bluuebunny/crossref_metadata_2025 huggingface dataset:
Slipping Through the Safety Net: Implications for Women's Health
Authors: Pearlman Deborah N.
Published: July 2012

The failure of the 104th Congress to pass legislation that would have provided universal health care coverage has created gaping holes in the health care safety net for the working poor. As a result, the number of Americans without health insurance, which was 37 million in 1992, could reach 50 million in 1998. Current changes in welfare policy, centered on reform of the joint federal-state program Aid to Families with Dependent Children (AFDC), have further redefined the safety net for the poor. These changes may jeopardize the health of poor women as any change in eligibility requirements for AFDC also limits eligibility for Medicaid. Given the financial and social difficulties facing poor women, a growing number of researchers are redefining what constitutes research on women's health. Research is needed on how the high rates of health problems and few health resources of poor racial/ethnic minority women affect their quality of life.
Managed Care: Theoretical or Practical
Authors: Bowles Robert L.
Published: July 2012

Managed care organizations that serve the poor face unique challenges. Not only must they empower their enrolled populations with awareness and knowledge about the benefits of being enrolled, but they must also provide significant outreach, offer services that are sensitive to urban and rural concerns, and stress health education and disease prevention. The managed care model offers efficiency and effectiveness that can place providers on the leading edge of not only providing solutions that address the needs of the underserved, but being competitive in servicing these populations.
A Randomized Trial to Improve Follow-Up Care in Severe Uncontrolled Hypertensives at an Inner-City Walk-In Clinic
Authors: Ahluwalia Jasjit S. , McNagny Sally E. , Kanuru Narendra K.
Published: July 2012

A single-blinded, randomized trial was conducted to determine whether a mailed postcard improved follow-up in uncontrolled hypertensives. One hundred and seven patients with a systolic blood pressure (BP) of 180 or more or a diastolic blood pressure of 110 or more at an inner-city, hospital-based walk-in clinic were enrolled; mean age was 56 years, 95 percent were African American, 73 percent were female, and mean BP was 193/106. Patients were required to be aware of their diagnosis and to have been informed of their need for medication at least a month before the trial. Of those who received postcard reminders, 45 percent followed up within 10 days, compared with 47 percent of controls ( p = 0.93). At 30 days, 64 percent of the intervention group followed up, compared with 55 percent of controls ( p = 0.36). In an adjusted logistic regression model, there was no difference in follow-up. Correlates of appointment noncompliance at one month included alcoholism and lack of insurance in an adjusted logistic regression model. Follow-up in severe hypertensives was poor, and a mailed postcard reminder had no effect in a walk-in setting.
Interaction of Hallucinogenic Compounds with Cholinergic Receptors
Authors: Kopsombut P , Maleque MA
Published: July 2012

Tetrahydroisoquinoline (TIQ) compounds are plant alkaloids and structurally similar to hallucinogenic agents. We have found that these compounds inhibit cholinergic transmission at the frog neuromuscular junctions. We also observed that they induce contractions and potentiate acetylcholine-induced contractions of the rat ileum. The purpose of this study was to determine the interaction of these compounds with nicotinic and muscarinic acetylcholine receptors. Rat cortical tissues were used for receptor binding assays. In nicotinic receptor binding studies, up to 1 mM, they did not displace α-Bungarotoxin. However, they displaced quinuclidinyl benzilate (QNB) from muscarinic receptor binding sites. The IC 50 values of the TIQs varied from 29 to 380 μM. Binding data suggest that they interact with muscarinic but not nicotinic receptors. It is therefore concluded that TIQ compounds inhibit neuromuscular transmission by decreasing acetylcholine release and potentiate smooth muscle contractility by activating muscarinic receptor and possibly other sites. (Supported by NSF R11-8904140)
Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education
Authors: Tervalon Melanie , Murray-García Jann
Published: July 2012

Researchers and program developers in medical education presently face the challenge of implementing and evaluating curricula that teach medical students and house staff how to effectively and respectfully deliver health care to the increasingly diverse populations of the United States. Inherent in this challenge is clearly defining educational and training outcomes consistent with this imperative. The traditional notion of competence in clinical training as a detached mastery of a theoretically finite body of knowledge may not be appropriate for this area of physician education. Cultural humility is proposed as a more suitable goal in multicultural medical education. Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and nonpaternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations.
Health Care Utilization and Service Needs of Homeless Substance Users
Authors: Moore RE , Hoven CW , Chiang P
Published: July 2012

