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1.
BMC Health Serv Res ; 19(1): 582, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426768

RESUMO

BACKGROUND: To examine the association between delay in planned diabetes care and quality of outcomes. METHODS: A retrospective analysis of primary care and inpatient records for 2567 Aboriginal patients, with diabetes, living in 49 remote communities in the Northern Territory of Australia. Poisson regression was used to estimate the association between delay from diagnosis to documented diabetes care plan and three outcome measures: mean HbA1c level, most recent blood pressure and number of diabetes-related hospital admissions. RESULTS: Compared with no delay (< 60 days), patients with delay had increased risk of elevated mean HbA1c: 60 days to < 2 years, incidence rate ratio (IRR), 1.2 (95% CI:1.07-1.39); 2 years to < 4 years, incidence rate ratio (IRR), 1.2 (95% CI:1.04-1.45); 4 years and over, incidence rate ratio (IRR), 1.3 (95% CI:1.12-1.52). There was no evidence of association between delay and optimal blood pressure control. Risk of diabetes-related admission increased with increased delay. Compared with no delay the IRRs for delay were: 60 days to < 2 years, 1.2 (95% CI:1.07-1.42); 2 to < 4 years, 1.3 (95% CI: 1.15-1.58): and 4 years and over, 2.6 (95% CI,2.28-3.08). CONCLUSION: The study found that a timely diabetes care plan was associated with better short-term blood glucose control and fewer diabetes-related admissions but not with improved blood pressure control. Delays may be a result of both patient and service-related factors.


Assuntos
Assistência à Saúde/normas , Diabetes Mellitus/terapia , Grupo com Ancestrais Oceânicos/etnologia , Atenção Primária à Saúde/normas , Tempo para o Tratamento/estatística & dados numéricos , Adolescente , Adulto , Idoso , Pressão Sanguínea/fisiologia , Assistência à Saúde/etnologia , Assistência à Saúde/estatística & dados numéricos , Diabetes Mellitus/etnologia , Feminino , Hemoglobina A Glicada/metabolismo , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Northern Territory/epidemiologia , Northern Territory/etnologia , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
2.
BMC Int Health Hum Rights ; 19(1): 22, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319819

RESUMO

BACKGROUND: Refugees have significant unmet health needs. Delivering services to refugees continues to be problematic in the Australian healthcare system. A systematic review and thematic synthesis of the literature exploring refugee perceptions of the Australian healthcare system was performed. METHODS: Titles and abstracts of 1610 articles published between 2006 and 2019 were screened, and 147 articles were read in full text. Depending on the type of study, articles were appraised using the Modified Critical Appraisal Tool (developed by authors), the Mixed Methods Appraisal Tool, or the JBI Appraisal Checklist for Systematic Reviews. Using QSR NVivo 11, articles were coded into descriptive themes and synthesised into analytical themes. An explanatory model was used to synthesise these findings. Confidence in the review findings were assessed with GRADE-CERQual approach. RESULTS: The final synthesis included 35 articles consisting of one systematic review, 7 mixed methods studies, and 27 qualitative studies. Only one study was from a regional or rural area. A model incorporating aspects of engagement, access, trust, and privacy can be used to explain the experiences of refugees in using the Australian healthcare system. Refugees struggled to engage with health services due to their unfamiliarity with the health system. Information sharing is needed but this is not always delivered effectively, resulting in disempowerment and loss of autonomy. In response, refugees resorted to familiar means, such as family members and their pre-existing cultural knowledge. At times, this perpetuated their unfamiliarity with the broader health system. Access barriers were also encountered. Trust and privacy are pervasive issues that influenced access and engagement. CONCLUSIONS: Refugees face significant barriers in accessing and engaging with healthcare services and often resorted to familiar means to overcome what is unfamiliar. This has implications across all areas of service provision. Health administrators and educators need to consider improving the cultural competency of staff and students. Policymakers need to consider engaging communities and upscale the availability and accessibility of professional language and cultural supports. Research is needed on how these measures can be effectively delivered. There is limited research in remote areas and further evidence is needed in these settings.


