Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 26
Filtrar
1.
J Public Health (Oxf) ; 45(1): e87-e94, 2023 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-35380730

RESUMO

BACKGROUND: Face mask use offers an important public health tool for reducing the spread of coronavirus disease 2019 (COVID-19), yet the politicization of COVID-19 has resulted in uneven adherence. This study assesses the effects of setting characteristics and the sociodemographic composition of crowds on group-level masking rates. METHODS: We conducted 123 site observations of masking behavior at public locations across Oklahoma (USA) between June and September 2020. We used analyses of variance and t-tests to examine variation in masking and ordinary least squares regression to model the effect of setting and sociodemographic characteristics on site-level masking rates. RESULTS: The masking rate across all sites averaged 34% but varied widely. Site-level masking rates were higher at metropolitan sites and sites with a store or municipal masking mandate. The masking rate at sites where women or older adults (60+) were the predominant group did not differ significantly from other sites. Ethnically diverse sites exhibited significantly higher masking rates compared with predominantly white sites. Findings indicate that setting characteristics explained a greater amount of variation in collective masking rates than sociodemographic differences. CONCLUSIONS: This study underscores the importance of place and policy for mask adherence. In the absence of state-level mandates, masking policies at a more local level may be effective.


Assuntos
COVID-19 , Pandemias , Feminino , Humanos , Idoso , Oklahoma/epidemiologia , Pandemias/prevenção & controle , COVID-19/epidemiologia , COVID-19/prevenção & controle , Máscaras , Comportamentos Relacionados com a Saúde
2.
BMC Public Health ; 23(1): 1146, 2023 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-37316843

RESUMO

BACKGROUND: Oklahoma's cumulative COVID-19 incidence is higher in rural than urban counties and higher than the overall US incidence. Furthermore, fewer Oklahomans have received at least one COVID-19 vaccine compared to the US average. Our goal is to conduct a randomized controlled trial using the multiphase optimization strategy (MOST) to test multiple educational interventions to improve uptake of COVID-19 vaccination among underserved populations in Oklahoma. METHODS: Our study uses the preparation and optimization phases of the MOST framework. We conduct focus groups among community partners and community members previously involved in hosting COVID-19 testing events to inform intervention design (preparation). In a randomized clinical trial, we test three interventions to improve vaccination uptake: (1) process improvement (text messages); (2) barrier elicitation and reduction (electronic survey with tailored questions/prompts); and (2) teachable moment messaging (motivational interviewing) in a three-factor fully crossed factorial design (optimization). DISCUSSION: Because of Oklahoma's higher COVID-19 impact and lower vaccine uptake, identifying community-driven interventions is critical to address vaccine hesitancy. The MOST framework provides an innovative and timely opportunity to efficiently evaluate multiple educational interventions in a single study. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05236270, First Posted: February 11, 2022, Last Update Posted: August 31, 2022.


Assuntos
COVID-19 , Vacinas , Humanos , Vacinas contra COVID-19 , Teste para COVID-19 , Oklahoma/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Arch Sex Behav ; 50(7): 3137-3154, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34642837

RESUMO

Minority stigma against sexual minority women and its contributions to these women's health disparities have been widely investigated in Western countries. By contrast, little has been known about minority stigma against women with same-sex attraction (WSSA) in mainland China. This study aimed at exploring the nature, genesis, and pathways of minority stigma among this rarely studied minority group in terms of China's unique social and cultural organization of gender and sexuality. A grounded theory approach was applied to 28 participants of Chinese WSSA through in-depth telephone interviews to elicit their views and perspectives anchored in their daily experiences with gender hierarchy and normative heterosexuality. Findings of this study identified marital pressure and cultural unintelligibility as two principal components of minority stigma against Chinese WSSA. A conceptual framework was developed to illustrate how minority stigma relies on the mutually reinforcing loop of martial pressure and culturally unintelligible status of female same-sex attraction to oppress Chinese WSSA within and across intrapersonal, interpersonal, and structural levels. The parent-daughter relationship, laden with the Confucian value of filial piety, was highlighted as the major pathway of minority stigma to force Chinese women with same-sex attraction into heterosexual marriage and make female same-sex attraction culturally unintelligible. These findings lay a foundation for conceptualizing and measuring minority stigma of Chinese WSSA caused by the stigmatization of their same-sex attraction. Moreover, these findings would contribute greatly to understanding how cultural particularities critically affect the local process of stigmatization through which power relations and social control are practiced.