Homeless adults who use alcohol or drugs are at high risk of accidents, injury, victimization, and physical health problems. In this study, we examine how such variables as current entitlement benefits (e.g., Medicaid and /or Medicare), physical health and mental health status, demographics, and other factors, including length of homelessness, account for hospitalization and use of emergency-room and substance-use detoxification services in the preceding three years. Data for this study are based on 1,000 randomly surveyed adults residents (848 male, 152 female) of the New York City shelter system. 1 Alcohol and drug use was determined from multiple scales and will be analyzed and presented accordingly. These measures include a lifetime measure of problem-drinking based on the Short Michigan Alcoholism Screening Test; two scales measuring symptoms of dependence on both alcohol and drugs in the last year; lifetime treatment history and detoxification for alcohol and drug use; and use by type of substance (heroin, amphetamines, barbiturates, etc.) in the preceding five-year period (five-, three-, one-year, and six months). Treatment needs are measured by respondent and interviewer ratings of 20 service needs, including substance-use treatment. Logistic regression results reveal significant relationships of past and recent alcohol use/ dependence with medical, psychiatric, and substance treatment hospitalization and detoxification in the preceding three years. Entitlements were significantly associated with psychiatric inpatient stay and substance-use detoxification in the preceding six months. Finally, homeless adults with substance-use histories self-reported and were interviewer-rated as having significantly more service needs than those without substance-use histories. Implications of study findings will be presented in relationship to improving access to treatment services for homeless persons.
Meeting the Needs of the Poor and Underserved Under Health Care Reform
Authors: Lavizzo-Mourey Risa
Published: July 2012

President Clinton's health care reform plan is premised on six principles: security, simplicity, savings, choice, quality, and responsibility. To the extent that negotiations with Congress and others to arrive at the final reform package respects the primacy of these principles, the President's plan will meet the needs of America's poor and underserved.
Health Care Reform: What it Might Mean to Urban Public Hospitals
Authors: Johnson Robert B.
Published: July 2012

Health care reform proposals may affect public hospitals in a number of ways. To insure that such proposals benefit the underserved communities within which public hospitals operate, reform initiatives should be evaluated against 10 criteria that emphasize prevention and primary care, community health education, cost control, tort reform, and community values.
Findings from a Demonstration Outreach Project at a Community Health Center
Authors: Stoskopf Carleen H. , Samuels Michael E. , Ciesla James R.
Published: July 2012

Outreach using personal contact was a cornerstone of the federally funded Community Health Center (CHC) movement of the 1960s. Funding cuts and changes in federal policy have led to the discontinuation of this activity in most CHCs. This paper assesses aspects of a demonstration outreach project designed to encourage use of a CHC in Orangeburg, South Carolina. The evaluation shows that this type of outreach effort, which includes door-to-door canvassing, can identify specific needs for primary health care services in a poor under served community, and can enhance community access to Medicaid, although the financial impact of bringing poor patients into CHCs by means of this type of outreach is relatively low.
How Tennessee Finances Medicaid
Authors: Dixon Roscoe
Published: July 2012

Tennessee is fortunate to have a comprehensive Medicaid program involving some 22 optional services, all financed through a combination of state revenues. These range from general state revenues to provider-donated funds, provider-specific taxes, and recently, a privilege tax. The state pays approximately $920 million to participate in Medicaid; the state's share generates $1.9 billion in federal dollars. The current system for financing the state's Medicaid program is unsustainable. Because Tennessee is relatively poor, legislators cannot afford to continue to increase its share of Medicaid expenditures at a rate 10 times greater than the general revenue increase from the entire state. To continue a comprehensive Medicaid program, Tennessee must move forward with alternative strategies to control Medicaid expenditures and manage resources.
Future Management Opportunities for Minorities in Managed Care
Authors: Phillips Janis Nero
Published: July 2012

Current proposals for health care reform emphasize managed care in an effort to achieve universal coverage and access to health care for all Americans. One of the many strategies to achieve this goal is to create a new health care workforce by supporting the recruitment and education of health professionals from population groups underrepresented in health care. To help insure that the managed care industry will be adequately prepared to face the challenges of reform, the Group Health Foundation of the Group Health Association of America, Inc., has crafted an innovative Minority Training Program—a management training program in the field of managed care. The program involves resident fellows who will train in select health maintenance organizations (HMOs) in the Washington, DC/Baltimore metropolitan area. To augment training, the fellows will simultaneously participate in a comprehensive didactic program especially designed to prepare each fellow for a first or middle-management position in an HMO or a similar managed care organization. Following successful completion of the first years in Washington, DC, the program will be broadened to other geographical areas.
Mental Health Services: Critical Component of Integrated Primary Care and Substance Abuse Treatment
Authors: Brach Cindy , Falik Marilyn , Law Colleen , Robinson Gail , Trent-Adams Sylvia , Ulmer Cheryl , Wright Arnette
Published: July 2012

The documented high incidence of mental health disorders among individuals in substance abuse treatment argues for the importance of studying the provision of mental health services to this population. This survey documents how the Linkage Programs assembled an array of mental health services based on the assessed health care needs of clients. Specialty and nonspecialty personnel addressed the extensive mental health needs of ethnically diverse, multiproblem clients with substance abuse problems. The innovative use of nonconventional providers, however, did not eliminate the shortfall between the number of clients with mental health problems and the number who were referred to and received mental health services; nor did it enable all Linkage Programs to address the mental health needs of the most severely ill clients. There is a continuing need to forge relationships between mental health providers and integrated providers of primary care and substance abuse treatment.
Correlates of Health Insurance Coverage: Evidence from the Midwest
Authors: Comer John , Mueller Keith
Published: July 2012

