bluuebunny/crossref_metadata_2025 huggingface dataset:
Dickinson's Civil War Poetics: From the Enrollment Act to the Lincoln Assassination
Authors: Shoptaw John
Published: July 2012

This article focuses on the significance of the Civil War to Dickinson as a poet. The war not only reflected Dickinson's inner turmoils, it threatened to trivialize them. What did her poems of stoic suffering and private torment matter in a nation at war with itself? How could she aspire to glory on the page when heroes were forming daily on the battlefield? In her struggle to justify her poetics and her bid for poetic fame, Dickinson took various approaches, ranging from ardent identification to aggressive emulation, and from protestations of modesty to outright confessions of envy. The challenge for Dickinson is most evident in the poems she wrote following Lincoln's assassination. How could the poet make her own name while elegizing the martyred president? In these poems, Dickinson found her answer in her role as an elegist whose "deathless syllable" would help make Lincoln's memory immortal.
From God's Work to Fieldwork: Charlotte Tonna's Evangelical Autoethnography
Authors: Rasmussen Bryan B.
Published: July 2012

This essay links the concept of autoethnography with spiritual conversion narrative in order to argue that evangelical autobiography contains the tools not only for spiritual but for cultural selffashioning. What I call spiritual autoethnography was a way of imagining the self in relation to knowledge that turns the (spiritual) self into the condition of (cultural) knowledge. I argue this by way of the radical evangelical social critic Charlotte Elizabeth Tonna, whose autobiography Personal Recollections: Life of Charlotte Elizabeth (1841) harnessed the rhetorical contradictions of evangelical conversion narrative to fashion a method for negotiating ethnic and religious difference at the margins of Britain: in rural Ireland, but also in its London proxy, the Irish slum of St. Giles'. Tonna's spiritual autoethnography allowed for a form of textual selffashioning that transcended the genre of spiritual autobiography to become a model for cultural inquiry 'on the ground,' so to speak--the spiritual self-writer as fieldworker.
Modern Elegy and the Fiction and Creation of Loss: Wallace Stevens's "The Owl in the Sarcophagus"
Authors: Komura Toshiaki
Published: July 2012

Recent scholars have noted the anti-consolatory trend in modern elegy, and remarked on the ways in which twentieth-century elegies revolt against the convention of compensatory consolation in their expression of disconsolation. Using Wallace Stevens's "The Owl in the Sarcophagus" as a test case, this essay proposes a rethinking of our notion of elegiac consolation: instead of reading this allegorical, equivocating poem as an anti-elegy, this article argues, with the aid of D. W. Winnicott's object-relation theory, that the poem's consolation is based less on the mechanism of compensation than on the cryptonymic process of placing an unplaced feeling of loss.
Intimacy, Survival, and Resistance: Daniel Defoe's A Journal of the Plague Year
Authors: Degabriele Peter
Published: July 2012

Reading Defoe's A Journal of the Plague Year alongside Hobbes's Leviathan allows us to rethink the narrative of the division of society into private and public spheres and the political contribution of the novel as a genre. This paper analyses Hobbes's attempt to remove all private sources of authority, including personal revelation, in favour of the public authority of the sovereign. It then argues that Defoe, far from countering this move by valorizing the individual, presents us with an intimate social space which is irreducible to the public or the private spheres and which is not covered by the social contract.
Not thinking of you as Left Behind": Virgil and the Missing of Love in Hardy's Poems of 1912–13
Authors: François Anne-Lise
Published: July 2012

"The Missing of Love" locates Hardy's debt to Virgil in the Poems of 1912-13 in the sequence's reprisal of the episode of Aeneas's forgetting to look behind for Creusa in their flight from Troy. By reading both Hardy's and Aeneas's failures to look behind as inversions of Orpheus' fatal failure not to, the paper asks after the good of this negative power to forget, abandon, take for granted, or leave behind, insofar as it becomes a trope for love between poets, and relates to the strangely imperceptive capacity various philosophical and literary traditions have designated as faith or trust.
Know Thy Side": Propaganda and Parody in Jonson's Staple of News
Authors: Rockwood Catherine
Published: July 2012

Argues that Jonson's 1626 comedy The Staple of News contains a parody, and a detailed critique of, Thomas Middleton's 1624 political satire A Game At Chess . Examines the relevance of the episode to the structure and intent of The Staple of News as a whole, and sets both plays in historical context. Concludes that Jonson's objections to Middleton's play were stylistic and political, in that A Game At Chess can be regarded as pro-war propaganda; discusses the particular reasons for Jonson's aversion to such propaganda.
Frank's Grace / Ramon's Rapture
Authors: Burgwinkle William
Published: July 2012

Sanctity does not require institutional sanction; it can emerge spontaneously through an unreciprocated giving of the self. Frank O'Hara's colloquial love poetry and Ramon Llull's mystical Book of the Beloved , when read against Bataille and Badiou, provide an illustration of this truism as they enact their dramas of secular sanctity.
Le Toucher and the Corpus of Tact: Exploring Touch and Technicity with Jacques Derrida and Jean-Luc Nancy
Authors: Landes Donald A
Published: July 2012