Assuntos
Barreiras de Comunicação , Competência Cultural , Assistência à Saúde/etnologia , Acesso aos Serviços de Saúde , Refugiados/psicologia , Austrália , Hospitais , Humanos , Privacidade , Confiança
3.
Int J Circumpolar Health ; 78(1): 1630233, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31199204

RESUMO

Historically, heart health was approached holistically by First Nations (FN) peoples, which was integrated into daily living. Caring for the physical, emotional and spiritual needs of individuals, community, family, and the living environment was integral. The Truth and Reconciliation Commission of Canada demonstrates the decimation of health practices through governmental policy to destroy the cultural foundations of FN peoples. Relational systems and ways of living were outlawed, and the health of FN people suffered. A digital storytelling study collaborated with Manitoba FN women with lived experience of caring for a biomedical-diagnosed heart condition. The objective was to identify concepts, language, and experiences of heart health among FN women. Six women created five digital stories; four are available publically online. Themes addressed by the storytellers include: changes to diet and lifestyle, related health conditions, experiences with healthcare system, residential schools, and relationships with children and grandchildren. The intersection of Western and FN knowledges heard in the women's stories suggests heart health knowledge and care is embedded within historical and social contexts. Insights into the non-dichotomous relationship between FN and biomedical knowledge of heart health, along with their conceptualisations of heart, suggests historical and social roots underlying heart health issues First Nations women face.


Assuntos
Assistência à Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Cardiopatias/etnologia , Índios Norte-Americanos/psicologia , Regiões Árticas , Dieta/etnologia , Relações Familiares/etnologia , Feminino , Humanos , Estilo de Vida/etnologia , Manitoba , Narração
4.
Int J Qual Stud Health Well-being ; 14(1): 1600940, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31033431

RESUMO

PURPOSE: Access to primary care can help mitigate the negative impacts of social inequity that disproportionately affect Indigenous people in Canada. Despite this, however, Indigenous people cite difficulties accessing care. This study seeks to understand how Indigenous mothers-typically responsible for the health of their infants-living in urban areas, experience selecting and using health services to meet the health needs of their infants. Results provide strategies to improve access to care, which may lead to improved health outcomes for Indigenous infants and their families. METHODS: This qualitative interpretive description study is guided by the Two-Eyed Seeing framework. Interviews were conducted with 19 Indigenous mothers and 5 primary care providers. RESULTS: The experiences of Indigenous mothers using primary care for their infants resulted in eight themes. Themes were organized according to three domains of primary care: structural, organizational and personnel. CONCLUSIONS: Primary care providers can develop contextual-awareness to better recognize and respond to the health and well-being of Indigenous families. Applying culturally safe, trauma and violence-informed and family-centred approaches to care can promote equitable access and positive health care interactions which may lead to improved health outcomes for Indigenous infants and their families.


Assuntos
Assistência à Saúde/etnologia , Equidade em Saúde , Índios Norte-Americanos , Saúde do Lactente , Mães , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Atenção Primária à Saúde , Adulto , Competência Cultural , Cultura , Feminino , Humanos , Lactente , Ontário , Relações Profissional-Paciente , Pesquisa Qualitativa , Fatores Socioeconômicos , Inquéritos e Questionários , População Urbana , Violência , Adulto Jovem
5.
J Altern Complement Med ; 25(S1): S69-S77, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30870024

RESUMO

OBJECTIVES: Indigenous people have unique health needs that require culturally appropriate holistic care that addresses physical, mental, emotional, and spiritual health. Access to both traditional Indigenous healing practices and Western medicine are needed for all encompassing holistic health. DESIGN: This inquiry addresses actions suggested by the United Nations (UN) and the Truth and Reconciliation Commission of Canada (TRC) with regard to traditional Indigenous medicine and healing and was guided by an Organizational Sponsor and Inquiry Team. SETTING: The fieldwork for this study took place within Alberta Health Services (AHS), established in 2008 when 12 separate health entities merged to become Canada's first and largest fully integrated provincial health system. PARTICIPANTS: Two Elders and a Cultural Helper provided perspectives on cultural protocols surrounding the traditional Indigenous sweat lodge ceremony. Three Indigenous community members provided perspectives on AHS services and holistic health through participation in the traditional Indigenous sweat lodge ceremony. Seven AHS administrative employees provided perspectives on implementation. INTERVENTIONS: This study was conducted within an action research framework and the researcher conducted a literature review, interviews, and a focus group to allow for triangulation. RESULTS: Throughout the interviews and focus group, participants consistently emphasized the importance of increasing efforts to expand traditional Indigenous healing practices within AHS, giving rise to the primary study theme: Expanding Traditional Indigenous Healing Practices within AHS. Several subthemes emerged in support of this primary focus, including the following: (1) enhancing cultural competency and safety training among leadership and employees; (2) adhering to tradition and protocol; (3) establishing meaningful partnerships; (4) strengthening organizational facets of program delivery; and (5) need for additional financial, human, and logistical resources. CONCLUSIONS: During this time of reconciliation with Indigenous peoples in Canada and beyond, health care leaders and providers have an ethical responsibility and important opportunity to help improve the troubling health disparities at hand. This will inevitably require tremendous reflection, humility, courage, and commitment by stakeholders at all levels, as they work to transform health systems that disproportionately disadvantage Indigenous ways of knowing and being while implicitly privileging Eurocentric, biomedical perspectives. This pursuit, despite the barriers that may arise, is a moral, social, and political imperative for all those health care workers who seek to reduce suffering.


