estadística & datos numéricos , Adulto Joven
13.
Sleep Health ; 5(6): 532-538, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31708438

RESUMEN

BACKGROUND: Suboptimal sleep has been documented in at-risk groups such as urban minority children, particularly those with asthma. It is therefore critical to examine differences in sleep outcomes across specific racial and ethnic groups and to identify factors that contribute to such variations in sleep outcomes to inform tailored interventions to improve sleep health. OBJECTIVES: The objectives were to examine racial/ethnic differences in sleep outcomes among urban children with and without asthma and to evaluate the extent to which asthma status and aspects of sleep hygiene and the sleep environment contribute to racial/ethnic differences in sleep outcomes in this sample. METHODS: Two hundred and sixteen African American, Latino, or non-Latino white (NLW) urban children, ages 7-9 years, with (n = 216) and without asthma (n = 130) and their primary caregivers were included. Objective sleep duration and efficiency were assessed via actigraphy. Asthma status was assessed by a study clinician. Caregiver-reported sleep hygiene and exposure to noise were assessed using a questionnaire. RESULTS: Minority children in the sample had, on average, shorter sleep duration compared to NLW children during the monitoring period (mean difference Latino vs NLW = -22.10, SE = 5.02; mean difference AA vs NLW = -18.69, SE = 5.28) Additionally, several racial/ethnic group differences in sleep outcomes emerged and were dependent on whether or not children had asthma. Specifically, Latinos had lower mean number of awakenings compared to NLWs but only among control participants with no asthma. Furthermore, specific aspects of sleep hygiene and exposure to nighttime noise in the home and neighborhood contributed to racial/ethnic differences in sleep outcomes. CONCLUSION: Considering urban stressors and asthma status when treating pediatric populations is important, as factors related to urban stress and asthma management may influence sleep hygiene practices and sleep outcomes.


Asunto(s)
Afroamericanos/estadística & datos numéricos , Asma/etnología , Disparidades en el Estado de Salud , Hispanoamericanos/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Sueño , Salud Urbana/etnología , Cuidadores , Niño , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Masculino , New England , Higiene del Sueño , Encuestas y Cuestionarios , Factores de Tiempo
14.
Br J Nurs ; 28(18): S4-S10, 2019 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-31597062

RESUMEN

Prostate cancer is a complex disease which is more prevalent among men of black and minority ethnic (BME) background than their Caucasian counterparts, with men of African-Caribbean background experiencing higher levels of incidence and mortality than any other ethnic group. The reasons behind this health inequality are poorly understood and likely to be multifactorial. Several theories have been posited, including genetic disposition, poorer access to health care, a lack of understanding of the risks posed by prostate cancer and an unwillingness to access mainstream health care. There is, however, a notable disparity between the amount of literature focusing on prostate cancer as it affects those with a BME background and on prostate cancer in general. This further compounds the difficulties encountered by BME men, who rely on health professionals being aware of the greater risk they face. More knowledge and understanding is required by both the general population and medical practitioners to address this health inequality.


Asunto(s)
Grupos Étnicos/estadística & datos numéricos , Disparidades en el Estado de Salud , Neoplasias de la Próstata/etnología , Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Humanos , Masculino , Grupos Minoritarios/estadística & datos numéricos , Factores de Riesgo , Reino Unido/epidemiología
15.
J Bone Joint Surg Am ; 101(18): e96, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31567811

RESUMEN

BACKGROUND: Orthopaedic surgery has generally lagged behind other surgical subspecialties with respect to racial and ethnic diversity in its U.S. residency programs. Efforts have been made to increase the number of underrepresented minorities (URMs) applying to orthopaedic surgery residencies; however, the impact on diversity at the residency program level is unknown. The purpose of this study was to determine whether orthopaedic surgery residency programs have become more racially diverse over time. METHODS: The Graduate Medical Education Track database was queried for individual racial/ethnic identification of orthopaedic surgery residents in U.S. Accreditation Council for Graduate Medical Education (ACGME)-accredited programs for 15 consecutive years (2002-2003 through 2016-2017). The number of URMs in each residency program during each academic year was recorded. The number of programs per year with no URMs, 1 URM, 2 URMs, and >2 URMs was recorded, and the change over time was assessed. RESULTS: The number of programs per year with >1 URM resident decreased over time, from 61 programs in 2002 to 53 programs in 2016, with the trough being 31 programs in 2010 (p < 0.0001). The number of programs per year without any URM residents increased over the period of study, from 40 programs in 2002 to 60 programs in 2016, with the peak being 76 programs in 2011 (p < 0.0001). CONCLUSIONS: The number of residency programs with >1 URM resident has decreased significantly over time, suggesting that diversity at the program level is limited. Program-level diversity should be further examined as a potential barrier to the recruitment of URMs to orthopaedics. Difficulty attracting URM residents to certain programs may have the unintended consequence of effectively limiting potential positions for these candidates, which can decrease the odds of minority students matching into orthopaedics and, therefore, perpetuate the cycle of lack of diversity in our field.


