Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 45
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Popul Health Manag ; 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31928510

RESUMO

The Robert Wood Johnson Foundation's Culture of Health Action Framework aims to "make health a shared value" and improve population health equity through widespread culture change. The authors draw upon their expertise as anthropologists to identify 3 challenges that they believe must be addressed in order to effectively achieve the health equity and population health improvement goals of the Culture of Health initiative: clarifying and demystifying the concept of "culture," contextualizing "community" within networks of power and inequality, and confronting the crises of trust and solidarity in the contemporary United States. The authors suggest that those who seek to build a "Culture of Health" refine their understanding of how "culture" is experienced, advocate for policies and practices that break down unhealthy consolidations of power, and innovate solutions to building consensus in a divided nation.

5.
Med Anthropol Q ; 33(2): 242-262, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29700845

RESUMO

New York City has the largest number of opioid dependent people of U.S. cities, and within New York, Whites have the highest rate of prescription opioid and heroin overdose deaths. The rise of opioid abuse among Whites has resulted in popular narratives of victimization by prescribers, framing of addiction as a biological disease, and the promise of pharmaceutical treatments that differ from the criminalizing narratives that have historically described urban Latino and black narcotic use. Through an analysis of popular media press and interviews with opioid prescribers and community pharmacists in Staten Island-the epicenter of opioid overdose in New York City and the most suburban and white of its boroughs-we found that narratives of white opioid users disrupted notions of the addict as "other," producing alternative logics of blame that focus on prescribers and the encroachment of dealers from outside of white neighborhoods.

8.
Subst Use Misuse ; 53(2): 301-310, 2018 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-29161171

RESUMO

BACKGROUND/OBJECTIVE: Office-based buprenorphine maintenance has been legalized and promoted as a treatment approach that not only expands access to care, but also reduces the stigma of addiction treatment by placing it in a mainstream clinical setting. At the same time, there are differences in buprenorphine treatment utilization by race, ethnicity, and socioeconomic status. METHODS: This article draws on qualitative data from interviews with 77 diverse patients receiving buprenorphine in a primary care clinic and two outpatient substance dependence clinics to examine differences in patients' experiences of stigma in relation their need for psychosocial supports and services. RESULTS: Management of stigma and perception of social needs varied significantly by ethnicity, race and SES, with white educated patients best able to capitalize on the medical focus and confidentiality of office-based buprenorphine, given that they have other sources of support outside of the clinic, and Black or Latino/a low income patients experiencing office-based buprenorphine treatment as isolating. CONCLUSION: Drawing on Agamben's theory of "bare life," and on the theory of intersectionality, the article argues that without attention to the multiple oppressions and survival needs of addiction patients who are further stigmatized by race and class, buprenorphine treatment can become a form of clinical abandonment.


Assuntos
Tratamento de Substituição de Opiáceos/psicologia , Pacientes Ambulatoriais/psicologia , Estigma Social , Adulto , Buprenorfina/uso terapêutico , Grupos Étnicos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Pesquisa Qualitativa , Classe Social , Apoio Social
11.
Biosocieties ; 12(2): 217-238, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28690668

RESUMO

The US 'War on Drugs' has had a profound role in reinforcing racial hierarchies. Although Black Americans are no more likely than Whites to use illicit drugs, they are 6-10 times more likely to be incarcerated for drug offenses. Meanwhile, a very different system for responding to the drug use of Whites has emerged. This article uses the recent history of White opioids - the synthetic opiates such as OxyContin® that gained notoriety starting in the 1990s in connection with epidemic prescription medication abuse among White, suburban and rural Americans and Suboxone® that came on the market as an addiction treatment in the 2000s - to show how American drug policy is racialized, using the lesser known lens of decriminalized White drugs. Examining four 'technologies of whiteness' (neuroscience, pharmaceutical technology, legislative innovation and marketing), we trace a separate system for categorizing and disciplining drug use among Whites. This less examined 'White drug war' has carved out a less punitive, clinical realm for Whites where their drug use is decriminalized, treated primarily as a biomedical disease, and where their whiteness is preserved, leaving intact more punitive systems that govern the drug use of people of color.