Assuntos
Assistência à Saúde , Saúde Holística , Índios Norte-Americanos/etnologia , Medicina Integrativa , Medicina Tradicional , Alberta/etnologia , Assistência à Saúde/etnologia , Assistência à Saúde/métodos , Assistência à Saúde/normas , Grupos Focais , Humanos , Banho a Vapor
6.
MMWR Morb Mortal Wkly Rep ; 68(4): 81-86, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30703079

RESUMO

Identifying persons with human immunodeficiency virus (HIV) infection who are unaware of their infection status, linking them to HIV care, and reducing racial/ethnic disparities are important national HIV prevention goals (1). Blacks/African Americans (blacks)* are disproportionately affected by HIV infection in the United States. Although blacks represent 13% of the U.S. population (2), in 2017, 44% of diagnoses of HIV infection were in blacks, and the rate of new diagnoses in blacks (41.1 per 100,000 persons) was approximately eight times that of non-Hispanic whites (5.1) (3). HIV partner services are offered by health officials to persons with diagnosed HIV infection (index patients) and their sex- or needle-sharing partners, who are notified of their potential HIV exposure and offered HIV testing and related services (4). CDC analyzed 2016 data from the National HIV Prevention Program Monitoring and Evaluation system submitted by 59 health departments.† Among 49,266 index patients identified as potential candidates for partner services, 21,191 (43%) were black. The percentage of black index patients interviewed for partner services (76%) was higher than that for all index patients combined (73%). Among the 11,088 black partners named by index patients, 78% were notified of their potential HIV exposure. Fewer than half (47%) of those notified were tested for HIV infection. Among those tested, one in six (17%) received a new HIV diagnosis. The prevalence of newly diagnosed HIV infection was particularly high among black partners who were gay, bisexual, and other men who have sex with men (MSM) (37%) and transgender persons (38%). Effective implementation of partner services is important to identify HIV infection, link patients to care or reengage them in care, and provide prevention services to reduce HIV transmission.


Assuntos
Afro-Americanos/estatística & dados numéricos , Assistência à Saúde/etnologia , Infecções por HIV/etnologia , Parceiros Sexuais , Adolescente , Adulto , Feminino , Infecções por HIV/terapia , Pesquisas sobre Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
7.
Australas J Ageing ; 38(1): 39-46, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30632245

RESUMO

OBJECTIVE: To examine the prevalence and context of racism self-reported by older Aboriginal and Torres Strait Islander people. METHODS: The 2015 National Aboriginal and Torres Strait Islander Survey was used to measure the prevalence, contexts and demographic differences in reports of racism. Multivariable logistic regression was used to examine the association of age with racism in later life. RESULTS: A sizeable minority of older Aboriginal people reported experiences of unfair treatment (31%) and avoidance (15%), oftentimes occurring in contexts critical to human capital investments. Specific demographic groups, including those with higher levels of education, were more likely to report experiences of unfair treatment. The prevalence of unfair treatment and avoidance remains relatively high in later life (albeit lower than younger ages), with a significant reduction from age 65. CONCLUSION: Addressing racism, particularly in contexts crucial to human capital, is important for the health and well-being of older Aboriginal people.