Asunto(s)
Diversidad Cultural , Grupos Étnicos/estadística & datos numéricos , Internado y Residencia/tendencias , Grupos Minoritarios/estadística & datos numéricos , Ortopedia/educación , Estudiantes de Medicina/estadística & datos numéricos , Femenino , Humanos , Masculino , Ortopedia/tendencias , Distribución por Sexo , Estados Unidos
16.
Artículo en Inglés | MEDLINE | ID: mdl-31581695

RESUMEN

Addressing health disparities and promoting health equity for Roma has been a challenge. The Roma are the largest disadvantaged ethnic minority population in Europe and have been the victims of deep social and economic injustices, institutional discrimination, and structural antigypsyism over many centuries. This has resulted in a much worse health status than their non-Roma counterparts. Current strategies based on ameliorative and top-down approaches to service delivery have resulted in paradoxical effects that solidify health disparities, since they do not effectively address the problems of vulnerable Roma groups. Following a health justice approach, we present a community-based participatory action research case study generated by a community and university partnership intended to address power imbalances and build collaboration among local stakeholders. This case study involved a group of health providers, Roma residents, researchers, Roma community organizations, and other stakeholders in the Poligono Sur, a neighborhood of Seville, Spain. The case study comprises four phases: (1) identifying Roma health assets, (2) empowering Roma community through sociopolitical awareness, (3) promoting alliances between Roma and community resources/institutions, and (4) building a common agenda for promoting Roma health justice. We highlighted best practices for developing processes to influence Roma health equity in local health policy agendas.


Asunto(s)
Investigación Participativa Basada en la Comunidad/métodos , Equidad en Salud , Política de Salud , Disparidades en Atención de Salud , Roma/psicología , Roma/estadística & datos numéricos , Justicia Social , Grupos Étnicos/psicología , Grupos Étnicos/estadística & datos numéricos , Promoción de la Salud/métodos , Humanos , Grupos Minoritarios/psicología , Grupos Minoritarios/estadística & datos numéricos , Estigma Social , España
17.
J Dent Educ ; 83(9): 1057-1064, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31477584

RESUMEN

Pipeline programs aim to increase the representation of underrepresented minorities in the dental profession. At New York University College of Dentistry (NYUCD), two dental students initiated the development of a pipeline program for high school students called Saturday Academy. The purpose of the program is twofold: to mentor and coach underrepresented minority and low-income high school students through the college application process, and to expose them to the field of dentistry as a viable career option through both didactic and hands-on learning. The aim of this pilot study was to determine outcomes for the first five years (2013-17) of the Saturday Academy pipeline program at NYUCD with regard to the high school students' experience with the program and their career interests after high school graduation. Across five cohorts, a total of 82 students participated in Saturday Academy. A "where are you now?" survey sent to 72 participants who reported high school graduation years between 2013 and 2018 received a response rate of 76%. The survey results showed that all (100%) of the responding Saturday Academy participants had graduated from high school and were enrolled in college, and 71% were interested in health profession careers. Almost half (47%) of the students self-identified as being pre-dental, and 96% reported that Saturday Academy had increased their interest in the dental profession. These pilot results justified an expansion of Saturday Academy at NYUCD in both size and creation of an alumni outreach initiative. Other dental schools may benefit from the strategies used by this program in establishing or expanding their pipeline programs.


Asunto(s)
Selección de Profesión , Odontología , Educación en Odontología , Facultades de Odontología , Estudiantes de Odontología/estadística & datos numéricos , Estudiantes/psicología , Femenino , Empleos en Salud , Humanos , Masculino , Grupos Minoritarios/estadística & datos numéricos , Salud de las Minorías , New York , Proyectos Piloto , Pobreza , Instituciones Académicas , Encuestas y Cuestionarios , Universidades
18.
Artículo en Inglés | MEDLINE | ID: mdl-31547132