Although Derrida emphasizes touch in the thought of Nancy, he does not engage Nancy's thinking of touch regarding the plurality of the arts. By returning to Nancy's work on sensibility and materiality, touch and bodies, this article links Derrida's Le Toucher to the political and ethical challenges of Nancy's deconstructive project.
Impossible Contact: The Thing in Lacan and Rachel Whiteread
Authors: Malt Johanna
Published: July 2012

The article examines the work of contemporary British artist Rachel Whiteread in the light of Lacan's L'Éthique de la psychanalyse, and particularly his concept of 'la Chose', arguing that Whiteread's work illuminates this concept and the relationship Lacan establishes between the 'container' of signification and the empty space of potentiality it contains
Institutrices et instituteurs français à Madagascar sous la Troisième République (1896–1939): Éléments de compréhension d'un groupe social en situation coloniale
Authors: Duteil Simon
Published: July 2012

This article focuses on a particular social group working in the colony of Madagascar: French teachers, representatives of France's "civilizing mission." While taking gender distinctions into account, it examines the various motives of these teachers for leaving the metropole for a long colonial career, the evolution of school politics and teacher's positions, and their reflections on colonialism and colonized populations. The goal is to cast new light on this important group, which was responsible for educating the Malagassy elite that came to power after independence.
Tribute to William Shorrock (1941–2007)
Authors: Boucher Philip
Published: July 2012

Bill Shorrock, a member of the French Colonial Historical Society for over 25 years, passed away in November, 2007. Philip Boucher offers this remembrance of our colleague and friend and his important place in the Society.
A Culture of Panic: "Communist" Scapegoats and Decolonization in French West Africa and French Polynesia (1945–1957)
Authors: Keese Alexander
Published: July 2012

La confrontation entre militants communistes et gouvernement français à la fin des années quarante et la sympathie des pays du bloc soviétique pour les mouvements de libération en Indochine et au Maghreb influença aussi la vision des administrateurs français dans les deux parties de l'Union française qui étaient largement épargnées de conflits armés violents. En Afrique subsaharienne et en Polynésie, les fonctionnaires coloniaux élaborèrent leur propre interprétation des tensions locales s'appuyant sur le schéma pris des expériences avec le « danger communiste global ». Ils crurent se trouver face à une conspiration communiste générale. Ce fait les anima d'appliquer des contre-mesures souvent hâtives. Dans le cas de l'Afrique subsaharienne, ces réponses eurent même comme conséquence un processus de décolonisation involontaire.
Tattooing and Its Role in French–Native American Relations in the Eighteenth Century
Authors: Balvay Arnaud
Published: July 2012

Au XVIII e siècle, le tatouage est pratiqué par toutes les nations amérindiennes. Les motifs représentés et les fonctions de cet art sont multiples. Rapidement et malgré les préjugés attachés à une telle pratique, officiers français, soldats et coureurs de bois se font eux-aussi tatouer lors de cérémonies, qui s'apparentent à des rituels d'adoption. Le tatouage apparaît alors comme un outil de pouvoir, une marque de reconnaissance que les militaires français utilisent afin d'exister au sein des communautés autochtones.
Remembering the Tirailleurs Sénégalais and the Great War: Oral History as a Methodology of Inclusion in French Colonial Studies
Authors: Lunn Joe
Published: July 2012

Pendant la Première Guerre mondiale plus que 140 000 Ouest-Africains ont été recrutés dans l'armée française de force et ont servi comme combattants en Europe. Cet essai examine un aspect crucial de cette unique rencontre interculturelle: la manière de commémorer les soldats de cette guerre. Ce thème est exploré dans trois contextes temporels et interprétatifs: (1) représentations coloniales françaises au sujet du rôle des Africains en temps de guerre antérieur à 1960, (2) les conventions françaises d'autrefois qui sont mises en question par les historiens des années 1960 à la fin des années 1980, et (3) la révélation des hommes derrière les masques du mythe colonial pendant les quinze ans précédents. L'accent de la dernière section sera mise sur la contribution de l'histoire orale à révéler-après presque 75 années de silence-contre-interprétations africains au sujet de leurs expériences en temps de guerre. En faisant ainsi cet essai illustre des tendances récentes dans l'historiographie interculturelle et dans l'interprétation du passé colonial franco-africain en général.
Connaissance de l'islam et pouvoir colonial: L'exemple de la France au Sénégal, 1936-1957
Authors: Grandhomme Hélène
Published: July 2012

This study urges us to describe and to understand the attitude and the point of view of France on Islam in a particular territory, Senegal, and over a specific period: that of colonialism. In this West African colony, the French policy vis-à-vis Islam and Muslims is at the same time a pragmatic policy and a vision of the other. We thus suppose that it fluctuated, even clashed, but it especially presented a common core syllabus consisting of practices and knowledge.
La Révolution de Haïti vue par deux personnages contemporains: Le scientifique prussien Alexander von Humboldt et l'homme d'état américain Thomas Jefferson
Authors: Rebok Sandra
Published: July 2012