Assuntos
Envelhecimento/psicologia , Aprendizagem da Esquiva , Grupo com Ancestrais Oceânicos/psicologia , Racismo/psicologia , Adolescente , Adulto , Fatores Etários , Idoso , Envelhecimento/etnologia , Atitude do Pessoal de Saúde/etnologia , Austrália , Assistência à Saúde Culturalmente Competente/etnologia , Assistência à Saúde/etnologia , Escolaridade , Feminino , Empregados do Governo/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Opinião Pública , Racismo/etnologia , Fatores de Risco , Autorrelato , Fatores de Tempo , Adulto Jovem
8.
Med Anthropol ; 38(3): 224-238, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29912575

RESUMO

Racial/ethnic identity is contingent and arbitrary, yet it is commonly used to evaluate disease risk and treatment response. Drawing on open-ended interviews with patients and clinicians in two US clinics, we explore how racialized risk is conceptualized and how it impacts patient care and experience. We found that racial/ethnic risk was a common but poorly defined construct for both patients and clinicians, who intermingled concepts of genetics, biology, behavior, and culture, while disregarding historical or structural context. We argue that racializing risk embodies social power in marked and unmarked bodies, reinforcing inequality along racial lines and undermining equitable health care.


Assuntos
Grupos de Populações Continentais/etnologia , Assistência à Saúde/etnologia , Assistência ao Paciente , Racismo/etnologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Responsabilidade Social , Estados Unidos/etnologia , Adulto Jovem
9.
Med Anthropol ; 38(3): 210-223, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30247078

RESUMO

Puerto Rico's politically liminal status as a US territory has dire consequences for Puerto Rico's economy: the island does not receive the same funding as states for health insurance. In addition, Puerto Rico's unraveling health care system, coupled with the island's high poverty rate and the medical brain drain, interact. I weave my research on depression into this article as an example of the ways in which political and economic factors aggravate disease.


Assuntos
Assistência à Saúde/etnologia , Acesso aos Serviços de Saúde , Seguro Saúde , Antropologia Médica , Humanos , Pobreza/etnologia , Porto Rico/etnologia
10.
Anthropol Med ; 26(2): 213-227, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28758798

RESUMO

Health care systems as well as bodies of medical knowledge are dynamic and change as the result of political and social transformations. In recent decades, health care systems have been subjected to a whole assemblage of regulatory practices. The local changes undertaken in Denmark that are being explored here are indicative of a long-term shift that has occurred in many welfare states intended to make public services in the Global North more efficient and transparent. Departing in prolonged field work in Danish general practice and the anthropological literature on audit culture, this paper suggests that the introduction of regulatory practices has enhanced the need for triage as a key organising principle. The term triage literally means separating out and refers to the process of sorting and placing patients in time and space. The paper suggests that an increasing introduction of triage feeds into a reconfiguration of diagnostic work, where the clinical setting is gradually becoming more intertwined with the governing domains of policy, and the work of the secretary is gradually becoming more intertwined with that of the doctor. Finally, the paper argues that an increasing regulation of general practice poses an ethically charged challenge to existing welfare politics of responsibility between the state and the public, as it makes it increasingly difficult to negotiate access to care.


Assuntos
Assistência à Saúde , Medicina Geral , Antropologia Médica , Assistência à Saúde/economia , Assistência à Saúde/etnologia , Assistência à Saúde/legislação & jurisprudência , Assistência à Saúde/organização & administração , Dinamarca/etnologia , Medicina Geral/economia , Medicina Geral/legislação & jurisprudência , Medicina Geral/organização & administração , Medicina Geral/normas , Humanos
11.
Cancer Epidemiol ; 58: 1-7, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30415099

RESUMO

BACKGROUND: The study aimed to examine racial/ethnic differences in chemotherapy utilization by breast cancer subtype. METHODS: Data on female non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic stage I-III breast cancer patients diagnosed in 2011 were obtained from a project to enhance population-based National Program of Cancer Registry data for Comparative Effectiveness Research. Hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) were used to classify subtypes: HR+/HER2-; HR+/HER2+; HR-/HER2-; and HR-/HER2 + . We used multivariable logistic regression models to examine the association of race/ethnicity with three outcomes: chemotherapy (yes, no), neo-adjuvant chemotherapy (yes, no), and delayed chemotherapy (yes, no). Covariates included patient demographics, tumor characteristics, Charlson Comorbidity Index, other cancer treatment, and participating states/areas. RESULTS: The study included 25,535 patients (72.1% NHW, 13.7% NHB, and 14.2% Hispanics). NHB with HR+/HER2- (adjusted odds ratio [aOR] 1.22, 95% CI 1.04-1.42) and Hispanics with HR-/HER2- (aOR 1.62, 95% CI 1.15-2.28) were more likely to receive chemotherapy than their NHW counterparts. Both NHB and Hispanics were more likely to receive delayed chemotherapy than NHW, and the pattern was consistent across each subtype. No racial/ethnic differences were found in the receipt of neo-adjuvant chemotherapy. CONCLUSIONS: Compared to NHW with the same subtype, NHB with HR+/HER2- and Hispanics with HR-/HER2- have higher odds of using chemotherapy; however, they are more likely to receive delayed chemotherapy, regardless of subtype. Whether the increased chemotherapy use among NHB with HR+/HER2- indicates overtreatment needs further investigation. Interventions to improve the timely chemotherapy among NHB and Hispanics are warranted.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Assistência à Saúde/etnologia , Receptor ErbB-2 , Sistema de Registros , Tempo para o Tratamento/estatística & dados numéricos , Afro-Americanos , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/classificação , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etnologia , Assistência à Saúde/estatística & dados numéricos , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu , Feminino , Hispano-Americanos , Humanos , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
12.
Anthropol Med ; 26(3): 328-344, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30572709