12.
Disaster Med Public Health Prep ; 11(5): 531-537, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28264758

RESUMO

OBJECTIVE: After Hurricane Sandy flooded Bellevue Hospital in New York City, its opiate maintenance patients were displaced and Bellevue's outpatient program was temporarily merged with the program at Metropolitan Hospital for continuation of care. The merger forced Metropolitan to accommodate a program twice as large as its own and required special staff coordination and adjustments in clinical care. METHODS: Physicians, clinicians, and administrators from both institutions participated in interviews regarding the merger. RESULTS: Issues that emerged in the interviews fell into 4 major themes: (1) organization and meshing of professional cultures, (2) regulation, (3) communication, and (4) accommodations. CONCLUSIONS: Despite these barriers, data collected after the merger showed high retention rates and low rates of positive urine toxicology results. (Disaster Med Public Health Preparedness. 2017;11:531-537).


Assuntos
Medicina do Vício/métodos , Comportamento Cooperativo , Tempestades Ciclônicas/estatística & dados numéricos , Planejamento em Desastres/métodos , Tratamento de Substituição de Opiáceos/métodos , Planejamento em Desastres/estatística & dados numéricos , Planejamento em Desastres/tendências , Pessoal de Saúde/psicologia , Pessoal de Saúde/tendências , Humanos , Cidade de Nova Iorque , Tratamento de Substituição de Opiáceos/estatística & dados numéricos
13.
Acad Med ; 92(3): 279-281, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28079725

RESUMO

Structural competency provides a language and theoretical framework to promote institutional-level interventions by clinical practitioners working with community organizations, non-health-sector institutions, and policy makers. The special collection of articles on structural competency in this issue of Academic Medicine addresses the need to move from theory to an appraisal of core educational interventions that operationalize the goals of and foster structural competency. In this Commentary, the authors review the role of clinical practitioners in enhancing population-level health outcomes through collaborations with professionals in fields outside medicine, including the social sciences and law. They describe the core elements of structural competency in preclinical and clinical education, as illustrated by the articles of this special collection: perceiving the structural causes of patients' disease, envisioning structural interventions, and cultivating alliances with non-health-sector agencies that can implement structural interventions. Finally, the authors argue that preparing trainees to form partnerships will empower them to influence the social determinants of their patients' health and reduce health inequalities.


Assuntos
Assistência à Saúde/organização & administração , Educação Médica/organização & administração , Pessoal de Saúde/educação , Médicos/normas , Competência Profissional , Comunicação , Currículo , Humanos , Relações Interprofissionais , Estados Unidos
14.
Psychiatr Serv ; 68(3): 295-298, 2017 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-27745534

RESUMO

OBJECTIVES: This report identifies the institutional barriers to, and benefits of, buprenorphine maintenance treatment (BMT) integration in an established hospital-based opioid treatment program (OTP). METHODS: This case study presents the authors' experiences at the clinic, hospital, and corporation levels during efforts to integrate BMT into a hospital-based OTP in New York City and a descriptive quantitative analysis of the characteristics of hospital outpatients treated with buprenorphine from 2006 to 2013 (N=735). RESULTS: Integration of BMT into an OTP offered patients the flexibility to transition between intensive structured care and primary care or outpatient psychiatry according to need. Main barriers encountered were regulations, clinical logistics of dispensing medications, internal cost and reimbursement issues, and professional and cultural resistance. CONCLUSIONS: Buprenorphine integration offers a model for other OTPs to facilitate partnerships among primary care and mental health clinics to better serve diverse patients with varying clinical needs and with varying levels of social support.