The Midwest is often overlooked in national studies of health insurance status. We analyzed the economic and social characteristics of uninsured and underinsured individuals and households in a Midwestern state using both bivariate and multivariate techniques. As in much of the country, economic factors, particularly income and employment, were most significant in accounting for insurance coverage. Unexpectedly, rural and urban residents were equally likely to lack insurance. Results indicate that in rural areas, underinsurance may be a greater problem than uninsurance, and that income-based health insurance is more effective than employer-provided plans in reaching all Americans.
Impact of Care Setting on Cost and Quality Under Medicaid
Authors: Bronstein Janet M. , Johnson Victoria A. , Fargason Crayton A.
Published: July 2012

Medicaid claims data were used to compare the costs and care quality of ambulatory visits for two childhood illnesses, urinary tract infection (UTI) and suppurative otitis media (OM), in the fee-for-service Medicaid program in Alabama across three care settings: offices where patients had been seen before, offices where patients had not been seen before, and outpatient hospital departments. Forty percent of UTI visits and 46 percent of OM visits occurred in return office settings. Visits to outpatient hospital and first-time office settings were more expensive than those to return office settings, due to the billing of facility fees and the provision of additional services. Adherence to common measures of quality of care for both types of visits was low; 52 percent of UTI visits included urine cultures and 40 percent of OM visits included recheck visits. Adherence to these quality measures was significantly lower in visits occurring in hospital settings.
Severity of Spousal and Intimate Partner Abuse to Pregnant Hispanic Women
Authors: Wiist William H. , McFarlane Judith
Published: July 2012

Abuse to pregnant women can result in complications to maternal and child health. This study assessed the severity of intimate male partner abuse to Hispanic pregnant women receiving prenatal care at an urban public health department. The mean age of the 329 pregnant, abused Hispanic women was 24 years. The women had an average of eight years of education, annual incomes of less than $10,000, and most spoke only Spanish. In all, 30 percent of the women had been threatened with death, 18 percent had been threatened with a knife or gun, 80 percent had been shaken or roughly handled, 71 percent pushed or shoved, and 64 percent slapped on the face and head. Pregnant, abused Hispanic women experience abuse of sufficient severity to pose a risk to maternal and child health. Prenatal care provides a window of opportunity for routine abuse assessment and counseling for low-income, Hispanic pregnant women.
Effects of Calcium Channel Entry Blockers on Cocaine-and Amphetamine-Induced Locomotor Activity in Rats
Authors: Ansah TA , Wade LH , Shockley DC
Published: July 2012

The effects of calcium channel entry blockers (CCEBs) on the spontaneous locomotor activity induced by submaximal and toxic doses of cocaine and amphetamine were determined. Rats were habituated to an automated activity monitor for 30 min, then administered cocaine (0.30-60 mg/kg) or amphetamine (0.04-5 mg/kg), i.p. and data collected for 30 min. CCEBs were administered 30 min prior to the administration of stimulants. Cocaine produced a dose-dependent increase in locomotor activity and stereotypy behavior with a maximum response at 40 mg/kg. Amphetamine produced similar increases in locomotor and stereotypy behavior with a maximum response at 0.6 mg/kg. Nimodipine (5 mg/kg) but not amphetamine (0.3 mg/kg) decreased (p<0.01) cocaine (20 mg/kg)-induced activity and stereotypies. Diltiazem (20 mg/kg) reduced (p<0.01) the stereotypies produced by cocaine but not the cocaine-induced locomotor activity or the stimulant action of amphetamine. Nifedipine (2 mg/kg) inhibited (p<0.05) the stereotypy behavior stimulated by amphetamine (0.3 mg/kg) but not that by cocaine. Nimodipine (5 mg/kg) and nifedipine (2 mg/kg) increased the number of convulsions and lethalities produced by toxic doses of cocaine (40 and 60 mg/kg). The CCEBs also potentiated the toxicity produced by amphetamine (2.5 and 5 mg/kg). The results of this study underscore the variability in the antagonism of the actions of psychomotor stimulants by CCEBs. (Supported by DA 06686)
Health Care Access and Advocacy for Immigrant and other Underserved Elders
Authors: Yee Donna L.
Published: July 2012