RESUMEN

The Long-Term Care Insurance Law provides support to older Israelis who wish to remain in their home. The present study evaluated the experience of perceived discrimination and stigma in the context of the law among Arab older adults, their family members, and their paid home care workers. For triangulation purposes, we interviewed 15 National Insurance Institute workers (NII; responsible for implementing the law; 47% Arab), 31 older adults (81% Arab), 31 family members (87% Arab), and six paid home care workers (83% Arab) in the north of Israel. Respondents were queried about their home care experience and their encounter with the NII. Thematic analysis was conducted. Four main themes emerged: (a) a strong sense of perceived discrimination among Arab interviewees, (b) reports suggesting the internalization of stigma and the adoption of negative views regarding the Arab population by some Arab respondents, (c) implicit stigma manifested in claims concerning the Arab population (primarily) as "cheating" the system, and (d) the negation of discrimination of Arabs as reported by Jewish interviewees and NII workers. The findings show that a sense of perceived discrimination is common and colors the experience of service seeking among Arabs. On the other hand, the Jewish interviewees in this study completely negated any discrimination or stigma directed toward Arabs. The findings point to the importance of group affiliation (e.g., minority vs. majority) in interpreting the existence of discrimination. The findings likely have major implications for both service providers and policy-makers and legislators.


Asunto(s)
Seguro de Cuidados a Largo Plazo/estadística & datos numéricos , Grupos Minoritarios/psicología , Racismo/psicología , Estigma Social , Árabes , Familia/psicología , Auxiliares de Salud a Domicilio/psicología , Auxiliares de Salud a Domicilio/estadística & datos numéricos , Israel , Judíos , Grupos Minoritarios/estadística & datos numéricos , Racismo/estadística & datos numéricos
19.
Comput Inform Nurs ; 37(9): 455-462, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31518339

RESUMEN

Web-based interventions that promote physical activity have been tested in various populations and proven effective. However, information on recruiting and retaining ethnic minorities in these interventions is limited. This study discusses practical issues in recruitment and retention of Asian Americans using three strategies: (1) only Web-based intervention (Group 1), (2) one with Fitbit Charge HR (Group 2), and (3) one with Fitbit Charge HR and office visits (Group 3). Recruitment and retention rates, minutes of weekly research team meetings, and the researchers' memos were collected. Retention rates were analyzed using descriptive statistics, and the minutes and memos were content analyzed following Weber's methods. Retention rates varied by the end of the first (12% in Group 3, 36.9% in Group 2) and third month (0% in Group 3, 36.9% in Group 2). The practical issues were (1) difficulties in recruitment across strategies, (2) the necessity of using community consultants/leaders across strategies, (3) subethnic differences across strategies, (4) timing issues across strategies, (5) Fitbit as a facilitator with several hindrances, and (6) office visits as an inhibitor. Fitbits with user guidelines and community consultants'/leaders' involvement are proposed for future Web-based interventions to promote physical activity in Asian Americans.


Asunto(s)
Americanos Asiáticos/estadística & datos numéricos , Ejercicio Físico/fisiología , Promoción de la Salud , Internet , Selección de Paciente , Adulto , Ejercicio Físico/psicología , Humanos , Persona de Mediana Edad , Grupos Minoritarios/estadística & datos numéricos , Dispositivos Electrónicos Vestibles , Adulto Joven
20.
J Youth Adolesc ; 48(10): 1883-1898, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31520237

RESUMEN

Research on sexual and gender minority student achievement indicates that such students report lowered achievement relative to other students. Increased victimization and less school belonging, amongst other factors, have been identified as contributing to these inequalities. However, supportive schooling structures and caregiver support may support their achievement. A nationally representative survey of secondary school students was used to identify specific factors that support achievement for sexual minority (n = 485), gender minority (n = 298), and heterosexual cisgender (where one's sex assigned at birth "matches" a binary gender identity, i.e., a male assigned at birth identifies as a boy/man, n = 7064) students in New Zealand. While reported victimization did not affect achievement for sexual and gender minority students, school belonging, and teacher expectations of success, emerged as significant factors. Differences emerged between sexual minority and gender minority achievement factors, suggesting a range of detailed policy implications and recommendations.


Asunto(s)
Éxito Académico , Logro , Víctimas de Crimen/psicología , Heterosexualidad/psicología , Grupos Minoritarios/psicología , Minorías Sexuales y de Género/psicología , Adolescente , Acoso Escolar/estadística & datos numéricos , Víctimas de Crimen/estadística & datos numéricos , Femenino , Heterosexualidad/estadística & datos numéricos , Humanos , Masculino , Grupos Minoritarios/estadística & datos numéricos , Nueva Zelanda , Conducta Sexual/estadística & datos numéricos , Minorías Sexuales y de Género/estadística & datos numéricos , Estudiantes/estadística & datos numéricos , Encuestas y Cuestionarios
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