Assuntos
Casamento , Grupos Minoritários , China , Feminino , Teoria Fundamentada , Heterossexualidade , Humanos
4.
J Elder Abuse Negl ; 29(1): 43-58, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27779448

RESUMO

The problem of how to conceptualize elder mistreatment goes back several decades, and is especially important for ethnic minority populations, who may have perspectives that differ from the dominant society. This community-based participatory research study, which examined perceptions of mistreatment by family among 100 urban and rural older American Indians, permits a rare glimpse into how Native elders themselves understand this issue. Here, good treatment was conceptualized in terms of being taken care of, having one's needs met, and being respected. We found relatively high standards for how elders should be treated-such as the belief that an elder's needs should be anticipated and met without the elder needing to ask-in the face of widespread accounts of the mistreatment of elders within the community, largely through various acts of financial exploitation and neglect. Substance abuse and culture loss were blamed formuch of the elder mistreatment occurring in contemporary Native communities.


Assuntos
Abuso de Idosos/etnologia , Indígenas Norte-Americanos , Idoso , Idoso de 80 Anos ou mais , Características Culturais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Rural , Inquéritos e Questionários
5.
J Elder Abuse Negl ; 28(4-5): 301-319, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27739929

RESUMO

This article provides an overview of the status of research on elder mistreatment among underserved populations in the United States, including gaps in our current knowledge base and scientific and structural barriers to growing research on the exploitation, neglect, and abuse of older people from diverse and disadvantaged ethnic/racial, geographic, sexual identity, and socioeconomic groups. High-priority areas in need of new elder mistreatment research with underserved populations are identified, and suggestions are given for how this research can be facilitated by researchers, university institutional review boards, and funding agencies.


Assuntos
Abuso de Idosos/estatística & dados numéricos , Pesquisa/tendências , Populações Vulneráveis , Idoso , Humanos , Estados Unidos
6.
PLoS One ; 19(3): e0300872, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38536876

RESUMO

Prior research identifies trust as critical to increase vaccine acceptance and uptake. However, few intervention studies have sought to develop or test strategies for bolstering vaccine-related trust. To address this gap, this exploratory study identifies features of COVID-19 vaccine hesitancy interventions that can promote or undermine trust across three interconnected domains: institutional, interpersonal, and product (the vaccine itself). We draw on focus groups (N = 27 participants) with community and university partners involved with hosting COVID-19 testing and vaccine events in underserved Oklahoma communities. Focus groups explored participants' experiences serving community health needs and elicited feedback on proposed vaccine hesitancy interventions. Proposed interventions included two technology-based strategies (text message reminders and tablet-based testimonials and education) and one dialogue-based strategy (anti-body test interpretation). We find that community partners perceived local universities as trustworthy institutions because of their association with popular sports programs, academic credentials, and proximity, creating opportunities to address vaccine-related distrust through community-university partnerships. The most promising intervention strategies for building interpersonal trust included engaging in one-on-one dialogue and using autonomy enhancing approaches. Finally, interventions that successfully encouraged vaccine trust did so by incorporating personalized health information about individuals' potential level of protection and susceptibility to the COVID-19 virus. These findings can inform future public health efforts to create trustworthy vaccine hesitancy interventions.


Assuntos
COVID-19 , Humanos , COVID-19/prevenção & controle , Teste para COVID-19 , Universidades , Vacinas contra COVID-19 , Confiança , Vacinação
7.
Artigo em Inglês | MEDLINE | ID: mdl-38498116

