The Impact of Delays in Low-Income Women's Breast Cancer Experiences.

BACKGROUND: Low-income, underinsured and uninsured women are less likely to be diagnosed via mammogram and more often diagnosed at later stages, with a resultant negative impact on survival. The New Jersey Cancer Education and Early Detection Program provides access to cancer screening services for low-income, underinsured and uninsured individuals. This program was recently evaluated, and it was found that enrollees were more likely to be diagnosed at later stages than nonenrollees, which may be related to delays in diagnosis and treatment OBJECTIVE: The aim of this study was to determine if there were delays in diagnosis and treatment for program enrollees and, if so, what were the causes of these delays. METHODS: A qualitative methodology was used incorporating in-depth interviews with 20 women diagnosed with breast cancer through the New Jersey Cancer Education and Early Detection Program. Qualitative content analysis was used for data analysis. RESULTS: Three themes emerged: poor access to healthcare, lack of knowledge, and sense of spirituality. Nineteen of 20 women experienced delays in care; 9 were diagnosed with late stage (III or IV) disease. CONCLUSIONS: While the lack of insurance was a factor, fear, family needs, and a tendency to not prioritize their own health were additional reasons for delays in diagnosis and treatment. IMPLICATIONS FOR PRACTICE: Programs such as this are integral to the care of low-income, uninsured individuals. However, such programs are not sufficient to meet the needs of low-income women. The lack of a usual source of care is likely to be a factor in the delays these women experienced.

Suicide in Latin America: a growing public health issue.

INTRODUCTION: Suicide has become an international public mental health challenge, resulting in a need for interventions to address it as an individual, family, and community levels. The current scope review assesses trends regarding suicide within Latin America and the Caribbean: risk factors, protective factors, and mediators of suicidal ideation and behavior. Body: Our review is split into three sections, as a way of addressing the complex topic of suicide in an organized, comprehensive manner: (i) epidemiology of suicide in Latin America and Caribbean; (ii) factors associated to suicide ideation and attempts; and (iii) cultural factors as a predictors and mediators of suicide. Further, proper evidence about the association between suicide and cultural dimensions such as Familismo, Machismo/Marianismo, Religion and Acculturation is provided. CONCLUSION: Upon analyzing trends of and factors associated with suicide, we offer recommendations regarding future studies and intervention programs. We conclude that interventions and research should be based on and in response to cultural values and norms related to suicide within each community, in order to make more culturally-specific programs.