The Haitian Revolution was a historical event that immediately provoked numerous and very different reactions in the New as well as the Old World. It can be regarded as an ideological laboratory for Enlightenment actors, in which they tested how far their principles of liberty, equality, fraternity, and the right to revolt against oppression extended. Their reactions were tightly linked to their personal interests and convictions and their relationship to the political system they inhabited. This study analyzes the different points of view of two personalities with a significant influence on the events and the spirit of their time: the famous traveler and Prussian scientist Alexander von Humboldt (1769–1859) and the Virginian statesman Thomas Jefferson (1743–1826). Emphasis will be on their perception of the incidents in Saint-Domingue and their impact on the outer world, the way they referred to these events in their writings and their personal correspondence, and finally the position they took regarding the new situation of this Caribbean Island.
Traître au colonialisme? The Georges Boudarel Affair and the Memory of the Indochina War
Authors: Edwards M. Kathryn
Published: July 2012

Le 13 février 1991, le Professeur Georges Boudarel a été interpelé, lors d'un congrès au Sénat sur "L'actualité vietnamienne," par un groupe d'anciens combattants, qui l'ont accusé d'avoir été 'commissaire politique' dans le camp Viêt minh 113 et d'être ainsi responsable d'un nombre élevé de morts. "L'affaire Boudarel" a éclaté, provoquant un débat public intense, centré non seulement sur les actions de Boudarel (qu'il qualifiait lui-même d'anticoloniales), mais sur la nature de la guerre d'Indochine et les mérites du projet colonial. La complexité de la guerre, qui était à la fois une guerre coloniale et un point chaud de la guerre froide, a retenti dans ces débats, les défenseurs de Boudarel insistant sur la nature coloniale du conflit, tandis que ses détracteurs ne reconnaissaient que l'objectif anticommuniste des forces françaises. Cet article analyse les débats concernant la nature de la guerre, ainsi que les enjeux médiatiques de la question de la 'mémoire' de la guerre d'Indochine, avant d'élargir la discussion afin de replacer l'affaire Boudarel dans le contexte plus large de la question mémorielle en France.
Governing the Swamp: Health and Environment in Eighteenth-Century Nouvelle-Orléans
Authors: Stange Marion
Published: July 2012

En s'installant, en 1718, dans la région marécageuse de la vallée inférieure du Mississippi, les colons prirent des risques énormes pour leur santé. Les conditions régnant dans les environs de La Nouvelle-Orléans, préjudiciables à la santé humaine, étaient en forte contradiction avec les avantages stratégiques et économiques que la région offrait. Les colons réussirent à s'adapter rapidement à leur nouvel environnement. En plus de s'habituer à la chaleur, à l'humidité, aux marais et aux moustiques, les habitants modifièrent les terres pour qu'elles soient plus adaptées aux besoins des colons et présentent moins de risques sanitaires. Cherchant à se protéger des épidémies et des maladies, les français combinèrent les connaissances des ingénieurs royaux sur place à des méthodes de contrôle des maladies utilisées en Europe. Ayant reçu une formation solide en France, les ingénieurs prenaient en considération les conditions topographiques particulières de la colonie pour créer des méthodes adaptées aux exigences des colons. Les plus importantes de ces mesures furent la construction de levées et le creusement de fossés pour protéger les terres des inondations qui auraient non seulement endommagé les maisons et les récoltes des habitants, mais aussi généré des miasmes. Les fonctionnaires coloniaux tâchaient de prévenir l'apparition des épidémies en promulguant des ordonnances sanitaires très similaires à celles des villes européennes du Moyen Âge et de l'Ancien Régime. En outre, la santé des colons fut améliorée par l'établissement d'hôpitaux très tôt dans le développement de la colonie. Cependant, malgré l'engagement fort des fonctionnaires royaux, toutes ces mesures n'auraient pas pu réussir sans le soutien des colons et leur acceptation des mesures adoptées.
Anderl of Rinn, the Accusation of Jewish Ritual Murder, and the Historical Memory of Childhood
Authors: Kuefler Mathew
Published: July 2012

The legend of Anderl of Rinn is almost unique among the ritual murder accusations lodged against Jews during the Middle Ages and Early Modern Period. The story of Anderl provides a glimpse not only of the long and tragic history of anti-Semitism but also of the history of childhood. Due to a lack of sources, and the fact that his story was not recorded until decades later, it is impossible to gauge the accuracy of any elements of his life or death. The documents that exist, however, do shed an interesting light on the treatment of some children in European history since, without much in the way of facts to work with, the authors who crafted the legend of Anderl of Rinn had little choice but to portray him as a typical child, borrowing elements from the treatment of children both in their own day and in what they knew of the medieval past.
Reflections on the Oral Traditions of the Nterapo of the Salaga Area
Authors: Okoro J. Ako
Published: July 2012

This paper presents initial thoughts on the historical, linguistic, and archeological significance of the oral traditions of Nterapo communities in the Salaga area. As members of a minority, and a commoner group in the Gonja traditional sociopolitical system, the Nterapo have not been recognized as relevant as the Nchumuru and Nawuri, who have been highlighted in historical works as autochthones. Historians, cultural anthropologists, and archeologists on Gonja have often failed to identify the Nterapo as being critical for research.