RESUMO

Intimate connections between culture and health are complicated by various understandings of the human body, divergent beliefs about reality and place-bound theories about healing. Health care systems in various countries are modified with a goal of creating 'hybrid' structures that make room for traditional practices within a dominant Western model. But genuine intercultural health care is elusive. In Ecuador, a country with great cultural and geographic diversity, the culture-health spectrum is broad and bumpy. This is especially evident in health care politics, education and administration. A constitution adopted in 2008 aims for inclusivity and equality by incorporating indigenous concepts of the 'good life' and ideals of an intercultural society. These new values and perspectives should be reflected in economics, law, education and health care. But these concepts confront a racial, political and economic history that has delegitimized indigenous systems of knowledge and belief. This paper contrasts 'ideal' and 'real' intercultural health care using case studies of the Tsáchila, an indigenous group in coastal Ecuador. The conclusion is that 'ideal' intercultural health care, as reflected in medical school education and clinical practice, is a superficial attempt at dialogue and understanding between indigenous and western medicine. 'Real' intercultural health care involves a more profound level of mutual respect and cross-cultural understanding that aims for symmetry in patient-doctor relationships. Insights from medical anthropology guide the authors through a critical analysis that addresses interculturality as a political issue and a political struggle that the Tsáchilas - like other indigenous groups - are losing.


Assuntos
Assistência à Saúde Culturalmente Competente/etnologia , Assistência à Saúde/etnologia , Medicina Tradicional , Idoso , Antropologia Médica , Equador/etnologia , Humanos , Masculino , Pessoa de Meia-Idade
13.
J Adolesc Health ; 63(2): 257-261, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30149927

RESUMO

Racism can exert negative effects on the self-concepts, health and well-being, and life trajectories of both nondominant racial-ethnic (NDRE) youth and youth-serving providers. In the face of growing nationalism, ethnocentrism, xenophobia, and overt expressions of racism, the Society for Adolescent Health and Medicine recognizes the critically important need to address the issue of racism and its impact on both NDRE youth and youth-serving providers. Organizations involved in clinical care delivery and health professions training and education must recognize the deleterious effects of racism on health and well-being, take strong positions against discriminatory policies, practices, and events, and take action to promote safe and affirming environments. The positions presented in this paper provide a comprehensive set of recommendations to promote routine clinical assessment of youth experiences of racism and its potential impact on self-concept, health and well-being, and for effective interventions when affected youth are identified. The positions also reflect the concerns of NDRE providers, trainees, and students potentially impacted by racism, chronic minority stress, and vicarious trauma and the imperative to create safe and affirming work and learning environments across all levels of practice, training, and education in the health professions. In this position paper, Society for Adolescent Health and Medicine affirms its commitment to foundational moral and ethical principles of justice, equity, and respect for humanity; acknowledges racism in its myriad forms; defines strategies to best promote resiliency and support the health and well-being of NDRE youth, providers, trainees, and students; and provides recommendations on the ways to best effect systemic change.