RESUMO

INTRODUCTION: American Indian and Alaska Natives serve in the military at one of the highest rates of all racial and ethnic groups. For Veterans, the already significant healthcare disparities Natives experience are aggravated by barriers to accessing care, care navigation, and coordination of health care within the Veterans Health Administration (VHA) between the VHA and tribal health systems. To mitigate these barriers, the VHA is developing a patient navigation program designed specifically for rural Native Veterans. We describe formative work aimed at understanding and addressing barriers to VHA care from the perspective of rural Native Veterans and those who facilitate their care. METHODS: Thirty-four individuals participated in semi-structured interviews (22 Veterans, 6 family members, and 6 Veteran advocates) drawn from 9 tribal communities across the US. RESULTS: Participants described many barriers to using the VHA, including perceptions of care scarcity, long travel distances to the VHA, high travel costs, and bureaucratic barriers including poor customer service, scheduling issues, and long waits for appointments. Many Veterans preferred IHS/tribal health care over the VHA due to its proximity, simplicity, ease of use, and quality. CONCLUSION: Rural Native Veterans must see a clear benefit to using the VHA given the many obstacles to its use. Veteran recommendations for addressing barriers to VHA care within a navigation program include assistance enrolling in, scheduling, and navigating VHA systems; paperwork assistance; cost reimbursement; and care coordination with the IHS/tribal health care.

8.
Soc Psychiatry Psychiatr Epidemiol ; 48(6): 895-905, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23135256

RESUMO

PURPOSE: To determine conditional risk of posttraumatic stress disorder (PTSD) in two culturally distinct American Indian reservation communities. METHOD: Data derived from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project, a cross-sectional population-based survey that was completed between 1997 and 2000. This study focused on 1,967 participants meeting the DSM-IV criteria for trauma exposure. Traumas were grouped into interpersonal, non-interpersonal, witnessed, and "trauma to close others" categories. Analyses examined distribution of worst traumas, conditional rates of PTSD following exposure, and distributions of PTSD cases deriving from these events. Bivariate and multivariate logistic regressions estimated associations of lifetime PTSD with trauma type. RESULTS: Overall, 15.9 % of those exposed to DSM-IV trauma qualified for lifetime PTSD, a rate comparable to similar US studies. Women were more likely to develop PTSD than were men. The majority (60 %) of cases of PTSD among women derived from interpersonal trauma exposure (in particular, sexual and physical abuse); among men, cases were more evenly distributed across trauma categories. CONCLUSIONS: Previous research has demonstrated higher rates of both trauma exposure and PTSD in American Indian samples compared to other Americans. This study shows that conditional rates of PTSD are similar to those reported elsewhere, suggesting that the elevated prevalence of this disorder in American Indian populations is largely due to higher rates of trauma exposure.


Assuntos
Indígenas Norte-Americanos/psicologia , Características de Residência , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adolescente , Adulto , Análise de Variância , Estudos Transversais , Características Culturais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Violência Doméstica/estatística & dados numéricos , Feminino , Humanos , Indígenas Norte-Americanos/estatística & dados numéricos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Fatores de Risco , Distribuição por Sexo , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Estados Unidos/epidemiologia , Adulto Jovem
9.
J Neuropsychiatry Clin Neurosci ; 22(4): 417-25, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21037127

RESUMO

Little is known about factors that predict older American Indians' performance on cognitive tests. This study examined 137 American Indian elders' performance on the MMSE and the Dementia Rating Scale-Second Edition (DRS-2). Multivariate regression identified younger age, more education, not receiving Supplemental Security Income, and frequent receipt of needed health care as predictors of better performance on the MMSE. Better performance on the DRS-2 was predicted by more education, boarding school attendance, not receiving Supplemental Security Income, and frequent receipt of needed health care. This study points to the importance of economic and educational factors on cognitive test performance among American Indian elders.


Assuntos
Transtornos Cognitivos/diagnóstico , Demência/diagnóstico , Avaliação Geriátrica , Entrevista Psiquiátrica Padronizada , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/etiologia , Demência/complicações , Demência/etnologia , Economia , Etnicidade , Feminino , Humanos , Indígenas Norte-Americanos/psicologia , Transtornos da Linguagem/diagnóstico , Transtornos da Linguagem/etiologia , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Valor Preditivo dos Testes , Análise de Regressão
10.
J Cross Cult Gerontol ; 25(4): 355-69, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21063902

RESUMO

In recent years, a vast literature has accumulated on the negative effects on family caregivers of providing care to elders, while relatively little research has explored caregiving as a positive experience. Only a handful of studies have examined any aspect of informal caregiving among American Indians. This mixed methods study explores the negative and positive aspects of providing elder care among 19 northern plains American Indian family members. These caregivers described low levels of burden and high levels of reward, attributable to cultural attitudes toward elders and caregiving, collective care provision, strong reciprocal relationships with elders, enjoyment of elders, and relatively low levels of care provision. Caregiving manifested as part of a complex exchange of assistance rather than a unidirectional provision of assistance from the family member to the elder. That caregiving emerged as such an overwhelmingly positive experience in a community faced with poverty, alcohol disorders, trauma, and cultural traumatization is testimony to the important roles that elders often continue to play in these communities.