The Nterapo represent a group whose history goes beyond the time of the introduction of Gonja rule in the Volta Basin from the sixteenth century. There is reason to think that the wars of Gonja expansion in the second half of the sixteenth century were particularly brutal ones, in which well-trained cavalry were pitted against local peasantries poorly equipped to withstand the invaders (Wilks et al. 1986:15). Despite this, the Nterapo survived the invasion by accepting and adapting to the process of state formation and emergence of greater sociopolitical complexity in east Gonja. The settlement history and cultural lifeways of the Nterapo can provide insights for the production of premises, conceptual frameworks, and methodological approaches that would create a deeper understanding of human experience in the Salaga area.

Historical method is a systematic body of principles for gathering, critically examining, and presenting the source material of history (Garraghan 1946:33). Written accounts and the spoken word are two important sources of historical information used for historical, anthropological, and archeological research and writing.
Are Unpublished Sources Best? Reflections on a Seventeenth-Century Dutch Source
Authors: Jones Adam
Published: July 2012

In his excellent edition of the abortive Dutch expedition to capture Elmina Castle on the Gold Coast in 1625, Henk den Heijer has transcribed from records in the Algemeen Rijksarchief the journal by Admiral Jan Dirksz Lam and the resolutions passed by the ships' council. I was puzzled, however, by his decision not to include the anonymous 13-page pamphlet Waerachtich verhael van den gantsche reyse ghedaen by den eersamen Jan Dircksz Lam…, published in Amsterdam immediately after the fleet's return to the Netherlands in 1626. He includes a facsimile of the title page and mentions my own translation of the section dealing with Sierra Leone, but offers no explanation for not including it. Could it be that he considered the printed document somehow less “primary”—and hence less valuable—than the manuscript(s)?

Without wishing to compare both texts in detail, we may look at two examples. In the section on Sierra Leone, where the fleet spent three months, the two sources record a number of things in more or less the same way, albeit in quite different wording: both mention meeting a French yacht from Dieppe, negotiating successfully with the “king” for permission to take water, firewood, limes etc.; both report on a “strange beast” (probably a chimpanzee) which was caught, teased, and eventually thrown overboard. But the pamphlet (pp. 4-8) gives us a wealth of information on the king's appearance (orange stockings, grey hat with orange plumes, etc.), his wives, the military parade he offered in honor of the Dutch, an African interpreter named Herry who had spent a long time in England, and many other topics.
Getting the Quasi-Picture: Twardowskian Representationalism and Husserl's Argument Against It
Authors: Hickerson Ryan
Published: July 2012

This paper advances an account of Twardowski as a representationalist. In particular, Twardowskian representationalism is a blend of what I call resemblance representationalism and mediator-content representationalism. It was not, I argue here, proxy-percept representationalism. Twardowski treated mental contents as "signs" or "quasi-pictures." Husserl was a well-known critic of this view. I additionally argue that Husserl's criticism is grounded in the claim that Twardowski conflated representational content with sensations. The distinction on which this Husserlian criticism rests is between the psychological and ideal contents of consciousness, the cornerstone of the early Husserlian phenomenology.
Peculiar Perfection: Peter Abelard on Propositional Attitudes
Authors: Lenz Martin
Published: July 2012

In the course of the debates on Priscian's notion of the perfect sentence, the philosopher Peter Abelard developed a theory that closely resembles modern accounts of propositional attitudes and that goes far beyond the established Aristotelian conceptions of the sentence. According to Abelard, the perfection of a sentence does not depend on the content that it expresses, but on the fact that the content is stated along with the propositional attitude towards the content. This paper tries to provide an analysis and a consistent interpretation of Abelard's arguments within the framework of the mediaeval models of language and mind.
Increasing Mammography Screening among African American Women in Rural Areas
Authors: Powell Mary Edith , Carter Vivian , Bonsi Eunice , Johnson Gwendolyn , Williams Licia , Taylor-Smith Lucile , Hayes Quanita , Hull Pamela C , Cain Van A , Husaini Baqar A
Published: July 2012

The objective of this study was to evaluate the effectiveness of a church-based breast cancer screening education program on mammography attainment by African American women 40 years old and older in rural Alabama. The sample consisted of 192 women who volunteered to participate in the study through 13 African American churches in a rural, economically-depressed Alabama county. The design was quasi-experimental and had some features of community-based participatory research. Churches were randomly assigned to three groups (full program, partial program and control). The full program (group educational session plus an in-home visit from a Home Health Educator) positively affected mammography attainment (38% increase from baseline to Time 2). In addition, barriers to mammography attainment were reduced for women who had not obtained a mammogram by follow-up. Community-based participatory projects in collaboration with churches and cooperative extension programs have the potential to reduce racial disparities in breast cancer in rural areas.
HIV Risk Behaviors, Knowledge, and Prevention Service Experiences Among African American and Other Offenders
Authors: Belenko Steven R , Shedlin Michele , Chaple Michael
Published: July 2012