Little is known about health care access and advocacy for elders of color, and even less is known about immigrant elders, whose growing number is the major reason that almost one of every three older persons in the U.S. by the year 2050 will be an elder of color. This paper explores a number of access barriers faced by underserved elders, including inequitable long-term care services and counterproductive "colorblind" approaches to caregiving. It also addresses barriers, such as problematic immigration policies, that present particular challenges to elderly immigrants. While available materials provide baseline information and help providers learn about underserved elders, real change in how target populations gain access to health and social services comes when providers make explicit efforts to improve the accessibility and quality of services.
Implementing Breast and Cervical Cancer Prevention Programs Among the Houma Indians of Southern Louisiana: Cultural and Ethical Considerations
Authors: Coughlin Steven S.
Published: July 2012

This paper provides an overview of the ethical and cultural issues that were taken into account in planning a cross-cultural study of barriers to breast and cervical cancer screening among Houma Indian women who reside in Terrebonne Parish, Louisiana. In such cross-cultural studies, the investigators and members of the target population are from different cultural backgrounds. In planning the study, ethical principles and cultural norms were carefully specified to ensure that the welfare of the participants would be protected and potential benefits maximized. This experience with the Houma Indian Nation illustrates the need for greater participation of research subjects in the planning and implementation of studies on their behalf. An ethical, culturally sensitive approach to cancer control research is needed to address the health concerns of Native American populations.
A Group Counseling Model for Developing Manhood Among Black Male Adolescents
Authors: Lee Courtland
Published: July 2012

The session began with the showing of a videotape on successful African-American men in America. The audience was a combination of young black men and adult observers. After the audience watched the videotape, Dr. Lee demonstrated his model in a brief discussion with the young men. Later he explained the model to the adults.
Prenatal Care Use and Health Insurance Status
Authors: Oberg Charles N. , Lia-Hoagberg Betty , Skovholt Catherine , Hodkinson Ellen , Vanman Renee
Published: July 2012

Many observers explain the prevalence of inadequate prenatal care in the United States by citing demographic or psychosocial factors. But few have evaluated the barriers faced by women with different health insurance status and socioeconomic backgrounds. In this study of 149 women at six hospitals in Minneapolis, insurance status was significantly related to the source of prenatal care (p<.0001). Private physicians cared for 52 percent of privately insured, 23 percent of Medicaid-insured, and two percent of uninsured women. Public clinics were the primary source of care for Medicaid and uninsured women, who, compared to privately insured women, experienced longer waiting times (p<.001) during prenatal visits and were more likely (p<.01) to lack continuity of care with a provider. Multiple measures, including expanding Medicaid eligibility, may help correct these problems.
Relationships Between Socioeconomic Status and Race-Specific Cervical Cancer Incidence in the United States, 1973-1992
Authors: Liu Tiepu , Wang Xingqiu , Waterbor John W. , Weiss Heidi L. , Soong Seng-Jaw
Published: July 2012

The association between low socioeconomic status (SES) in minority groups and higher incidence and mortality from cervical cancer was examined using two large U.S. databases. With cases from 1973 to 1992, all registries of the Surveillance, Epidemiology, and End Results (SEER) (except Hawaii) were used to calculate incidence rates of in situ and invasive cervical cancers by race group. SES indicators were derived from the Regional Economic Information System, Department of Commerce. Higher levels of SES indicators were related to decreased risk and lower incidence of invasive cancers in all race groups, but especially white and black populations, and to increased incidence of in situ cancer in these populations. Results suggest that higher SES status is related to a decrease in invasive cervical cancer, but an increase in in situ cervical cancer in recent years. These findings may explain the racial differences in cervical cancer incidence and help target intervention programs.
The Medically Vulnerable: Their Health Risks, Health Status, and Use of Physician Care
Authors: Broyles Robert W. , McAuley William J. , Baird-Holmes Diane
Published: July 2012

Employing the Andersen/Neuman model of health behavior, this research compares the medically vulnerable (elderly, poor, and uninsured) with their less vulnerable counterparts with regard to (1) health and disability status, (2) likelihood of physician use, and (3) (among users) amount of physician use. Data were from the Oklahoma Behavioral Risk Factor Surveillance Survey and the Area Resource File. Findings indicate that the medically vulnerable are more likely to be disabled and to experience poorer health than the nonmedically vulnerable. The uninsured are less likely to have seen a physician in the past year. Among those who have seen a physician in the past year, the uninsured and Medicare recipients without supplemental insurance experienced fewer physician visits. The results point to inequalities in the distribution of physician care that may be exacerbated by federal policies that are currently under consideration.
Violence in Schools: Why-and What Can We Do About it?
Authors: Gilbert Shirl E.
Published: July 2012

This paper discusses the causes and effects of the violence that occurs in schools. The author explores the notion of need (to be a part of, to belong, and to be connected) as it relates to the tendency toward violence, and conversely, the association between success in school, which allows for the development of positive self-esteem and therein socially acceptable behavior, with a tendency toward nonviolence. The paper explains how behavioral factors common to poor and disadvantaged students, such as a lack of esteem for self and for their educational institution contributes to a failure cycle. The paper also suggests that the development of the affective domain, coupled with sensitivity to culture, good instruction, and an educational environment that nurtures success, leads to an effectively functioning individual with a social, economic, political, and ethnic identity.
Cardiovascular Disease in African American and White Physicians: The Meharry Cohort and Meharry-Hopkins Cohort Studies
Authors: Thomas John , Thomas D. Johniene , Pearson Thomas , Klag Michael , Mead Lucy
Published: July 2012