Assuntos
Atitude , Cuidadores/psicologia , Cultura , Família/etnologia , Indígenas Norte-Americanos/psicologia , Relação entre Gerações/etnologia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Assistência Domiciliar , Humanos , Indígenas Norte-Americanos/estatística & dados numéricos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pobreza , Pesquisa Qualitativa , Características de Residência , População Rural , Estados Unidos , Adulto Jovem
11.
J Aging Health ; 19(2): 260-74, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17413135

RESUMO

OBJECTIVE: Residents' cognitive, psychiatric, and behavioral statuses were examined as part of a larger study of care in a nursing home (NH) owned and operated by a Northern Plains American Indian tribe. METHOD: Reviews of 45 medical records and semistructured interviews with 36 staff were completed. RESULTS: Creekside residents had considerable psychiatric and behavioral morbidity. High prevalences of non-Alzheimer's disease dementia, cognitive impairment, anxious symptomatology, and resistance to care were met with psychopharmacotherapy, reorientation, and informal techniques for behavior management. Significant depressive, anxious, psychotic, and behavioral symptoms remained. Staff interpretations of resident problems consisted of an ethnopsychological schema emphasizing resident loneliness, grumpiness, and propensity to "fight" rather than formal psychiatric nosology. DISCUSSION: Tribal NH residents were likely underdiagnosed for dementia and anxiety. Residual behavioral and psychiatric symptomatology suggest room for improvement in the NH's behavioral management regimen. Need for greater attention to conceptual, diagnostic, clinical, and documentation processes in the NH setting is noted.


Assuntos
Atenção à Saúde , Indígenas Norte-Americanos , Transtornos da Memória , Transtornos Mentais , Ansiedade/diagnóstico , Ansiedade/etnologia , Atitude do Pessoal de Saúde , Terapia Comportamental , Humanos , Indígenas Norte-Americanos/etnologia , Entrevista Psicológica , Assistência de Longa Duração , Auditoria Médica , Transtornos da Memória/diagnóstico , Transtornos da Memória/etnologia , Transtornos Mentais/diagnóstico , Transtornos Mentais/etnologia , Casas de Saúde , Recusa do Paciente ao Tratamento/etnologia , Estados Unidos
12.
J Am Med Dir Assoc ; 8(1): 1-7, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17210496

RESUMO

OBJECTIVE: Suboptimal medication use among nursing home (NH) residents is common. NH residents tend to be older, suffer from multiple conditions, and take numerous medications, increasing their risk of serious complications. This article examines pharmacotherapy in a rural, tribally owned NH. DESIGN: Medical records were reviewed and case studies were conducted by a team composed of a medical anthropologist, psychiatrist, and geriatrician. SETTING: A rural, American Indian-owned NH in the US northern plains. PARTICIPANTS: 40 American Indian and 5 EuroAmerican NH residents. MEASUREMENTS: Minimum Data Set assessments, admission records, care plans, social histories, prescription lists, and behavioral consultation reports. RESULTS: Potential underuse affected almost 75% of residents; undertreatment of depressive and psychotic/agitated symptoms was especially common. Potential inappropriate use, especially of analgesics, psychotropics, and antihistamines, affected 30% of residents. A smaller, but still substantial, number of residents (21%) experienced potential overuse, much of which involved anticonvulsants, antibiotics, cardiovascular, and psychotropic agents. The prescription of 10 or more medications was significantly associated with potential drug interactions, as well as underuse, inappropriate medication use, and overuse. CONCLUSIONS: Psychotropic medications were the most potentially problematic medication category, and were strongly implicated in potential underuse, inappropriate use, and overuse. Fewer medications; the discontinuation of drugs known to be potentially problematic for NH residents; modification of psychotropic medication regimens; use of cognitive-enhancing medications where appropriate; implementation of an electronic medical record system; and greater use of nonpharmacological behavioral interventions may have substantially improved residents' treatment regimens.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Indígenas Norte-Americanos , Casas de Saúde , Polimedicação , Padrões de Prática Médica/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Interações Medicamentosas , Revisão de Uso de Medicamentos , Feminino , Avaliação Geriátrica , Necessidades e Demandas de Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Auditoria Médica , Anamnese , Pessoa de Meia-Idade , Casas de Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Serviços de Saúde Rural , Inquéritos e Questionários , Estados Unidos
13.
Gerontologist ; 57(6): 1011-1019, 2017 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-27048710