Assuntos
Grupos Étnicos , Pessoal de Saúde/organização & administração , Grupos Minoritários , Inovação Organizacional , Racismo/etnologia , Discriminação Social/prevenção & controle , Adolescente , Saúde do Adolescente , Assistência à Saúde/etnologia , Assistência à Saúde/normas , Feminino , Pessoal de Saúde/normas , Humanos
14.
PLoS One ; 13(8): e0201887, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30096171

RESUMO

OBJECTIVE: In China, patients increasingly choose to access already severely overcrowded higher level hospitals, leaving lower level facilities with low utilization rates. This situation undermines the effectiveness and efficiency of the health system. The situation tends to worsen despite policy measures aimed at improvement. We systematically review the factors affecting patient choice to synthesize scientific understanding of health system access in China. The review provides an evidence base for measures to direct patient flow towards lower level facilities. METHODS: We screened the peer-reviewed literature published from April 2009 to January 2016 that investigates Chinese patients' choice of health care facilities at different levels and assessed 45 studies in total. We applied two structured forms to extract data on each study's characteristics, methodology, and factors. RESULTS OF DATA SYNTHESIS: The results identified four factor types: 1) patient, 2) provider, 3) context and 4) composite: combined patient, provider, and/or context attributes. Patient factors are mentioned the most, but the evidence on patient factors is often inconclusive. Evidence suggests that the provider factors 'drug variety' and 'equipment', and composite factor 'perceived quality', push patients from lower levels towards higher levels. CONCLUSION: Underuse of primary care facilities and overcrowding of higher level facilities will likely be amplified by current demographic trends. Evidence suggests that improving drug availability, equipment and perceived quality of primary care services can improve the situation. Well-designed research that considers the interactions between factors is called for to better inform future interventions.


Assuntos
Comportamento de Escolha , Assistência à Saúde , Comportamentos Relacionados com a Saúde , China , Assistência à Saúde/etnologia , Comportamentos Relacionados com a Saúde/etnologia , Humanos , Atenção Primária à Saúde
15.
Med Anthropol Q ; 32(4): 539-555, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30015362

RESUMO

While vernacular therapeutics had long been a topic of interest to many writing about medicine and healing in Africa, with a few exceptions most recent anthropological writings on medicine in Africa are focused on biomedicine. In this article, I trace this shift back to the turn of the millennium and the convergence of three events: the emergence of global health, the accession of the occult economies paradigm, and critiques of culturalism in medical anthropology. I argue that these three shifts led to research projects and priorities that looked different from those defined and undertaken as late as the late 1990s. While seeking to avoid the errors that could come with writing about vernacular therapeutic traditions in Africa as bounded comprehensive systems, I argue that there are empirical, political, and practical reasons why medical anthropologists may want to reconsider our collective research priorities.


Assuntos
Assistência à Saúde/etnologia , Saúde Global/etnologia , Medicina Tradicional Africana , África ao Sul do Saara/etnologia , Antropologia Médica , Humanos
16.
Health Hum Rights ; 20(1): 283-293, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30008570

RESUMO

In this paper, I apply Kymlicka's theory of cultural rights to the health care of Canada's First Nations, within the framework of human rights and the rights of indigenous peoples, as formulated by the United Nations. I extend Kymlicka's concept of cultural rights into a specific right to culturally appropriate health care, and I consider how this right can be categorized. I also explore how far the Canadian state recognizes a right to health care in general and to culturally appropriate health care in particular; and whether it has instituted a statutory or constitutional right in these areas. Finally, I consider the same questions with regard to First Nations health care in British Columbia. My conclusions are that the right to culturally appropriate health care is not recognized nationally, or in British Columbia, and that the potential exists to establish such a right politically.


Assuntos
Cultura , Assistência à Saúde/etnologia , Acesso aos Serviços de Saúde , Direitos Humanos/legislação & jurisprudência , Índios Norte-Americanos , Canadá , Competência Cultural , Humanos
17.
PLoS One ; 13(7): e0198781, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30052634

RESUMO

BACKGROUND: Developing guidelines and policies is critical to address HIV-related stigma and discrimination (SAD) in healthcare settings. To this end, a multidisciplinary panel developed a guideline to reduce SAD. This project evaluated the appropriateness of implementing the guideline in the Ethiopian context. METHODS: A consensus of the expert panel was established through a modified Delphi technique which was followed by a panel meeting. Initial tentative recommendations were distributed to experts through e-mails to be evaluated using the modified guideline implementability appraisal (GLIA) v.2.0 checklist. RESULTS: In the first round of the Delphi survey, all (13) panel members evaluated the guideline. The overall score for the general domain of the modified GLIA checklist was 96.56%. The scores for individual recommendations ranged from 68.33% to 92.76%. Maximum and minimum scores were attained for measurability (97.71%) and flexibility (59.77%) domains respectively. Percentages mean score lower than 75% was obtained for flexibility and validity domains. Participants suggested that additional tools and training should be added to the guideline. In the second round of the survey, all the recommendations received endorsement with scores above 75%. Maximum and minimum scores were attained for measurability (100%) and flexibility (86.88%) domains respectively. During the panel meeting, issues of responsibility for implementing the guideline were discussed. CONCLUSION: The project evaluated implementability of a guideline developed to reduce HIV-related SAD in healthcare settings. The Delphi survey was followed by a half-day meeting that helped in further clarification of points.