Differences in cardiovascular disease (CVD) were studied in a cohort of medical students from the classes of 1958-65 of Meharry Medical College (n = 435), all African Americans, and the classes of 1957-64 of Johns Hopkins University (n = 580), all white. At baseline, African Americans were older (27 vs. 24 years, p = 0.001), more likely to smoke (71 vs. 47 percent), had greater body mass index (24 vs. 23 kg/m), and had higher systolic blood pressure (120 vs. 116 mmHg). At follow-up (23-35 years later), African American physicians had higher CVD risk (RR = 1.65, 95% CI = 1.3-2.41), higher incidence of coronary artery disease (1.4 times), and much higher case fatality (51.5 vs. 9.4 percent). Risk factor levels in youth can predict CVD events several years later; predictors may differ between racial groups. Best predictors were cigarette smoking, cholesterol, and paternal history in white physicians, and blood pressure in African American physicians.
Frailty, Family, and Church Support Among Urban African American Elderly
Authors: Bowles Jacqueline , Brooks Theodore , Hayes-Reams Phyllis , Butts Trudi , Myers Hector , Allen Walter , Kington Raynard S.
Published: July 2012

A community-based survey of 507 African Americans aged 60 and older from South Central Los Angeles was conducted to estimate the prevalence of frailty and describe the correlation between frailty, social support from family and church, and use of community services. Persons were considered frail if they met criteria for any of four conditions: functional impairment, depression, urinary incontinence, falls. Sixty-seven percent met criteria for frailty. Analyses revealed that frail elderly were significantly less likely to report feeling very close to family. Family contact, feeling that church was important, and receiving church support were similar for the frail and nonfrail. Frail elderly were more likely to use community services. These findings suggest that frail elderly in this population may not receive more support from family and church than nonfrail elderly. There is a need for caution when assuming families and churches in urban African American communities are able to support the most vulnerable elderly.
Racial and Ethnic Differences in Health Insurance for the Near Elderly
Authors: Pol Louis G. , Mueller Keith J. , Adidam Phani Tej
Published: July 2012

Recent increases in the number of Americans without health insurance have spurred research designed to identify factors related to noncoverage. One age group receiving recent attention is the near elderly, persons 55 through 64 years of age. This paper brings together health insurance research on the near elderly with that focused on racial and ethnic differences in coverage. Logistic regression is used to study the factors that predict whether or not an individual has health insurance coverage. Results indicate that even after accounting for health insurance correlates such as education and income, non-Hispanic African Americans and Hispanics have a significantly higher probability of not having coverage than their non-Hispanic white counterparts. The results are discussed in terms of recent efforts to reshape public policy regarding health insurance, especially proposals that would affect the Medicare program.
Building Community Capacity to Prevent Violence Through Coalitions and Partnerships
Authors: Chavis David M.
Published: July 2012

This paper will explore the most effective strategic roles that coalitions can play in the prevention of complex, entrenched social and health problems such as violence, alcoholism, and other substance abuse problems. There is a growing body of "wisdom" and research literature that suggests that the most effective role for community coalitions and partnerships in terms of prevention is to build the capacity of community leaders and their institutions to better serve their constituencies. This can be accomplished through the use of the coalition to strengthen the enabling or support system for community initiatives. An enabling system provides a variety of services, including training and consultation, information and referral, networking and local coalition development, communication, incentive grants and recognition, information and social marketing, resource development, and research and evaluation services. This paper also outlines the key internal capacities a coalition will need in order to establish this system.
Access to Care Among Vulnerable Populations Enrolled in Commercial HMOs
Authors: Carlson Matthew J. , Blustein Jan
Published: July 2012

This cross-sectional study compares self-reported access to care among a representative sample of 13,952 HMO enrollees in New Jersey. Using multivariate logistic regression, this study found that compared with college graduates, those with less than a high school education reported more difficulty obtaining tests or treatment. Compared with whites, Hispanics were more likely to report difficulty seeing their primary care provider, and African Americans reported greater difficulty seeing a specialist and obtaining tests and treatment. Enrollees in poor health were more likely to report problems seeing a specialist and obtaining tests and treatment than enrollees in excellent health. Income was not a consistent predictor of access. Nonfinancial barriers appear to be more influential than financial barriers for predicting access problems in commercial HMOs. More work is needed to identify the source of nonfinancial barriers to care among vulnerable populations.
"I Have a Future" Comprehensive Adolescent Health Promotion: Cultural Considerations in Program Implementation and Design
Authors: Greene Lorraine Williams , Smith M. Shelton , Peters Sheila R.
Published: July 2012