RESUMO

Dementia is an issue of increasing importance in indigenous populations in the United States. We begin by discussing what is known about dementia prevalence and elder family caregiving in American Indian, Alaska Native, and Native Hawaiian populations. We briefly highlight examples of culture-based programming developed to address a number of chronic diseases and conditions that disproportionately affect these communities. These programs have produced positive health outcomes in American Indian, Alaska Native, and Native Hawaiian populations and may have implications for research and practice in the dementia context of culture-based interventions. Evidence-based and culture-based psychosocial programming in dementia care for indigenous populations in the United States designed by the communities they intend to serve may offer elders and families the best potential for care that is accessible, respectful, and utilized.


Assuntos
Assistência à Saúde Culturalmente Competente , Demência , Serviços de Saúde do Indígena/organização & administração , Indígenas Norte-Americanos , Havaiano Nativo ou Outro Ilhéu do Pacífico , Idoso , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Assistência à Saúde Culturalmente Competente/etnologia , Assistência à Saúde Culturalmente Competente/métodos , Assistência à Saúde Culturalmente Competente/organização & administração , Demência/etnologia , Demência/psicologia , Feminino , Humanos , Masculino , Técnicas Psicológicas , Sistemas de Apoio Psicossocial , Estados Unidos/epidemiologia
14.
Infect Dis Poverty ; 6(1): 95, 2017 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-28569208

RESUMO

BACKGROUND: Taeniasis and cysticercosis are two diseases caused by Taenia solium, a parasite transmitted between humans and pigs, leading to considerable economic loss and disabilities. Transmission of the parasite is linked to environmental and behavioural factors such as inadequate sanitation and hygiene, poor pig management, and consumption of infected pork. This study used implementation research method to design a health education intervention strategy for reducing T. solium infections in Burkina Faso, a country endemic for the parasite. METHODS: Eighteen group discussions were conducted with 8-18 participants each in three villages. In addition, structured interviews were conducted among 4 777 participants and 2 244 pig owners, who were selected through cluster random sampling in 60 villages of three provinces of Burkina Faso. Both approaches assessed knowledge and practices related to T. solium. The information obtained was used to develop a community-adapted health education intervention strategy to control taeniasis and cysticercosis in Burkina Faso. RESULTS: The group discussions revealed that participants had a poor quality of life due to the diseases as well as inadequate access to latrines, safe water, and healthcare services. In addition, it was found that pig production was an important economic activity, especially for women. Furthermore, financial and knowledge constraints were important limitations to improved pig management and latrine construction. The survey data also showed that open defecation and drinking unboiled water were common behaviours, enhanced by a lack of knowledge regarding the transmission of the parasite, perceived financial barriers to the implementation of control measures, lack of public sensitization, as well as a lack of self-efficacy towards control of the parasite. Nevertheless, the perceived financial benefits of controlling porcine cysticercosis could be emphasized by an education program that discourages open defecation and encourages drinking safe water. The final intervention strategy included a Participatory Hygiene and Sanitation Transformation (PHAST) approach, as well as a 52-min film and an accompanying comic booklet. CONCLUSIONS: The main problem in the study communities regarding the transmission of T. solium cysticercosis is the random disposal of human faeces, which can be contaminated with parasite eggs. Prevention of open defecation requires the building of latrines, which can be quite problematic in economically challenged settings. Providing the community with the skills to construct durable latrines using low-cost locally available materials would likely help to resolve this problem. Further studies are required to implement and evaluate the T. solium control strategy developed in this study.