African Americans are at the intersection of the AIDS epidemic and burgeoning prison and offender populations, yet little is known about offenders' HIV knowledge and risk behaviors or ability to access effective services. We present findings from an exploratory study based on 300 interviews with New York City offenders conducted in 2001–2002. The data indicate relatively high rates of HIV infection and HIV risk behaviors among African American and other offenders. There were no clear patterns of risk behaviors by race/ethnicity. Although overall HIV knowledge level is high, important gaps in HIV knowledge remain and there is widespread skepticism among offenders about government information about HIV/AIDS. In the corrections setting, there is inconsistent access to HIV prevention and education services, and an emphasis on more passive learning materials. To reduce HIV infection rates, there is a need to expand peer-led and culturally- and gender-specific interventions, and to improve access to correctional facilities for community-based HIV service providers. HIV interventions must also be expanded for offenders on probation and parole. Mandatory HIV education and harm reduction approaches should be considered.
Racial Disparity and the Legitimacy of the Criminal Justice System: Exploring Consequences for Deterrence
Authors: Taxman Faye S , Byrne James M
Published: July 2012

Minority (over) representation in the criminal justice system remains a puzzle, both from a policy and an intervention perspective. Cross-sectional reviews of the policies and practices of the criminal justice system often find differential rates of involvement in the criminal justice system that are associated with the nature of the criminal charge/act or characteristics of the offender; however, longitudinal reviews of the race effect often show it to be confounded by procedural and extralegal variables. This review focuses on how the cumulative policies and practices of the criminal justice system contribute to churning, or the recycling of individuals through the system. In conducting our review, we describe how the same criminal justice processes and practices adversely affect select communities. The consequences of policies and procedures that contribute to churning may affect the legitimacy of the criminal justice system as a deterrent to criminal behavior. A research agenda on issues related to legitimacy of the criminal justice system aimed at a better understanding of how this affects individual and community behavior is presented.
The Effect of Socioeconomic Status on the Survival of People Receiving Care for HIV Infection in the United States
Authors: Cunningham William E , Hays Ron D , Duan Naihua , Andersen Ronald , Nakazono Terry T , Bozzette Samuel A , Shapiro Martin F
Published: July 2012

HIV-infected people with low socioeconomic status (SES) and people who are members of a racial or ethnic minority have been found to receive fewer services, including treatment with Highly Active Antiretroviral Therapy (HAART), than others. We examined whether these groups also have worse survival than others and the degree to which service use and antiretroviral medications explain these disparities in a prospective cohort study of a national probability sample of 2,864 adults receiving HIV care. The independent variables were wealth (net accumulated financial assets), annual income, educational attainment, employment status (currently working or not working), race/ethnicity, insurance status, use of services, and use of medications at baseline. The main outcome variable was death between January 1996 and December 2000. The analysis was descriptive and multivariate adjusted Cox proportional hazards regression analysis of survival.

By December 2000, 20% (13% from HIV, 7% non-HIV causes) of the sample had died. Those with no accumulated financial assets had an 89% greater risk of death (RR=1.89, 95% CI=1.15–3.13) and those with less than a high school education had a 53% greater risk of death (RR=1.53, 95% CI=1.15–2.04 ) than their counterparts, after adjusting for sociodemographic and clinical variables only. Further adjusting for use of services and antiretroviral treatment
diminished, but did not eliminate, the elevated relative risk of death for those with low SES by three of the four measures. The finding of markedly elevated relative risks of death for those with HIV infection and low SES is of particular concern given the disproportionate rates of HIV infection in these groups. Effective interventions are needed to improve outcomes for low SES groups with HIV infection.
Identifying Areas for Improvement: Results of a Medicaid Managed Care Diabetes Survey
Authors: Pasley Beverly , Roohan Patrick J , Wagner Victoria , Novak Joyce , Gesten Foster
Published: July 2012

This study explores factors that contribute to dissatisfaction for Medicaid managed care enrollees with diabetes. Using results from a mail survey of 2,104 Medicaid managed care enrollees with diabetes, multivariate logistic regression models were fit for 3 outcomes: dissatisfaction with diabetes information from doctor or nurse, dissatisfaction with diabetes care received and dissatisfaction with health plan. Across the 3 models, enrollees who reported they were in poor health, who failed to engage in self-management activities, who reported little or inadequate patient education and/or who had difficulty accessing diabetes care were more likely to report dissatisfaction. The results of this study will be used to propose interventions that Medicaid managed care plans can initiate to improve satisfaction of enrollees with diabetes.
Limited Health Care Access Impairs Glycemic Control in Low Income Urban African Americans With Type 2 Diabetes
Authors: Rhee Mary K , Cook Curtiss B , Dunbar Virginia G , Panayioto Rita M , Berkowitz Kathy J , Boyd Barbara , George Christopher D , Lyles Robert H , El-Kebbi Imad M , Phillips Lawrence S
Published: July 2012

Limited access to health care is associated with adverse outcomes, but few studies have examined its effect on glycemic control in minority populations. Our observational cross-sectional study examined whether differences in health care access affected hemoglobin A1c (HbA1c) levels in 605 patients with diabetes (56% women; 89% African American; average age, 50 years; 95% with type 2 diabetes) initially treated at a municipal diabetes clinic. Patients who had difficulty obtaining care had higher A1c levels (9.4% vs. 8.7%; p=0.001), as did patients who used acute care facilities (9.5%; p<0.001) or who had no usual source of care (10.3%; p<0.001) compared with those who sought care at doctors' offices or clinics (8.6%). In adjusted analyses, HbA1c was higher in persons who gave a history of trouble obtaining medical care (0.57%; p=0.04), among persons who primarily used an acute care facility to receive their health care (0.49%; p=0.047), and in patients who reported not having a usual source of care (1.08%; p=0.009). Policy decisions for improving diabetes outcomes should target barriers to health care access and focus on developing programs to help high-risk populations maintain a regular place of health care.
The Care System Assessment Project: Values-based Health Care Planning and Delivery
Authors: Aranda-Naranjo Barbara
Published: July 2012

This is a commentary on the Care System Assessment (CSA) Project, utilizing a values-based health care framework to review the process undertaken by the three participating Ryan White CARE Act grantee sites. The CSA Project participants' dedication to the well-being of their communities reinforced the inclusion, active involvement, and participation of all stakeholders. That key community members had previously chosen not to participate in planning efforts or seek care because of stigma and fear in new immigrant populations was noted by all three sites as a major issue to address in their future planning. The sites selected for the CSA Project demonstrated that community-based Planning Councils, engaged with representatives from the target population, can assess, identify, and provide effective interventions sensitized to the needs of underserved, resilient clients. They also demonstrated that meeting these needs to enhance the common good of the community may require an increased respect for diversity. The CSA Project is one leadership exemplar of providers and clients coming together to find the common good of quality health care for people living with HIV and AIDS These grantee providers and their clients are intimately engaged in this paradigm shift and are taking the lead to redefine the type of health and support services they must provide within the context of the U.S. health care system.
Implementing the CSAD Process
Authors: Mejía Luis , Kedar Leah
Published: July 2012

This article describes the implementation of the Care System Assessment Demonstration (CSAD) Project. The article examines issues related to the participation of the community in the assessment of needs and systems of care for out-of-care minority populations living with HIV/AIDS. It describes methods to engage the local community, work with stakeholders, create consensus, and produce policy recommendations and action plans that are based on the culture and specific needs of the populations targeted by systems of HIV/AIDS care.
Understanding How Contextual Realities Affect African Born Immigrants and Refugees Living with HIV in Accessing Care in the Twin Cities
Authors: Othieno Joan
Published: July 2012

The Rapid Assessment, Response, and Evaluation (RARE) portion of the CSAD Project in the Twin Cities (Minneapolis–St. Paul, Minnesota) was designed to identify barriers to care faced by African refugees and immigrants. Data were collected from cultural experts and African people living with HIV (PLWH) who were out of care, who had newly entered care, or who were in and out of care. Findings from RARE can be categorized into five main themes: HIV/AIDS within the African context, experiences of African PLWH, unfamiliarity with HIV and support services that facilitate access to care, cultural and religious dilemmas in seeking or remaining in care, and accessing African PLWH and getting them into care. Most of the issues identified were manifestations of stigma, gender, religion and/or faith, as well as the two main underlying cross-cutting themes of knowledge and fear. The top barriers to care included fatalistic views about HIV, fear of isolation, fear of deportation, lack of knowledge of the care system and HIV-related services, and employment issues.
Disparities in Regular Source of Dental Care among Mothers of Medicaid-Enrolled Preschool Children
Authors: Grembowski David , Spiekerman Charles , Milgrom Peter
Published: July 2012

For mothers of Medicaid children aged 3 to 6 years, we examined whether mothers' characteristics and local supply of dentists and public dental clinics are associated with having a regular source of dental care. Disproportionate stratified sampling by racial/ethnic group selected 11,305 children aged 3 to 6 in Medicaid in Washington State. Mothers (n=4,373) completed a mixed-mode survey that was combined with dental supply measures. Results reveal 38% of mothers had a regular dental place and 27% had a regular dentist. Dental insurance, greater education, income, length of residence, and better mental health were associated with having a regular place or dentist for Black, Hispanic, and White mothers, along with increased supply of private dentists and safety net clinics for White and Hispanic mothers. Mothers lacking a regular source of dental care may increase oral health disparities disfavoring their children.
The Oral Health Status of Adolescents in Northern Manhattan
Authors: Mitchell Dennis A , Borrell Luisa N , Lassiter Shana L , Formicola Allan J
Published: July 2012

Objectives. This study was designed to describe the oral health status of adolescents residing in northern Manhattan. Methods. Clinical, demographic, and behavioral data were collected from 3,282 youths who ranged in age from 12 to 16 years. Clinical examinations were performed by two trained examiners. Demographic and behavioral data were self-reported. Results. The adolescents were predominantly Hispanic/Latino and Black/African American (94%), with 6% falling into other racial categories. Caries were discovered in a significant proportion of these youths (52% of Hispanics, 54% of Blacks and 54% of others). Despite similar caries experiences, the oral health disease burden was not evenly distributed across groups. In many cases, Hispanic youths demonstrated less disease and more frequent engagement in oral health promoting behaviors than their non-Hispanic peers. Gender differences were less consistent. Conclusions. Economically disadvantaged and minority youths, such as those residing in northern Manhattan, continue to be unduly burdened by untreated dental disease. Further, our data suggest that certain subpopulations may be particularly vulnerable to dental disease. This vulnerability underscores the need for accessible services addressing the oral health needs of these segments of the population. Finally, effective community-based oral disease prevention and health promotion programs are sorely needed to improve these youths' oral health.
Consumer Evaluation of a Disability Care Coordination Organization
Authors: Palsbo Susan E , Ho Pei-Shu
Published: July 2012

Disability care coordination organizations (DCCOs) arrange comprehensive, disability-competent social and medical services for people with disabilities. This study used consumer ratings of access and quality to measure outcomes in one of the first operational DCCOs over a three-year period. Working-age Medicaid adults with physical disabilities reported statistically significant improvements in service coordination, patient education, system-wide disability competency, comprehensive assessment, health visit support, and self-direction of care. Global quality ratings showed statistically significant and sustained improvement over two years, with the percentage of people rating the health system as excellent rising from 7% before enrollment to 44% in the DCCO. The percentage of people rating primary care physicians as excellent rose from 18% before enrollment to 38% in the DCCO. Over time, enrollees became more knowledgeable about the need for preventive health care services, were more likely to receive needed care and medical equipment, and reduced their need for rehabilitation therapies. Disability care coordination organizations can reduce disparities and improve access to care for this vulnerable population.
De Facto Mental Health Services in the Rural South
Authors: Fox Jeanne , Merwin Elizabeth , Blank Michael
Published: July 2012

Health care reform efforts highlighted the continuing scarcity of mental health services for the rural poor. Most mental health services are provided in the general medical sector, a concept first described by Regier and colleagues in 1978 as the de facto mental health service system, rather than through formal mental health specialist services. The de facto system combines specialty mental health services with general medical services such as primary care and nursing home care, ministers and counselors, self-help groups, families, and friends. The nature of the de facto system in rural areas with large minority populations remains largely unknown due to minimal available data. This article examines the availability, accessibility, and use of mental health services in the rural South and the applicability of the de facto model to rural areas. The critical need for data necessary to inform changes in health care relative to rural mental health service delivery is emphasized.
Community-Based Hypertension Control Programs That Work
Authors: Kong B. Waine
Published: July 2012

Hypertension is the number one public health problem in the United States, particularly among African Americans. Although the National High Blood Pressure Education Program, started in 1972, led the way to a substantial decrease in morbidity and mortality from this disease, the percentage of African American hypertensives whose conditions are detected, treated, and controlled continues to lag behind that of white hypertensives. Community-based programs at locations where people congregate—for example, churches, barbershops, beauty salons, firehouses, housing projects, and worksites—can play a valuable role in increasing the number of African American hypertensives who receive treatment. Physicians can be a potent force for the development of these programs by acting as consultants to define the scope and function of lay volunteers and by promoting these programs in a variety of other ways.
Cancer Screening in Homeless Women: Attitudes and Behaviors
Authors: Long Heather L. , Tulsky Jacqueline P. , Chambers Donald B. , Alpers Leila S. , Robertson Marjorie J. , Moss Andrew R. , Chesney Margaret A.
Published: July 2012

Little is known about the use of cancer-screening services in homeless women and their attitudes about early detection programs. Face-to-face interviews were conducted with homeless women in San Francisco to determine rates of clinical breast exams, mammograms, and Pap smears. A total of 105 women were randomly selected from two homeless shelters. By self-report, 51 percent were current on clinical breast exams, 47 percent on mammograms, and 54 percent on Pap smears. These women had very positive attitudes toward receiving cancer-screening exams. In multivariate analyses, discussion about cancer prevention with a health care provider predicted current clinical breast exams and mammograms. More medical visits predicted being current on mammograms and Pap smears. Although homeless women represent a unique group of the urban poor, they are accessing cancer-screening exams at rates comparable to the general population.
Access to Treatment for Depression in a Medicaid Population
Authors: Melfi Catherine A. , Croghan Thomas W. , Hanna Mark P.
Published: July 2012

Mentally ill Medicaid recipients represent a population that may be vulnerable to limited access to adequate treatment for their mental illness. In this study, depressed Medicaid recipients were compared with those with private insurance. Also examined were racial differences among the Medicaid recipients in the treatment of depression. It was found that in comparison with Medicaid patients, the privately insured patients who are treated with antidepressants are more likely to receive the newer selective serotonin reuptake inhibitors (SSRIs) rather than the older tricyclic antidepressants (TCAs). In the Medicaid group, African Americans are more likely to receive TCAs than are white patients. Privately insured patients are more likely to receive psychotherapy than are Medicaid patients. There is a higher rate of continuous therapy on initial antidepressants in the privately insured group. Results suggest that depressed Medicaid recipients' access to quality mental health care is restricted. Also, among depressed Medicaid patients, there are racial differences with regard to depression treatment.
HIV Prevention in U.S. Asian Pacific Islander Communities: An Innovative Approach
Authors: Loue Sana , Lloyd Linda , Loh Leng
Published: July 2012

Few HIV prevention efforts have focused on Asian Pacific Islander communities in the United States. Prevention messages developed for the general U.S. population have failed to reach many Asian Pacific Islanders. This article describes the development of an HIV prevention strategy for Asian Pacific Islanders through health care workers. This strategy was based on the ecological disease theory and action research methodology. The prevention program comprised four components: (1) a symposium for the health care workers, (2) a culturally sensitive and appropriate HIV-related video for the health care workers and their patients, (3) ongoing training of the health care providers, and (4) ongoing liaison and consultative services for the health care providers. The intervention is intended to encourage HIV risk-reduction behaviors among the patients, to encourage the HIV testing of those who may be at risk for HIV, and to facilitate access to services for those found to be infected.
A Health-Profile Comparison of Delinquent and Homeless Youths
Authors: Forst Martin L. , Harry Jonathan , Goddard Phil A.
Published: July 2012

Little is known about the health status and health care needs of homeless and delinquent youths. This study provides medical data (medical history and physical examination) on samples of delinquent (n=245) and homeless (n=160) youths in San Francisco, CA. Although homeless youths had somewhat more medical problems than did delinquent youths, both groups had a multiplicity of medical problems, many of which were worse than among the general adolescent population. A substantial percentage of both samples did not have adequate health care coverage. Medical services to high-risk youths should be improved by providing street outreach, public health clinics, and multiservice centers for adolescents.
Finding the Medically Underserved: A Need to Revise the Federal Definition
Authors: Wright Richard A. , Andres Terry L. , Davidson Arthur J.
Published: July 2012

The relationship between the primary service area (PSA) of an urban community health center (CHC) program and a federally defined "medically underserved area" (MUA) was assessed. Federal guidelines that most reliably predicted medical underservice were identified. The service area was statistically defined by census tract penetration rates. The MUA was defined by an index of medical underservice (IMU) according to federal parameters of physician supply, poverty level, percentage elderly persons, and infant mortality. An index score was calculated for the county, service area, and each census tract. Analysis by tract determined the most significant discriminating parameters. By excluding two tracts concentrated with managed-care physicians, the service area qualified as an MUA. Tracts that fulfilled MUA and service area criteria were highly associated ( p < 0.0001). Only poverty level and infant mortality were useful discriminating parameters. Federal indicators of demand (elderly population) and supply (physicians) did not adequately address issues to access for the medically underserved in urban neighborhoods. Other parameters that might serve as proxies of care access and underserved are discussed.
Health Status and Access to Care Among Rural Minorities
Authors: Mueller Keith J. , Ortega Suzanne T. , Parker Keith , Patil Kashinath , Askenazi Ahuva
Published: July 2012

This paper provides a review of the scholarly and applied literature published between 1970 and 1993 on health and health care access problems among racial and ethnic minority group members living in rural U.S. areas. Results on the distribution of specific illnesses and diseases, and utilization of medical services are summarized for two major minority groups—African Americans and Hispanic Americans. Findings generally document the expected pattern of rural and minority disadvantage. A review of the conceptual and methodological limitations of existing research suggests that research does not yet permit any clear understanding of the underlying structures and processes that give rise to racial health disparities. Very little is known about the health of rural minorities living in some areas of the country, for example, the west north central United States (Kansas, Missouri, Nebraska, Iowa, North Dakota, South Dakota and Minnesota).
Preparing for Managed Care: Family Practice Residents and Capitated Care in Community Health Centers
Authors: Zweifler John
Published: July 2012

This article examines the financial impact on patients of family practice residents when a community health center (CHC) serving as a residency training site is converted to a capitated payment system. The costs in this analysis included using and educating family practice residents at CHCs, the cost of patient encounters at CHCs, and the cost of contracted capitated services. These costs were measured against capitated per member per month (pmpm) payments received by the CHC. If capitated patients were cared for by residents, the CHC would lose $8.42 pmpm. The CHCfaced a $5.98 pmpm loss if it used staff physicians rather than residents. This analysis suggests there are educational costs associated with training physicians in capitated health care delivery systems. Family practice residencies and CHCs must prepare for the conversion to capitated systems; academic centers with managed care contracts must control patient encounter costs and utilization to remain competitive.