"I Have a Future" Adolescent Health Promotion Program is a life options program. The program uses the Nguzo Saba (seven principles) and African philosophy to systematically address violence and attitudes reinforcing the use of violence. The Nguzo Saba promotes self-respect, and commitment to and support for developing a positive community. Data was collected from four public housing developments-two served as match control sites. Adolescents residing in neighborhoods in which the program operated had greater acceptance of the Nguzo Saba than those in matched communities. Those who perceived themselves as having life options engaged in fewer delinquent/violent acts. There was a strong negative correlation between the acceptance of the Nguzo Saba and the number of reported delinquent/violent behaviors. There was a positive relationship between the acceptance of the Nguzo Saba and positive self-concept, psychosocial maturity, and clarity of goals.
Prior Nonfatal Firearm Injuries in Detainees of a Large Urban Jail
Authors: May John P. , Ferguson Martha G. , Ferguson Richard , Cronin Karen
Published: July 2012

Detainees of large urban jails have many health risks including injuries related to violence and firearms. A survey of 582 randomly selected detainees entering the Cook County Department of Corrections during the summer of 1994 found that 51 percent had previously entered hospitals for violence-related injuries, and 26 percent survived prior gunshot wounds. Patterns of firearm injuries were different from patterns of violence affecting the general population. Factors common to those with prior firearm injuries included witnessing a shooting at an early age, tattoos, previous sexually transmitted diseases, easy access to a semiautomatic weapon, and prior incarceration. Implications and prevention strategies are discussed.
African Americans' Beliefs and Attitudes Regarding Hypertension and Its Treatment: A Qualitative Study
Authors: Lukoschek Petra
Published: July 2012

Since low adherence rates contribute to morbidity and mortality among hypertensive African Americans, health beliefs known to influence nonadherence must be explored. Hypertensive African Americans were recruited from an urban, public hospital and divided into two categories: adherent, well-controlled versus nonadherent, poorly controlled participants. Separate focus group sessions were held for each category. Participants proved similar with respect to sociodemographic variables but varied in the duration of hypertension. Some beliefs were mentioned more often among nonadherent participants than among adherent participants when describing medical treatments and physicians' encounters. Some participants perceived medication to be harmful and noneffective, and some expressed distrust of pharmaceutical companies and physicians, believing them to use patients for experimentation to test medications. Their descriptions of dialogues with physicians suggested authoritarian and ethnicity-inappropriate communication patterns. To reduce the nonadherence rate among African Americans, it may be necessary to integrate health beliefs into educational interventions and physician-patient communication.
Racial/Ethnic Disparities in Adult Preventive Dental Care Use
Authors: Doty Hilary E. , Weech-Maldonado Robert
Published: July 2012

Using the Behavioral Model of Health Services Utilization, this study examines whether adult preventive dental care utilization differs by ethnicity/race. Logistic regression results find that controlling only for predisposing characteristics (gender, age, education, and health status), African Americans, Mexican Americans, and Other race/ethnicity are less likely than whites to utilize dental services. However, the effects are no longer significant when enabling resource variables are included in the model (income level, insurance, census region, and metropolitan statistical area). Interactions between race/ethnicity and insurance status show that privately insured racial/ethnic minority groups do not differ from privately insured whites in their utilization of dental services. Similarly, the preventive dental care utilization of publicly insured African Americans and Other Hispanics does not differ significantly from privately insured whites. However, publicly insured whites, Mexican Americans, and individuals of Other race/ethnicity have significantly lower odds of utilizing dental services relative to whites with private insurance.
Tuberculosis Cases Reported Among Migrant Farm Workers in the United States, 1993-97
Authors: Schulte Joann M. , Valway Sarah E. , McCray Eugene , Onorato Ida M.
Published: July 2012

Migrant farm workers (MFWs) are considered a high-risk group for tuberculosis. MFW tuberculosis cases reported to the Centers for Disease Control and Prevention represented 1 percent of all reported tuberculosis cases from 1993 to 1997. Most of these cases (70 percent) were reported from Florida, Texas, and California. MFW tuberculosis cases were more likely to be male, foreign-born, or Hispanic and to have a history of alcohol abuse and homelessness than were non-MFWs. Most (79 percent) foreign-born MFWs were from Mexico. HIV status was poorly reported, with results available for only 28 percent of MFW and 33 percent of non-MFW cases. Of the MFWs tested, 28 percent were HIV infected, whereas 34 percent of non-MFWs were HIV infected. Twenty percent of MFWs move or are lost to follow-up before completing therapy; these cases pose a management challenge for the nation's tuberculosis control efforts.
Low-Income Californians' Experiences With Health Insurance and Managed Care
Authors: Backus Lisa I. , Bindman Andrew B.
Published: July 2012