Assuntos
Controle de Doenças Transmissíveis/métodos , Educação em Saúde/métodos , Taenia solium/fisiologia , Teníase/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Burkina Faso , Cisticercose/parasitologia , Cisticercose/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Teníase/parasitologia , Adulto Jovem
15.
Arch Gen Psychiatry ; 61(12): 1197-207, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15583111

RESUMO

BACKGROUND: An explicit clinical significance (CS) criterion was added to many DSM-IV diagnoses in an attempt to more closely approximate the clinical diagnostic process and reduce the proportion of false positives in epidemiological studies. The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) offered a unique opportunity to examine the success of this effort. OBJECTIVE: To determine the impact of distress, impairment, and help-seeking reported in a lay structured interview on concordance with a clinical reappraisal. Further, to test the efficacy of 5 operationalizations of CS on the concordance and prevalence of DSM-IV lifetime disorders. DESIGN: Completed between 1997 and 2000, a cross-sectional probability sample survey with clinical reappraisal of approximately 10% of participants. SETTING: General community. PARTICIPANTS: A population-based sample of 3084 members of 2 American Indian tribal groups, who were between the ages of 15 and 54 years and resided on or near their home reservations, were randomly sampled from the tribal rolls and participated in structured psychiatric interviews. Clinical reappraisals were conducted with approximately 10% of the lay-interview participants. The response rate for the lay interview was 75%, and for the clinical reappraisal it was 72%. MAIN OUTCOMES MEASURES: The AI-SUPERPFP Composite International Diagnostic Interview (CIDI), a culturally adapted version of the CIDI, University of Michigan version. Adapted to assess DSM-IV diagnoses, questions assessing the CS criterion were inserted in all diagnostic modules. The Structured Clinical Interview for DSM-III-R (SCID) was used in the clinical reappraisal. RESULTS: Most participants who qualified as having AI-SUPERPFP CIDI lifetime disorders reported at least moderate levels of distress or impairment. Evidence of increased concordance between the CIDI and the SCID was lacking when more restrictive operationalizations of CS were used; indeed, the CIDI was very likely to underdiagnose disorders compared with the SCID (false negatives). Concomitantly, the CS operationalizations affected prevalence rates dramatically. CONCLUSION: The CS criterion, at least as operationalized to date, demonstrates little effectiveness in increasing the validity of diagnoses using lay-administered structured interviews.


Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Algoritmos , Estudos Transversais , Erros de Diagnóstico/estatística & dados numéricos , Projetos de Pesquisa Epidemiológica , Estudos Epidemiológicos , Humanos , Indígenas Norte-Americanos/psicologia , Indígenas Norte-Americanos/estatística & dados numéricos , Transtornos Mentais/classificação , Modelos Estatísticos , Valor Preditivo dos Testes , Prevalência , Escalas de Graduação Psiquiátrica/normas , Psicometria , Reprodutibilidade dos Testes , Fatores de Risco , Estudos de Amostragem , Sensibilidade e Especificidade , Terminologia como Assunto , Estados Unidos/epidemiologia
17.
Curr Biol ; 25(24): 3161-9, 2015 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-26671671

RESUMO

Existing studies characterizing gut microbiome variation in the United States suffer from population ascertainment biases, with individuals of American Indian ancestry being among the most underrepresented. Here, we describe the first gut microbiome diversity study of an American Indian community. We partnered with the Cheyenne and Arapaho (C&A), federally recognized American Indian tribes in Oklahoma, and compared gut microbiome diversity and metabolic function of C&A participants to individuals of non-native ancestry in Oklahoma (NNIs). While the C&A and NNI participants share microbiome features common to industrialized populations, the C&A participants had taxonomic profiles characterized by a reduced abundance of the anti-inflammatory bacterial genus Faecalibacterium, along with a fecal metabolite profile similar to dysbiotic states described for metabolic disorders. American Indians are known to be at elevated risk for metabolic disorders. While many aspects of this health disparity remain poorly understood, our results support the need to further study the microbiome as a contributing factor. As the field of microbiome research transitions to therapeutic interventions, it raises concerns that the continued exclusion and lack of participation of American Indian communities in these studies will further exacerbate health disparities. To increase momentum in fostering these much needed partnerships, it is essential that the scientific community actively engage in and recruit these vulnerable populations in basic research through a strategy that promotes mutual trust and understanding, as outlined in this study.