Assuntos
Consenso , Assistência à Saúde/ética , Infecções por HIV/psicologia , Discriminação Social/prevenção & controle , Grupo com Ancestrais do Continente Africano , Assistência à Saúde/etnologia , Técnica Delfos , Etiópia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/etnologia , Humanos , Guias de Prática Clínica como Assunto , Estigma Social , Inquéritos e Questionários
18.
J Adv Nurs ; 74(11): 2596-2609, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29893491

RESUMO

AIMS: To explore and describe the impact of the organizational culture on and the patient-practitioner patterns of actions that contributes to or detract from successful pain management for the patient with acute abdominal pain (AAP) across the acute care pathway. BACKGROUND: Although pain management is a recognized human right, unmanaged pain continues to cause suffering and prolong hospital care. Unanswered questions about how to successfully manage pain relate to both organizational culture and individual practitioners' performance. DESIGN: Focused ethnography, applying the Developmental Research Sequence and the Fundamentals of Care framework. METHODS: Participant observation and informal interviews (92 hr) were performed at one emergency department (ED) and two surgical wards at a University Hospital during April-November 2015. Data include 261 interactions between patients, aged ≥18 years seeking care for AAP at the ED and admitted to a surgical ward (N = 31; aged 20-90 years; 14 men, 17 women; 9 with communicative disabilities) and healthcare practitioners (N = 198). RESULTS: The observations revealed an organizational culture with considerable impact on how well pain was managed. Well-managed pain presupposed the patient and practitioners to connect in a holistic pain management including a trustful relationship, communication to share knowledge and individualized analgesics. CONCLUSIONS: Person-centred pain management requires an organization where patients and practitioners share their knowledge of pain and pain management as true partners. Leaders and practitioners should make small behavioural changes to enable the crucial positive experience of pain management.


Assuntos
Dor Abdominal/tratamento farmacológico , Dor Abdominal/etnologia , Assistência à Saúde/etnologia , Manejo da Dor/métodos , Manejo da Dor/normas , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Antropologia Cultural , Assistência à Saúde/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Suécia , Adulto Jovem
20.
PLoS One ; 13(5): e0197261, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29771933

RESUMO

OBJECTIVE: To identify and describe the perspectives, experiences, importance, and impact of compassionate care among ethnically diverse population groups. METHODS: A systematic search of peer-reviewed research focused on compassionate care in ethnically diverse populations published between 1946 and 2017 was conducted. RESULTS: A total of 2296 abstracts were retrieved, out of which 23 articles met the inclusion criteria. Synthesis of the literature identified the perspectives, facilitators and barriers of compassion in healthcare within ethnic groups. Compassion was described as being comprised of healthcare provider (HCP) virtues (honesty, kindness, helpful, non-judgment) and actions (smile, touch, care, support, flexibility) aimed at relieving the suffering of patients. The importance and impact of providing compassion to ethnically diverse patients was also identified which included overcoming cultural differences, alleviating distress at end-of-life, promoting patient dignity and improving patient care. This review also identified the need for more contextual studies directly exploring the topic of compassion from the perspectives of individuals within diverse ethnic groups, rather than superimposing a pre-defined, enculturated and researcher-based definition of compassion. CONCLUSIONS: This review synthesizes the current evidence related to perceptions of compassion in healthcare among diverse ethnic groups and the role that compassion can play in bridging ethno-cultural differences and associated challenges, along with identifying gaps in literature related to compassionate care within diverse ethnic groups. Establishing an evidence base grounded in the direct accounts of members of diverse ethnic communities can enhance culturally sensitive compassionate care and improve compassion related health outcomes among diverse ethnic groups.


Assuntos
Assistência à Saúde/etnologia , Empatia , Percepção Social , Atitude do Pessoal de Saúde/etnologia , Pessoal de Saúde/psicologia , Humanos
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