California is rapidly implementing mandatory managed care for most of its Medicaid (Medi-Cal) beneficiaries. To assess the impact of this delivery system change, the authors analyzed a 1996 statewide population-based random-sample telephone survey of 3,563 adults between the ages of 18 and 64. Respondents with Medi-Cal managed care and Medi-Cal fee-for-service rated access to care and quality of care significantly higher than uninsured respondents yet lower than low-income privately insured individuals. While the authors did not find a difference in health care access and quality among Medi-Cal managed care enrollees compared with Medi-Cal fee-for-service enrollees, they also did not find that managed care provided any observed advantages to Medi-Cal recipients.
Later-Stage Cancer in Relation to Medically Underserved Areas in Connecticut
Authors: Polednak Anthony P.
Published: July 2012

Health status indicators, including advanced stage at diagnosis of cancer, have been proposed as indicators of health care access and quality to be considered in revising the definition of medically underserved areas (MUAs). Using the population-based Connecticut Tumor Registry, "outlier" census tracts were defined as those that had a high proportion of breast, colorectal, or cervical cancer diagnosed at later stage, relative to all tracts in the state. In the six Connecticut cities that had MUAs, MUAs comprised the majority of outlier tracts, but non-MUA outliers were often located on the fringes of MUAs. The findings are discussed in relation to revising the criteria for defining MUAs and to targeting interventions for early detection of cancer in urban areas.
The Disabilities Convention: Human Rights of Persons with Disabilities or Disability Rights?
Authors: Mégret Frédéric
Published: July 2012

The UN Convention on the Rights of Persons with Disabilities is about more than making sure that existing human rights are applied to persons with disability. It also subtly reformulates and extends existing human rights to take into account the specific rights experience of persons with disability. In fact, the argument can be made that the Convention comes close to creating new rights, or at least very new ways of seeing common rights. This suggests a deeper point about the fragmentation of international human rights law and the increasingly recognized need to take into account the irreducibility of the experience of certain categories of persons. The Disabilities Convention has some interesting lessons to teach about human rights more generally.
Establishing a Workable Autonomy in Tibet
Authors: Davis Michael C.
Published: July 2012

This article recommends a change in China's policy toward Tibet to better conform to national commitments and international obligations. Since the People's Liberation Army marched into Tibet in the 1950s China has generally imposed its will on the Tibetan people. The 1951 "17-Point Agreement on Measures for the Peaceful Liberation of Tibet" reflected the view that China was liberating Tibetan territory from imperialist forces. From the Tibetan perspective such "liberation" was imposed and promises of local self-rule were not kept. The emerging communist and totalitarian state that followed the 1949 Chinese revolution proved incapable of allowing genuine Tibetan self-rule. A harsh attitude of domination ensued. The present instrument of Chinese rule is China's national minority policy provided in Article 4 of the Chinese Constitution and China's Law on Regional National Autonomy (LRNA). Though this policy promises local self-rule, the habits of intervention both formally in the political system and in the mechanisms of Communist Party oversight leave Tibetans with very little of the promised legislative and administrative autonomy. Assessing this policy against the backdrop of China's long historical relationship with Tibet and the requirements of international law, this article concludes that China's national minority policy fails to meet its obligations to the Tibetan people. Taking account of standards articulated in the new UN Declaration on the Rights of Indigenous Peoples, this article recommends a change of course to establish a more genuine autonomy under Article 31 of the Chinese Constitution relating to the establishment of special administrative regions.
The ICTY's Impact on Serbia: Judicial Romanticism meets Network Politics
Authors: McMahon Patrice C. , Forsythe David P.
Published: July 2012

It has been widely argued that international criminal justice is necessary for peace and security and that it promotes reconciliation. There have been few attempts to examine these claims with empirical evidence. This article examines the impact of the International Criminal Tribunal for former Yugoslavia on political thinking and behavior in Serbia. It finds that the ICTY has had thus far little direct impact on Serb leaders and political parties, the rule of law, or civic society. What impact the court has had has been indirect, the product of a network of other actors like the United States and the European Union. These network members make reference to the ICTY as they try to manage Balkan politics. This article shows that while internationalized criminal courts may punish certain individuals and develop legal norms and procedures, "judicial shock therapy" is more difficult to achieve. The ICTY has not yet pushed Serbia in a more liberal political direction, which is a foundation for progressive change in the Balkans.
"The Solzhenitsyn Effect": East European Dissidents and the Demise of the Revolutionary Privilege
Authors: Horvath Robert
Published: July 2012

For much of the modern era, revolution served as a justification for gross violations of human rights. The sources of this "revolutionary privilege" are to be found in the historical experience of the Western world. Both the Jacobin tradition and Marxism contributed to the readiness of many Western intellectuals concerned with human rights to turn a blind eye to the atrocities of the Bolshevik revolution, its Stalinist aftermath, and a variety of Third World regimes. During the 1970s, East European dissidents, citizens of revolutionary societies, challenged this double-standard. The ensuing "Solzhenitsyn Effect" contributed not merely to the "human rights boom" of the era, but also to the emergence of a new, radical humanitarianism.
Comparing the Intended and the Perceived: Administrator Expectations and Student Perceptions of Teacher Roles in Catholic Service-Learning
Authors: Stewart Trae
Published: July 2012

The classroom teacher plays a pivotal role in any formal educational environment. More specifically, how this individual is involved and how s/he structures activities and discussions about a topic depends on the preferred learning style, personal demeanor, and educational philosophy of the teacher. For teachers that employ service-learning pedagogy in their courses, these expectations and factors do not vary. Teachers motivate students, help them to make meaning of experiences, and assist them in making connections for future action. These roles become complicated, however, when novice teachers do not have sufficient pedagogical training and/or are not given ongoing guidance by administrators. Using data from interviews with students and administrators at an urban Catholic high school, the qualifications and roles of the service-learning teachers, and their intended roles as described by administrators, are compared to the perceived roles as voiced by students. Implications and recommendations are discussed with specific attention to administrator communication, types and frequency of reflection activities, and, as a result, tensions of service-based models of experiential education in Catholic schools vis-à-vis the development of social justice.
The Democracy Barometers (Part II): Attitudes in the Arab World
Authors: Jamal Amaney , Tessler Mark
Published: July 2012

Abstract: The Arab Barometer finds widespread support for democracy in Arab world. Definitions of democracy vary considerably, however, with some citizens emphasizing government accountability and political freedoms and while others stress instrumental considerations, including effectiveness in meeting economic needs. The Arab Barometer also finds that support for pluralism, tolerance and other democratic values are present to the same degree among those who favor secular democracy and those who favor a political system that is both democratic and Islamic. Finally, in contrast to some popular misconceptions, personal religiosity does not account for variance in support for democracy, in a preference for secular rather than Islamic democracy, or in attitudes toward authoritarian political formulae.
Morocco's Elections: A Dynamic Civil Society
Authors: Khrouz Driss
Published: July 2012

Abstract: Since the 1990s, Moroccan civil society groups have been proliferating, and they are increasingly influential in addressing society-wide matters including the rights of women, ethnic minorities, and the poor. Moroccan civil society and its NGOs know that they must promote change. To do this, they are mounting advocacy and lobbying efforts to reform laws and policies that need improvement.
Sierra Leone: A Vote for Better Governance
Authors: Wyrod Christopher
Published: July 2012

Abstract: Sierra Leone recently emerged from a decade of brutal civil war. In 2007, five years after the end of the conflict, Sierra Leone held its most open and fair political contest to date, resulting in a rare ruling party upset. Dissatisfaction with the party’s peacetime management explains the defeat suffered by the SLPP, which made scant progress in addressing corruption, mismanagement, and marginalization. While the vote gives hope that Sierra Leone and similar postconflict countries can regain their democratic footing, the new leadership must address the country’s endemic problems or risk renewed conflict.
Morocco's Elections: The Limits of Limited Reforms
Authors: McFaul Michael , Wittes Tamara Cofman
Published: July 2012

Abstract: Morocco’s experience suggests that expanded political liberty, especially freedom of association, can facilitate the emergence of multiple versions of political Islam, reducing the salience of a large, undifferentiated Islamist movement as an umbrella for oppositionist sentiment. The best means for containing potentially destabilizing discontent and promoting moderation among potentially antidemocratic forces are a pluralized political space and iterative free elections. The dilemmas that the king must now resolve in the face of citizen alienation reveal the limits of a strategy of gradual liberalization stage-managed from on high by a pro-Western autocrat.
The Politics of Illegitimacy in an Age of Reform: Women, Reproduction, and Political Economy in England's New Poor Law of 1834
Authors: Cody Lisa Forman
Published: July 2012

This article examines the bastardy clauses of the New
Poor Law of 1834 which made illegitimate children the responsibility of
single mothers. These clauses reveal a fundamental shift in thinking
about poverty and welfare from paternalism to Liberalism. Supporters
of the clauses imagined both men and women as free agents economically
responsible for themselves. Moreover, it was a Liberal project--largely
influenced by Thomas Robert Malthus and disseminated by the 1834
poor law Report from His Majesty's Commissioners for Inquiring into
the Administration and Practical Operation of the Poor Laws and
such novelists as Harriet Martineau--asserting that poverty arose
from overpopulation and that women more so than men were responsible
for determining demographic growth. In the context of Liberal thought,
single mothers and their out-of-wedlock children represented the worst
violators of independence and individualism, and the centuries-old
welfare provisions offered them among the worst obstacles to a free
market. Radical critics perceived in the bastardy clauses a challenge
to traditional notions of protecting society's weak and of allowing
the working class the "right" to receive parish and charitable
aid. Furthermore, critics recognized that the sexual double standard
inherent in the new clauses revealed the ideology of Liberalism: the
Liberal system magnified rather than minimized the advantages enjoyed
by society's enfranchised and the disadvantages experienced by society's
weakest members.