Assuntos
Microbioma Gastrointestinal , Indígenas Norte-Americanos , Adulto , Idoso , Idoso de 80 Anos ou mais , Dieta , Feminino , Humanos , Masculino , Metaboloma , Pessoa de Meia-Idade , Oklahoma , Adulto Jovem
18.
Soc Sci Med ; 54(1): 79-91, 2002 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11820683

RESUMO

Residents under age 65 comprise a small, but not insignificant, segment of the US nursing home population--a segment about which very little is known. This article explores the meaningful constitution of nursing home experience among younger, psychiatrically disabled residents of an urban nursing home. Residents' "behavior problems", the difficulties imposed by institutional life, and American age norms emerged as key dynamics in residents' understandings of nursing home life. In addition to these factors, the nursing home was evaluated in relation to previous life experiences, perceived alternatives, and expectations of personal freedom. Ultimately, most younger residents found the nursing home to be a refuge, albeit an imperfect one.


Assuntos
Diversidade Cultural , Ambiente de Instituições de Saúde/normas , Institucionalização , Relação entre Gerações , Pessoas Mentalmente Doentes/psicologia , Casas de Saúde/estatística & dados numéricos , Qualidade de Vida , Adulto , Distribuição por Idade , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/psicologia , Doença Crônica , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Casas de Saúde/normas , Privacidade , Meio Social , População Urbana
19.
J Appl Gerontol ; 33(3): 336-56, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24652864

RESUMO

Although elder mistreatment among ethnic minorities is increasingly gaining attention, our empirical knowledge of this phenomenon among American Indians remains quite limited, especially with respect to measurement. The Shielding American Indian Elders (SAIE) Project used a collaborative approach to explore culturally informed measurement of elder mistreatment in two American Indian elder samples (a Northern Plains reservation and a South Central metropolitan area). The project sought to investigate the performance characteristics of the commonly used Hwalek-Sengstock Elder Abuse Screening Test (HS-EAST), as well as to examine the psychometric properties of a new measure developed to capture culturally salient aspects of mistreatment in American Indian contexts--the Native Elder Life Scale (NELS). Using methods and samples comparable to those in the literature, the HS-EAST performed adequately in these Native samples. The NELS also shows promise for use with this population and assesses different aspects of elder mistreatment than does the HS-EAST.


Assuntos
Assistência à Saúde Culturalmente Competente/métodos , Abuso de Idosos , Programas de Rastreamento/métodos , Psicometria/métodos , Idoso , Competência Cultural , Abuso de Idosos/diagnóstico , Abuso de Idosos/etnologia , Abuso de Idosos/prevenção & controle , Abuso de Idosos/psicologia , Feminino , Avaliação Geriátrica/métodos , Disparidades em Assistência à Saúde/etnologia , Humanos , Indígenas Norte-Americanos/psicologia , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Características de Residência , Estados Unidos/epidemiologia
20.
Transcult Psychiatry ; 51(1): 23-46, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24045407

RESUMO

Whereas recent reports from national studies have presented extremely high rates for many personality disorders in American Indian communities, persistent concerns about the meaning of these symptoms have left many troubled by these reports. American Indians as a group are known to suffer disproportionately from a number of violent experiences, but the dynamics of this violence have received little attention. This paper examines perspectives on violence in the lives of 15 northern plains tribal members who met criteria for antisocial personality disorder and comorbid alcohol use disorder. It explores how study participants constructed and understood their own violent encounters, as well as the motivations they described (characterized here as reputation, leveling, retaliation, catharsis, and self-defense). Violence was gendered in this study, with men generally presenting as perpetrators and women as victims. Men often described themselves as ready participants in a violent world, while women were quite clear that aggression for them was often simply required as they tried to defend themselves from male violence. While this analysis does not replace clinical analyses of violence in antisocial personality disorder, it does reveal an underlying cultural logic that may play a role in shaping the recourse to violence for that minority of individuals for whom it appears to be the obvious choice.


Assuntos
Alcoolismo/etnologia , Transtorno da Personalidade Antissocial/etnologia , Indígenas Norte-Americanos/etnologia , Violência/etnologia , Adolescente , Adulto , Alcoolismo/epidemiologia , Transtorno da Personalidade Antissocial/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noroeste dos Estados Unidos/etnologia , Estados Unidos , Violência/estatística & dados numéricos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA