Browsing by Subject "health disparities"
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Item Beyond cultural competency: Using literature to foster socially conscious medicine(2008-07-07) J. Ernest Aguilar; Anne Hudson Jones, Ph.D.; Sayantani DasGupta, M.D., M.P.H.; Robert Bulik, Ph.D.; Howard Brody, M.D., Ph.D.; Harold Y. Vanderpool, Th.M., Ph.D.For at least the past three decades, training programs in cultural competency have enjoyed increasing popularity in medical schools and in continuing medical education. Proponents of cultural competency generally hold that when physicians and other health-care professionals are trained in cultural issues, there will be a reduction in race-based disparities in both the access to and the quality of health care. Yet there has been little evidence to support this claim. Further, a conceptual analysis of cultural competency suggests that this type of training may serve only to maintain or further aggravate the current state of affairs faced by cultural and racial minorities. New pedagogical models are needed. These models will need to include an opportunity (and the support) for the unlearning of old patterns of viewing society. Participants will need to reflect on the social factors and structures that are more likely to lead to race-based disparities. These factors include but are not limited to a legacy of interracial hostility and mistrust, the unjust distribution of social power, and a defective understanding of the proper posture to be taken towards the one that is other. Educational theories that promote participatory, transformative, and reflective learning experience must be used to shape new educational efforts. Reforms in medical education can draw more heavily from the theories developed by scholars in literature and medicine. These theorists argue that the development of narrative skills contributes to improved communication across interpersonal differences. Further, many scholars agree that reading well-written works of literature contributes to the skill required for recognizing injustice and engaging in the moral and ethical reflection needed to address it.Item Changes in the prevalence of cognitive impairment among older Americans, 1993-2004: Overall trends and differences by race/ethnicity and socioeconomic status(2010-03-03) Kristin Marie Sheffield; M. Kristen Peek; Rebeca Wong; Mukaila Raji; Laura Rudkin; Fredric WolinskyResearch indicates that the health of the older population in the United States, as measured by most dimensions, has improved over the past two decades. Population-level changes in health have been attributed to increases in education and income and improvements in the treatment and control of disease. Recent research suggests that rates of cognitive impairment have declined as well; however, results have been inconsistent and most studies have included only two time points in the analysis. This project used data from six waves of the Health and Retirement Study to achieve the following aims: 1) determine if the prevalence of cognitive impairment among older adults declined from 1993 to 2004, and 2) determine if the pattern of change in cognitive impairment was consistent across racial/ethnic and socioeconomic groups. Analyses investigated whether changes in demographic, socioeconomic, and health status and behavior variables contributed to overall and group-specific trends. Sampling weights applied to each wave of data enabled merged waves to represent comparable cross-sections of the community-dwelling older population in the United States in each respective year of study. Logistic regression analyses employing cognitive impairment as the dependent variable and a time trend variable as the key independent variable were used to analyze trends. Results showed an annual decline in the prevalence of cognitive impairment of -3.4% per year, adjusting for changes in the age and gender distributions of the population as well as prior test exposure. Increases in educational attainment in the population accounted for the trend. Racial/ethnic and socioeconomic disparities in the prevalence of cognitive impairment decreased considerably between 1993 and 2004. Declines in the prevalence of cognitive impairment were greater for blacks and Hispanics compared to whites and for lower education and wealth groups compared to more advantaged groups. Overall and group-specific trends did not appear to be due to selection bias resulting from changes in rates of mortality or attrition of HRS respondents over time. Improvements in the socioeconomic status of the population have contributed to declines in the prevalence of cognitive impairment among older adults—particularly blacks and Hispanics—in the United States.Item The Relationships among race/ethnicity, physical activity, education and cognitive function in late middle age(2007-08-13) Meredith Carolyn Masel; M. Kristen Peek, Ph.D.; Susan C. Weller, Ph.D.; Mulaila Raji, M.D., M.S.; Laura L. Rudkin, Ph.D.; Fredric D. Wolinsky, Ph.D.OBJECTIVES: This study describes cross-sectional and longitudinal racial/ethnic differences in cognitive function scores (memory and mental status), and the mediating roles of education and physical activity in late middle aged adults. The purpose of the study is to explain racial/ethnic disparities in cognitive function scores. METHODS: The Health and Retirement Study collected data on men and women aged 51-61 in the United States from 1992-2002 (n = 9204) of the following racial/ethnic groups: black, Hispanic, and white. Multivariable and mixed modeling techniques were used to describe racial/ethnic disparities on tests of memory and mental status (orientation, attention, naming), and to determine if physical activity or education mediated the relationship between race/ethnicity and cognitive function scores. Models were adjusted for demographic, social, and health-related covariates. RESULTS: Black and Hispanic adults had lower memory and mental status scores than whites (p<0.0001). However, in a subsample of those working for pay, Hispanic adults had no differences in mental status scores from their white counterparts. Leisure-time physical activity and education mediated some relationships between race/ethnicity and cognitive function scores, and were associated with cognitive function scores at each wave. Nevertheless, physical activity, education, and race/ethnicity were not associated with differential rates of change in cognitive function scores. CONCLUSIONS: Racial/ethnic differences in cognitive function scores exist in late middle age. Leisure-time physical activity and education partially mediate the relationships; however the covariates used in the analyses were unable to explain all of the differences. Although being white or Hispanic, increased education, increased vigorous activity, and less work-related physical activity were associated with higher memory scores, none differentially impacted rates of change in memory score. Being white and increased education were positively related to mental status scores at each wave. However, no variables of interest were associated with differential rates of mental status score change.Item Sociodemographic Factors and Coping with Pediatric Asthma(2016-12) Leija, Annette; Rodriguez, Erin M; Keith, Timothy ZThe purpose of this study was to examine the associations among sociodemographic factors (SES, parent language, race/ethnicity) and coping in children with asthma, and to examine if asthma-related stress accounts for this relationship. Correlational analyses were used to examine the association among SES variables, parent language, and coping, and t-tests were used to examine if coping differed by child race/ethnicity. Regression analyses examined if stress accounted for the associations between sociodemographic variables and coping. Results indicated that asthma-related stress explained the association between income and primary control coping, and between income and secondary control coping.