Assuntos
Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Serviços de Saúde Mental , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Atenção Primária à Saúde/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Transcult Psychiatry ; 53(4): 465-87, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27488225

RESUMO

Growing nonmedical prescription opioid analgesic use among suburban and rural Whites has changed the public's perception of the nature of opioid addiction, and of appropriate interventions. Opioid addiction has been recast as a biological disorder in which patients are victims of their neurotransmitters and opioid prescribers are irresponsible purveyors of dangerous substances requiring controls. This framing has led to a different set of policy responses than the "War on Drugs" that has focused on heroin trade in poor urban communities; in response to prescription opioid addiction, prescription drug monitoring programs and tamper-resistant opioid formulations have arisen as primary interventions in place of law enforcement. Through the analysis of preliminary findings from interviews with physicians who are certified to manage opioid addiction with the opioid pharmaceutical buprenorphine, we argue that an increase in prescriber monitoring has shifted the focus from addicted people to prescribers as a threat, paradoxically driving users to illicit markets and constricting their access to pharmaceutical treatment for opioid addiction. Prescriber monitoring is also altering clinical cultures of care, as general physicians respond to heightened surveillance and the psychosocial complexities of treating addiction with either rejection of opioid dependent patients, or with resourceful attempts to create support systems for their treatment where none exists.


Assuntos
Buprenorfina/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Humanos , Entrevistas como Assunto , Cidade de Nova Iorque , Tratamento de Substituição de Opiáceos/métodos , Padrões de Prática Médica , Programas de Monitoramento de Prescrição de Medicamentos , Classe Social
17.
J Subst Abuse Treat ; 69: 44-9, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27568509

RESUMO

Opioid overdose prevention is a pressing public health concern and intranasal naloxone rescue kits are a useful tool in preventing fatal overdose. We evaluated the attitudes, knowledge, and experiences of patients and providers related to overdose and naloxone rescue. Over a six month period, patients and providers within a large community hospital in Staten Island were recruited to complete tailored questionnaires for their respective groupings. 100 patients and 101 providers completed questionnaires between August, 2014 and January, 2015. Patient participants were primarily Caucasian males with a mean age of 37.7 years, of which 65% accurately identified naloxone for opioid overdose, but only 21% knew more specific clinical features. 68% of patients had previously witnessed a drug overdose. Notably, 58% of patients anticipated their behavior would change if provided access to an intranasal naloxone rescue kit, of which 83% predicted an increase in opioid use. Prior overdose was significantly correlated with anticipating no change in subsequent opioid use pattern (p=0.02). 99% of patients reported that their rapport with their health-care provider would be enhanced if offered an intranasal naloxone rescue kit. As for providers, 24% had completed naloxone rescue kit training, and 96% were able to properly identify its clinical application. 50% of providers felt naloxone access would decrease the likelihood of an overdose occurring, and 58% felt it would not contribute to high-risk behavior. Among providers, completion of naloxone training was correlated with increased awareness of where to access kits for patients (p<0.001). This study suggests that patients and providers have distinct beliefs and attitudes toward overdose prevention. Patient-Provider discussion of overdose prevention enhances patients' rapport with providers. However, access to an intranasal naloxone rescue kit may make some patients more vulnerable to high-risk behavior. Future research efforts examining provider and patient beliefs and practices are needed to help develop and implement effective hospital-based opioid overdose prevention strategies.


Assuntos
Overdose de Drogas/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Naloxona/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Administração Intranasal , Adulto , Estudos Transversais , Feminino , Pessoal de Saúde , Acesso aos Serviços de Saúde , Hospitais Comunitários , Humanos , Masculino , Naloxona/provisão & distribução , Antagonistas de Entorpecentes/administração & dosagem , Antagonistas de Entorpecentes/provisão & distribução , New York , Transtornos Relacionados ao Uso de Opioides/complicações , Projetos Piloto , Relações Profissional-Paciente , Inquéritos e Questionários
18.
Cult Med Psychiatry ; 40(4): 664-686, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27272904

RESUMO

The past decade in the U.S. has been marked by a media fascination with the white prescription opioid cum heroin user. In this paper, we contrast media coverage of white non-medical opioid users with that of black and brown heroin users to show how divergent representations lead to different public and policy responses. A content analysis of 100 popular press articles from 2001 and 2011 in which half describe heroin users and half describe prescription opioid users revealed a consistent contrast between criminalized urban black and Latino heroin injectors with sympathetic portrayals of suburban white prescription opioid users. Media coverage of the suburban and rural opioid "epidemic" of the 2000s helped draw a symbolic, and then legal, distinction between (urban) heroin addiction and (suburban and rural) prescription opioid addiction that is reminiscent of the legal distinction between crack cocaine and powder cocaine of the 1980s and 1990s. This distinction reinforces the racialized deployment of the War on Drugs and is sustained by the lack of explicit discussion of race in the service of "color blind ideology." We suggest potential correctives to these racially divergent patterns, in the form of socially responsible media practices and of clinical engagement with public policy.


Assuntos
Grupo com Ancestrais do Continente Europeu/etnologia , Meios de Comunicação de Massa/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/etnologia , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Humanos , População Rural/estatística & dados numéricos , Estados Unidos/etnologia , População Urbana/estatística & dados numéricos
19.
Drug Alcohol Depend ; 164: 14-21, 2016 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-27179822

RESUMO

BACKGROUND: Geographic and demographic variation in buprenorphine and methadone treatment use in U.S. cities has not been assessed. Identifying variance in opioid maintenance is essential to improving treatment access and equity. PURPOSE: To examine the differential uptake of buprenorphine treatment in comparison to methadone treatment between 2004 and 2013 in neighborhoods in New York City characterized by income, race and ethnicity. METHODS: Social area (SA) analysis of residential zip codes of methadone and buprenorphine patients in NYC, which aggregated zip codes into five social areas with similar percentages of residents below poverty, identifying as Black non-Hispanic and as Hispanic, to examine whether treatment rates differed significantly among social areas over time. For each rate, mixed model analyses of variance were run with fixed effects for social area, year and the interaction of social area by year. RESULTS: Buprenorphine treatment increased in all social areas over time with a significantly higher rate of increase in the social area with the highest income and the lowest percentage of Black, Hispanic, and low-income residents. Methadone treatment decreased slightly in all social areas until 2011 and then increased bringing rates back to 2004 levels. Treatment patterns varied by social area. CONCLUSIONS: Buprenorphine treatment rates are increasing in all social areas, with slower uptake in moderate income mixed ethnicity areas. Methadone rates have remained stable over time. Targeted investments to promote public sector buprenorphine prescription may be necessary to reduce disparities in buprenorphine treatment and to realize its potential as a public health measure.


Assuntos
Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Características de Residência/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Cidade de Nova Iorque/etnologia , Transtornos Relacionados ao Uso de Opioides/etnologia , Pobreza/estatística & dados numéricos
20.
J Bioeth Inq ; 13(2): 185-92, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27022923

RESUMO

In order to enhance the "structural competency" of medicine-the capability of clinicians to address social and institutional determinants of their patients' health-physicians need a theoretical lens to see how social conditions influence health and how they might address them. We consider one such theoretical lens, fundamental cause theory, and propose how it might contribute to a more structurally competent medical profession. We first describe fundamental cause theory and how it makes the social causes of disease and health visible. We then outline the sorts of "fundamental interventions" that physicians might make in order to address the fundamental causes.


Assuntos
Política de Saúde , Saúde Pública , Determinantes Sociais da Saúde/ética , Medicina Social/organização & administração , Comportamentos Relacionados com a Saúde , Disparidades nos Níveis de Saúde , Humanos , Papel do Médico , Medicina Social/ética , Fatores Socioeconômicos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA