bluuebunny/crossref_metadata_2025 huggingface dataset:
In novissimis diebus : Biblical Promises, Jewish Hopes and Early Christian Exegesis
Authors: Wilken Robert L.
Published: July 2012

The phrase "in these last days" ( novissimis diebus ) occurs in Isaiah 2 and Micah 4. This article discusses how this expression was interpreted in early Christian commentaries on Isaiah and Micah. It shows that the Christian interpretation of Isaiah 2 and Micah 4 is best seen in the context of a rival Jewish understanding of the text. Jews interpreted the passage not to refer to the exile in Babylonia but to the future coming of "their" Messiah. The question, then, for early Christian exegetes was not whether the text was to be taken "historically," but to which later events was it to be applied, those that defined the Jewish people or those that gave rise to the Church.
Patriarch and People: Peter Mongus of Alexandria and Episcopal Leadership in the Late Fifth Century
Authors: Haas Christopher
Published: July 2012

Peter Mongus, patriarch of Alexandria (477-490) is best known for his role in the Monophysite controversy of the fifth century and his support for the Henotikon of the emperor Zeno. He is often disparaged by ancient writers and modern scholars for his seeming vacillation in doctrinal matters. On closer examination, his theological stance is shown to be a calculated response to various social and religious conflicts in fifth-century Alexandria. His policies towards Alexandrian schismatics and intransigent pagans were expressions of a more fundamental program of furthering the local authority of the patriarchate, even when these local interests came into conflict with imperial directives.
The Life of Symeon the Fool and the Cynic Tradition
Authors: Krueger Derek
Published: July 2012

Leontius of Neapolis's Life of Symeon the Fool , written on Cyprus in the 640s, challenges the conventions for the composition of Christian saints' lives in Late Antiquity. In an effort to interpret Symeon's strange behavior, the present study argues that Leontius makes sustained allusion to traditions about Diogenes of Sinope, the Cynic philosopher, especially when Symeon defecates in public, eats lupines and raw meat, and arrives in Emesa dragging a dead dog. By allying the holy man with a pagan exemplar, Leontius comments on the difficulty of living a holy life in an urban environment. The study also reveals Leontius's ambivalence about his model.
The Blazing Body: Ascetic Desire in Jerome's Letter to Eustochium
Authors: Miller Patricia Cox
Published: July 2012

This essay explores the theory of sexuality that Jerome sets forth in his Ep. 22. Focusing on the manner in which sexuality is discussed in terms of erotic metaphors of the female virginal body, the essay argues that Jerome's view of asceticism was founded on a paradox wherein erotic sensibilities are both denied and intensified. Perspectives drawn from contemporary literary-critical theory are used to uncover a figural movement in Jerome's text in which an attempt is made to "erase" the literal body and its dangerous sexual passions by "rewriting" it with Scriptural tropes. The essay proposes that Jerome's ascetic theory foundered on an interpretive problematic, namely, his figuration of asceticism in terms of linguistic metaphors of desire.
Julian Saba, 'Father of the Monks' of Syria
Authors: Griffith Sidney H.
Published: July 2012

Julian Saba (d. 367) is the earliest person in the Syriac-speaking community whose name we know, who dedicated himself to the eremitical life. His story has been preserved for us in Theodoret's History of the Monks of Syria , in a collection of Syriac poems attributed to Ephraem (306-373), and in a Syriac memra attributed to Jacob of Serug (ca. 450-ca. 520). Based on these sources, the present article gives an account of Julian's fame in Syria, and explores the significance of his accomplishments for the history of monasticism in the Syriac-speaking regions of the Early Christian world.
Augustine's "I": The "Knowing Subject" and the Self
Authors: Mennel Susan
Published: July 2012

Augustine's scripturally inspired inquiry into the nature of time led him to raise many of the questions that contemporary theory poses regarding language and subjectivity. Particularly in the Confessions , Augustine subverted the Greek conceptual order, confronting the logocentric "metaphysics of presence" with the Jewish and Christian themes of faith, memory, and embodiment. In contrast to the conclusions drawn by post-structural theory, his work suggests that the deconstruction of the Knowing Subject of classical philosophy leads not to the abrogation of the self, but to its affirmation.
Early Christian Martyrdom and Civil Disobedience
Authors: Ferguson Everett
Published: July 2012

The success of non-violent resistance as employed by Gandhi and Martin Luther King for political ends prompts an inquiry concerning possible parallels with early Christian martyrdom. The martyr literature of the early church, in addition to theological motifs, does occasionally take note of practical aspects, such as "church-state" relations. The two elements of civil disobedience identified by David Daube—non-violence and unselfish motivation for the conduct—are present in early Christian martyrdom, but not in an unmixed way. Some early Christians did aim to convert the Roman Empire, and some noted martyrdom as contributing to this, but there is no indication that martyrdom was a conscious strategy to attain this goal.
Ignatius, Ad Polycarp . 4.3 and the Corporate Manumission of Christian Slaves
Authors: Harrill J. Albert
Published: July 2012

This study exegetes the passage in the second-century letter of the bishop Ignatius of Antioch to his fellow bishop Polycarp in Smyrna that concerns the liberation of baptized slaves. It argues that Ignatius does not prohibit private manumissions of Christian slaves by individual slaveowners in general, but seeks to curb abuses of common chest (or corporate) manumissions by local house churches in particular. The study, then, locates the passage within the context of Greco-Roman rhetorical and literary commonplaces alarming audiences to the dangers of slave recruitment. The thesis is that Ignatius's apprehension about the corporate manumission of Christian slaves reveals not his so-called social conservatism on slavery, but his wider apologetic stratagem for social acceptability and internal unity under his own terms as bishop.
"Pagan" and "Christian" Marriage: The State of the Question
Authors: Grubbs Judith Evans
Published: July 2012

There has been a great deal of scholarly interest in marriage and the family in pre-Christian Rome in the past ten years, and recent work has called for a reevaluation of older scholarly views al mores and family life. At the same time, much work has been done on attitudes toward sexuality and marriage in the early Christian period, particularly in the writings of Christian intellectuals like Augustine. Little attempt has been made, however, to bridge the gap between "pagan" and "Christian" or to examine late antique, Christian attitudes toward sexuality and marriage from the viewpoint of the "average" Christian. The first half of this article surveys marriage in pre-Christian Roman ideology and practice and in imperial law of the first three centuries; the second half looks at the evidence for Christian marital practice in the ante-Nicene period, using sources that are often overlooked: the Divine Institutes of the Christian writer Lactantius, the canons of early church councils, and Christian inscriptions of the second half of the third and early fourth centuries. These sources suggest a much greater degree of continuity with pre-Christian values and practice than the writings of more ascetically minded Christian theologians imply.
Libertines or Not: Fruit, Bread, Semen and Other Body Fluids in Gnosticism
Authors: Buckley Jorunn Jacobsen
Published: July 2012

Beginning with materials from the Church-Fathers—especially Epiphanius and Irenaeus—on "Libertines," and continuing with the Manichaean tradition and the Mandaean corpus, this article challenges the opposed terms "libertine" and "ascetic" and their conventional uses in the study of Gnosticism. Foods, sexual imagery and practices, and social relationships in Gnostic communities are analyzed in order to suggest more valid, expanded interpretations of the received traditions. Especially challenging, the so-called Libertines need to be understood according to their own logic.
Re-Textualizing Lucretia: Cultural Subversion in the City of God
Authors: Trout Dennis
Published: July 2012

Augustine devoted a section of the first book of the City of God to a critical reconsideration of the ancient story of the rape and suicide of the Roman matron Lucretia. Four centuries earlier, Livy had canonized Lucretia as an exemplum virtutis : in the Augustan age Lucretia embodied ideas about feminine chastity and civic order that Livy deemed vital for the regeneration of Roman moral and political life. Following the sack of Rome in 410, however, Augustine found Lucretia's tale a powerful idiom for responding to pagan recriminations, for critiquing current conceptions of honor, and for refuting contemporary Christian claims about sexual purity and the nobility of volitional death. Augustine's reappraisal of Lucretia was subversive and a direct challenge to widely held cultural assumptions.
Agrestius of Lugo, Eparchius Avitus, and a Curious Fifth-Century Statement of Faith
Authors: Mathisen Ralph W.
Published: July 2012

This study attempts to put into its correct historical context the single surviving page of a tract entitled De fide . The work was written by a certain "Agrestius" and dedicated to a certain "Avitus." In this study, Agrestius is identified as the bishop Agrestius of Lugo (in the Spanish province of Galicia) who attended the Gallic Council of Orange in the year 441. Avitus is identified as Eparchius Avitus, known to have been praetorian prefect of Gaul in 439, then emperor in 455-56. It is suggested that Agrestius of Lugo sought assistance in Gaul because of factional quarreling in Galicia. Because this quarreling involved accusations of heresy (Priscillianism), Agrestius had to attest to his orthodoxy when he visited Gaul—the De fide was part of this process. But the quarreling also resulted from questions of authority in Galicia—it seems that bishops such as Syagrius and Pastor, two of Agrestius' rivals, were being ordained in out-of-the-way places by various factions. Some of these quarrels also seem to have been the result of questions of jurisdiction involving the continued use in Spain of the old conventus , or judicial district. In Gaul, the episcopal establishment welcomed Agrestius' visit because it allowed Hilary of Aries and his partisans to have the appearance of extending their authority into Spain. The secular establishment, meanwhile, represented by Avitus, was happy to cooperate by placing its imprimatur upon Agrestius' orthodoxy. Eventually, however, the bishop of Rome, Leo, undertook to extend his authority into both Gaul and Spain. In 445, Leo issued rulings contrary to Hilary in Gaul, and in 447 he seems to have sided with Agrestius' rivals in Spain. The opportunity for a measure of unity among the western European churches represented by Agrestius' initiative in Gaul, therefore, eventually came to nought.
Ephraem the Syrian on the Utility of Language and the Place of Silence
Authors: Russell Paul S.
Published: July 2012

This paper attempts to trace the outlines of Ephraem the Syrian's ideas about the extent to which theological language can be usefully applied to the description of God. Centering on the Hymns on Faith and Sermons on Faith , the paper describes Ephraem's ideas about the usefulness of all languages used by created beings and how each of them is limited to dealing with realities close to it on the ontological scale. Ephraem is shown to believe that each language has its own range of usefulness but that no language is universally useful and that no verbal language suffices for the expression of the highest truths. Since all verbal languages function by defining what they describe, the highest realities, which cannot be subjected to definition because of their infinite natures, can be expressed only through the medium of silence. Silence is shown to be, in Ephraem's mind, the highest form of communication and to be used among the persons of the Trinity for their own communication.
La Résistance intime: contact et immédiateté du sens chez Jean Paulhan
Authors: Trudel Eric
Published: July 2012

Cet article s'intéresse à ce qui se présente dans le texte paulhanien et excède la représentation, excès que l'écrivain concevait comme un "effet" de lecture. Comment comprendre ce contact sans contact, ce sens au-delà de ce qui fait sens? Pour Paulhan, cette intimité n'est jamais autre chose que celle d'une "im-médiation," d'une résistance.
The Evidence of the Image
Authors: James Ian
Published: July 2012

This article examines Jean-Luc Nancy's thinking of 'evidence' as developed in his short work on the film of Abbas Kiarostami. In particular it examines the way in which Nancy's thinking 'evidence' engages with a phenomenological heritage surrounding the question of 'originary intuition' and through this affirms a specific mode of contact between images of art and worldly existence.
L'administration française dans les luttes de positionnement au sein de la Tijāniyya nord-africaine : Situation locale et répercussions sur les marabouts sénégalais (1840–1956)
Authors: Diallo El Hadji Samba Amadou
Published: July 2012

The Tijāniyya Brotherhood was created in the Algerian desert by Ahmad al Tijānī in 1781. While some researchers place emphasis on individual branches in West Africa, most have ignored analyzing this important movement through a transnational lens. This article examines the process of dissemination of the Tijāniyya, taking into consideration its historical conflicts of succession in North Africa after the death of the second Khalifa Ali Tamasīnī. It places particular emphasis on the struggle for succession during the French colonial period. First, it shows how the French administration exerted its authority over the masters and disciples of the Tijāniyya, always advocating for their candidate, who resides in Ayn Mādī (Algeria) or Fez (Morocco). Next, it analyzes how the North African tijānī hierarchy and the French administrators succeeded in forming relations with other influential West African families, notably Senegalese ones, such as the Sy, Aidara, and Niasse families. Finally, I clarify how the French administrations utilized these networks to attempt to disseminate their policies through the Tijāniyya in sub-Saharan Africa.
Mapping Shekgalagari in Southern Africa: a Sociohistorical and Linguistic Study
Authors: Chebanne A. M. , Monaka K. C.
Published: July 2012

The Bakgalagari were classified by Guthrie (1948) as S30 and by Cole (1954) as 60/2/5. They incorporate ethnic groups such as Bangologa, Bashaga, Babolaongwe, Balala, Bakhena, Baritjhauba, and Bakgwatheng and Baphaleng, the latter of which do not speak Shekgalagari any more. At the moment, Bakgalagari are only found in Botswana. They are thought to have arrived in southern Africa more than 2000 years ago, together with other Bantu groups (Tlou/Campbell 1997:33), and were the earliest Sotho-Tswana group to inhabit the Madikwe and Limpopo river basins (Figure 1) around 900 and 1000 CE (Tlou/Campbell, 1997).

Around 1200 CE, the Bakgalagari were already inhabiting the peripheries of this area as they migrated into Botswana, where they are estimated to have arrived around 1000 CE, as Figure 2 illustrates (cf. Tlou/Campbell, 1997:90). They would later be pushed into the Kgalagadi desert, which reinforced the peripheral and distant location of some of them from the rest of the Sotho-Tswana groups that subsequently inhabited the country.

History suggests that there were ethnic rivalries amongst the Bakgalagari, and they consequently split into various ethnic groups (Tlou/Campbell, 1997:90). These ethnic groups were dispersed in various directions in the country at different times as shown in Figure 3. Figure 3 shows the historical base and the subsequent movements of the Bakgalagari starting earlier than 1400 CE. It is possible that these movements might have been reversed at various times, and also that some people at a later stage took the same directions to find their ethic counterparts (e.g., Babolaongwe at around 1650 CE).
Exotic Plants of Western Africa: Where They Came From and When
Authors: Alpern Stanley B.
Published: July 2012

History in Africa carried an article in 1992 entitled “The European Introduction of Crops into West Africa in Precolonial Times.” I wrote this to correct an impression left by several historians that only maize and cassava were worth mentioning. My reading of precolonial African history had made it very clear that a great many new crops were brought to the continent during the slave-trade period. My initial geographical focus was what used to be called Lower Guinea, roughly the coast from Cape Palmas to Mt. Cameroon, but inevitably my research took in all of western Africa from Senegal to Angola and up to the southern fringe of the Sahara. My findings were admittedly interim, a sort of database for future refinement. And yet I was able to identify 86 introduced crops.

It was ingenuous of me to expect that one paper would suffice to over-turn what had become conventional wisdom. In 1995 John Iliffe, in 1997 Elizabeth Isichei, in 1998 John Reader repeated the maize-cassava mantra. In 2002 Christopher Ehret expanded the duo of exotic crops to include tobacco, peanuts, New World beans, Asian rice and sugar cane. David W. Phillipson reiterated in 2005 what he had said 20 years earlier, citing only maize, cassava and bananas. And in 2006 James L.A. Webb Jr. named just four: maize, cassava, peanuts and potatoes.

This pattern of minimization may reflect what seems to be a general disinclination of historians to dig deeply into botany. An important recent book titled Writing African History devotes only 17 of 510 pages to the subject.
Brentano's Intentionality Thesis: Beyond the Analytic and Phenomenological Readings
Authors: Bartok Philip J
Published: July 2012

Philosophers in the analytic and phenomenological traditions have interpreted Brentano's intentionality thesis, and his empirical psychology more generally, in significantly different ways. Disregarding Brentano's distinctive psychological method, analytic philosophers have typically read him as a philosopher of mind, and his intentionality thesis as a contribution to the Cartesian project of clarifying the distinction between the mental and the physical. Phenomenologists, while more attentive to his method, tended to read Brentano as merely Òon the wayÓ to a truly phenomenological approach. I offer a third reading of Brentano thesis, one that attends to both the motivating concerns and the distinctive methodological features of his psychological project.
Condillac's Paradox
Authors: Falkenstein Lorne
Published: July 2012

I argue that Condillac was committed to four mutually inconsistent propositions: that the mind is unextended, that sensations are modifications of the mind, that colours are sensations, and that colours are extended. I argue that this inconsistency was not just the blunder of a second-rate philosopher, but the consequence of a deep-seated tension in the views of early modern philosophers on the nature of the mind, sensation, and secondary qualities and that more widely studied figures, notably Condillac's contemporaries, Hume and Reid, were not ultimately any more successful at developing an account of vision that unproblematically avoids the paradox. In passing, I take issue with Nicholas Pastore's account of how Condillac's Treatise on Sensations deals with the visual perception of form (in A Selective History of Theories of Visual Perception).
Descartes and Malebranche on Thought, Sensation and the Nature of the Mind
Authors: LoLordo Antonia
Published: July 2012

Malebranche famously objects to Descartes' argument that the nature of the mind is better known than the nature of body as follows: if we had an idea of the mind's nature we would know the possible range of modes of the mind, including the sensory modes, but we do not know those modes and thus can't have an idea of the mind's nature. I argue that Malebranche's objections are readily answerable from within the Cartesian system. This argument involves examining the status of sensations in Descartes, innate ideas, and Malebranche's occasionalism.
Mere Possibilities: A Bolzanian Approach to Non-Actual Objects
Authors: Schnieder Benjamin
Published: July 2012

The paper is a detailed reconstruction of Bernard Bolzano's account of merely possible objects, which is a part of his ontology that has been widely ignored in the literature so far. According to Bolzano, there are some objects which are merely possible. While they are neither denizens of space and time nor members of the causal order, they could have been so. Thus, on Bolzano's view there are, for example, merely possible persons, i.e., objects which are neither actual nor persons but which could have been both. In course of the development of Bolzano's views, they are contrasted with the better known theory of his compatriot Alexius Meinong, and it is shown that they have a modern counterpart in the accounts of merely possible objects that were developed by Bernard Linsky and Ed Zalta, and by Timothy Williamson.
HEDIS Prevention Performance Indicators, Prevention Quality Assessment and Healthy People 2010
Authors: Levine Robert S , Husaini Baqar A , Briggs Nathaniel C , Foster Irene , Hull Pamela C , Pamies Rubens J , Tropez-Sims Susanne , Emerson Janice S
Published: July 2012

The purposes of the study were to contrast actual prevention services needs with quality assurance indicators from the Health Employer Data Information System (HEDIS®–Medicaid 3.0) and the goals and objectives of Healthy People 2010, to calculate allowable Medicaid reimbursement for comprehensive prevention services, and to describe patient expectations for prevention counseling. We obtained a convenience sample of all ages (under 17 years = 514, 18 years or older = 473), both sexes (male = 393, female = 594), and three racial/ethnic groups: African American = 687, White =173, Hispanic = 88 in a clinic that predominantly served Medicaid-insured patients. Participants 18 years of age and older were interviewed about expectations for preventive counseling. According to procedures rated A or B by the second United States Preventive Services Task Force (USPSTF), these patients had 11,504 service needs. Performance indicators from HEDIS–Medicaid 3.0 would have covered 2,571 (22%) while the goals and objectives of Healthy People 2010 would have covered 11,437 (99%). Allowable Medicaid reimbursement estimates for 100% coverage averaged $206.13 per person. A majority of patients in all race-sex groups expected counseling at least once per year. The results show that a focus on HEDIS–Medicaid 3.0 quality indicators in these patients would have been inconsistent with the goals and objectives of Healthy People 2010, that it would have promoted patient mistrust by failing to meet patient expectations, and that payment for 100% coverage of A and B USPFTF recommended preventive services at Medicaid rates would have constituted a small fraction of per capita yearly U.S. health care expenditures.
Injection Drug Use Among Homeless Adults in the Southeast with Severe Mental Illness
Authors: Linn J. Gary , Brown Michael , Kendrick Lorna
Published: July 2012

This study examined injection drug use and HIV risk behaviors in a predominantly African American sample of homeless men with mental illness. Personal interviews focusing on injection drug use and sexual risk behaviors were completed with 240 homeless mentally ill men in two shelters in a southeastern city. Sixty-two (26%) of the 240 men injected drugs. Among the injection drug users (IDUs), most reported high-risk behaviors, including needle sharing (70%) and participation in shooting galleries (71%). Very few performed risk reduction activities (e.g., cleaning needles with bleach [19%] or using a needle exchange program [0%]). Within the preceding 6 months, most of the IDUs had had sex with women (51%) or men (8%) without a condom. This investigation reported a high lifetime occurrence of injection drug use in a sample of predominantly African American homeless men with mental illness. The IDUs reported intravenous drug use and sexual activities with great risk of HIV transmission and provided little evidence of risk-reduction efforts. These men are outside of most social service and health care systems but must be included in special programs to decrease the transmission of HIV.
What's Culture Got to Do with It? Prevention Programs for African American Adolescent Girls
Authors: Corneille Maya A , Ashcroft Amie M , Belgrave Faye Z
Published: July 2012

This paper examines prevention programming for African American girls by placing the prevention process within the larger African and African American cultural context. We provide an overview of the theories and issues we consider most relevant to African American culture, including Africentric theory, ethnic identity, gender identity and relational theory, developmental issues, the community context, and historical considerations. Drawing from our own drug prevention work, we provide examples of how to incorporate culture into prevention programs to make them most relevant for the target population. We also summarize our own efforts to create culturally appropriate prevention interventions and their impact on the girls in our programs. We conclude with suggested directions for future research into culture-specific prevention programs.
Black-White Disparities in HIV/AIDS: The Role of Drug Policy and the Corrections System
Authors: Blankenship Kim M , Smoyer Amy B , Bray Sarah J , Mattocks Kristin
Published: July 2012

African Americans in the United States are disproportionately affected by HIV/AIDS. We focus in this paper on the structural and contextual sources of HIV/AIDS risk, and suggest that among the most important of these sources are drug policy and the corrections system. In particular, high rates of exposure to the corrections system (including incarceration, probation, and parole) spurred in large part by federal and state governments' self-styled war on drugs in the United States, have disproportionately affected African Americans. We review a wide range of research literature to suggest how exposure to the corrections system may affect the HIV/AIDS related risks of drug users in general, and the disproportionate HIV risk faced by African Americans in particular. We then discuss the implications of the information reviewed for structural interventions to address African American HIV-related risk. Future research must further our understanding of the relations among drug policy, corrections, and race-based disparities in HIV/AIDS.
How Criminal System Racial Disparities May Translate into Health Disparities
Authors: Iguchi M. Y. (Martin Y.) , Bell James , Ramchand Rajeev N , Fain Terry
Published: July 2012

Disadvantaged racial and ethnic minorities in the U.S. are strikingly over-represented in the juvenile justice and adult criminal justice systems. This paper briefly reviews the extent of over-representation attributable primarily to drug offenses and an earlier conceptual framework introduced by Iguchi and colleagues showing how the use of incarceration as a key drug control tool has disproportionately affected the health and well being of racial and ethnic minority communities. We then provide observations from the field that demonstrate how the implementation of a quality assessment approach might be used to mitigate procedural/structural biases that contribute to disparities in minority confinement, and ultimately, to reduce disparities in access to resources and health care.
African American Female Drug Users and HIV Risk Reduction Challenges with Criminal Involvement
Authors: Sterk Claire E. , Theall Katherine , Elifson Kirk W.
Published: July 2012

The main objectives of this paper are to examine the prevalence of criminal involvement among a sample of African American female drug users and to identify factors associated with that criminal involvement, where criminal involvement is defined as having been in jail or prison. Data were collected in Atlanta from 333 adult women at two points in time, namely during baseline assessments conducted prior to their enrollment in an HIV risk reduction intervention and at follow-up assessments conducted 6 months after completion of the intervention. The prevalence and period prevalence of criminal involvement were relatively high. At baseline, 86.8% of the women indicated criminal involvement at some point in their lives and over one-third (37.2%) were involved in the year prior to enrolling into the study. During follow-up interviews, 31.5% reported criminal involvement during the 6 months since enrollment. The findings revealed that victimization/abuse and drug use setting might be salient risk factors for criminal involvement. The unique needs of women such as those in this sample must be taken into account when designing intervention and prevention programs, both within and outside the criminal justice system.
Disseminating HIV/AIDS Information to African Americans
Authors: Stroman Carolyn A
Published: July 2012

Prior research indicates that HIV/AIDS communication must be viewed as a key component of the implementation of a comprehensive HIV/AIDS prevention program. In view of the radical increase in HIV/AIDS in the African American community, tailoring health messages on prevention strategies to African Americans becomes particularly important. This paper focuses on health communication to African Americans as an integral part of contemporary HIV/AIDS interventions.
HIV-Positive Black Women with Histories of Childhood Sexual Abuse: Patterns of Substance Use and Barriers to Health Care
Authors: Wyatt Gail Elizabeth , Carmona Jennifer Vargas , Loeb Tamra Burns , Williams John K
Published: July 2012

A constellation of factors contributes to Black women's health including stressors and traumatic experiences. Their psychological adjustment and substance use can further affect their health status. The purpose of this study was to examine patterns of substance abuse and barriers to health care among HIV-positive Black women with histories of childhood sexual abuse (CSA). Baseline data on a community sample of 75 Black HIV-positive women were analyzed to assess and identify drug use, alcohol use, participation in an alcohol or drug treatment program, and communication skills with providers, all of which may act as barriers to health care. Findings indicate that substance use is a significant health problem, with 83% of the participants having used at least one substance regularly and 28% having engaged in regular injection drug use. Barriers to health care included confidentiality issues, poor financial resources, difficulty getting an appointment, excessive waiting to see a health care provider and obligation to care for others. Contrary to past research, poor communication between the participants and the providers did not seem to be a barrier to health care utilization for these women. Early traumatic experiences, including CSA, regardless of whether incidents involved penetration, may exacerbate the problems faced by HIV-positive Black women. Implications for future research and culturally relevant prevention and intervention programs are discussed.
Cancer Screening among Native Americans in Eastern North Carolina
Authors: Farmer Deborah F , Bell Ronny A , Stark Nancy
Published: July 2012

The purpose of the study is to explore cancer screening predictors and practices among Lumbee Indians in eastern North Carolina. Interviewers from the community conducted phone interviews with 333 men and 456 women aged 40 and older randomly selected from the Lumbee Tribal roll as part of the Lumbee Diabetes and Health Survey. The survey has sections on demographic information and health conditions, family history of chronic conditions, and health behaviors. This paper reports on cancer screening behaviors. Rates of ever being screened for breast, cervical, prostate and colon cancer were relatively high compared with overall national rates. Predictors included younger age, better health, more education, and lifestyle factors such as engaging in regular physical activity and not smoking. Future research should focus on developing culturally appropriate campaigns to increase the frequency of cancer screening to conform to guidelines, and educational programs and interventions to reach Lumbee Indians most at risk for not being screened.
Predictors of Improved HbA1c Testing by Primary Care Physicians
Authors: Flanders W. Dana , Presley Rodney , McClellan William M
Published: July 2012

Measurement of glycosylated hemoglobin (HbA1c) among patients with diabetes mellitus contributes to attaining control of blood glucose, which in turn is associated with fewer complications. Here, we seek to identify physician and county level characteristics that predict increased HbA1c testing among Medicare beneficiaries with diabetes who did not have testing in the baseline year.
Physicians in counties with more people on Medicaid, or with fewer physicians per capita tended to have less improvement in HbA1c testing among Medicare beneficiaries over the three year study period.
Optimal Design Features for Surveying Low-Income Populations
Authors: Fredrickson Doren D , Jones Teresa L , Molgaard Craig A , Carman Claudia G , Schukman Jay , Dismuke S. Edwards , Ablah Elizabeth
Published: July 2012

Improving Medicaid program effectiveness for underserved populations is hampered by low survey response rates. This study determined how to maximize Medicaid consumer satisfaction survey response rates to the Consumer Assessment of Health Plans Study (CAHPS) survey. In a public immunization clinic, 8 focus groups and 15 extended interviews were used to assess consumer-preferred survey design features and incentives. To test hypotheses, we conducted the following trial. Out of 10,733 total participants in a Kansas Medicaid managed care plan, 3,685 eligible for CAHPS were unduplicated by household. After randomization of the 968 households with valid addresses to one of three groups, a controlled trial was conducted to assess response rates to CAHPS survey formats and incentives. Response rates were 35% for a standard mailing, 44% for a user-friendly low-literacy mailing, and 64% for a user-friendly low-literacy mailing with a $10 contingent incentive. Both experimental arms significantly improved response compared with the control; the response rate of the mailing group with the incentive was higher than the response rate of the group receiving that mailing without any incentive (p<0.0001). Using consumer-based preferences significantly increased response rates to this Medicaid satisfaction survey. Raising CAHPS response rates may increase validity of Medicaid consumer satisfaction information.
Provider Behaviors Contributing to Patient Self-Management of Chronic Illness Among Underserved Populations
Authors: Greene Jessica , Yedidia Michael J.
Published: July 2012

Effective treatment of chronic illness requires active engagement of patients in managing their own conditions. This research explores the influence of provider support for self-management on patients' performance of self-care activities, a widely presumed but under-studied relationship, particularly among underserved populations. We surveyed an ethnically diverse, primarily low-income sample of 956 patients (or parents of pediatric patients) with diabetes or asthma in 17 outpatient teaching settings across the country. Multivariate analysis established that patients with strongly positive assessments of their providers were substantially more confident in self-care. Further, among patients with diabetes, high assessments of provider support, in comparison with low, were significantly associated with performance of self-management tasks, amounting to approximately one more day per week. These relationships were significant for patients with either illness and from varied socio-economic backgrounds. The results provide evidence of the validity of our measure of provider support, its relevance to underserved populations, and its usefulness for evaluating quality of care.
The RARE Model of Rapid HIV Risk Assessment
Authors: Bates Christopher J , Singer Merrill , Needle Richard , Trotter Robert T
Published: July 2012

The impact of the HIV/AIDS epidemic on minority communities called for interventions to stem the increase in new HIV infections and identify HIV-positive individuals for referral to care and treatment services. The Rapid Assessment, Response and Evaluation (RARE) project was designed to provide highly affected communities with a tool that would quickly identify conditions that fuel new infections and serve as barriers to HIV-positive individuals getting HIV testing, care, and treatment. RARE brought indigenous community health outreach workers and key community-level stakeholders together to advocate for the transfer of findings into programmatic and policy responses in places where high risk behaviors were practiced. This article describes RARE's qualitative methods that captured the voice of those most affected by the HIV/AIDS threat and identified critical insights and dynamics about factors that lead to HIV infections and those that can move positive individuals into care and treatment.
Adapting RARE to Assess Barriers to Service Receipt among People out of Care
Authors: Conviser Richard , Singer Merrill , Pounds Moses Belt
Published: July 2012

This paper describes the components of Rapid Assessment, Response and Evaluation (RARE), developed for HIV prevention planning; the adaptation of its methods to services planning; the venues in which the use of RARE was recommended for the present Care System Assessment Demonstration Project; constraints on what projects using RARE and the system assessment model may expect to accomplish; the focus of RARE questions for the project, concerning the characteristics of PLWH not in regular primary care, the care system as PLWH not in care perceive and experience it, and characteristics of the physical and social environments in which they live; how information from RARE can contribute to the enhancement of care systems; and the types of questions that sites could ask to gather RARE information for services planning.
Bridging Cultural Chasms between Providers and HIV-Positive Haitians in Palm Beach County, Florida
Authors: Potocky-Tripodi Miriam , Dodge Karen , Greene Michael
Published: July 2012

This article discusses special challenges faced by HIV-positive Haitian immigrants, one of the groups targeted by the Care System Assessment Demonstration Project in Palm Beach County, Florida. The article examines the following issues: structural health care access barriers; language and literacy; health beliefs and practices and their intersection with Western medicine; health care-seeking attitudes, emotions, and behaviors; bridging cultural chasms; and lessons learned.
Using Photovoice to Improve Family Planning Services for Immigrant Hispanics
Authors: Schwartz Lisa R , Sable Marjorie R , Dannerbeck Anne , Campbell James D. (James Davis)
Published: July 2012

In a participatory action research program called Photovoice, Hispanic immigrants in a Midwestern community took photographs to provide researchers with insight regarding family planning. This report describes the Photovoice approach, why the researchers chose it, how they implemented it, what they learned, and the benefits derived for a larger service project.
High-Cost Users Among Dual Eligibles in Three Care Settings
Authors: Yip Judy , Nishita Christy M , Crimmins Eileen M , Wilber Kathleen H
Published: July 2012

Abstract: This study compares the expenditure patterns and characteristics of high-cost dual eligibles to normative-cost dual eligibles within institutional and community settings. Using claims records for people dually eligible for both Medicare and Medicaid in 18 California counties (n=349,433) in 2000, high-cost users in the long-stay institutional care setting spent a much higher amount and a much greater proportion of total costs in Medi-Cal (61%) but spent less proportionally in Medicare (39%) than high-cost users in the long-term community care (66% of total costs from Medicare) or episodic care (79% of total costs from Medicare) setting. Although individuals who are long-stay nursing facility residents are high-cost in the overall sample, multinomial logistic regressions revealed that the impact of diseases/conditions on high-cost status varied within each setting. These findings suggest that policymakers and providers should consider care setting as an important component when designing disease management strategies.
The Psychological Impact of Violence in Underserved Communities
Authors: Friday Jennifer C.
Published: July 2012

There is striking evidence that violence has a psychological impact on children and young adults in the United States, particularly those in underserved communities. Homicide is the second leading cause of death of all persons between the ages of 15 and 24 years and is the leading cause among African American youth. In 1990, more young African American men died from homicides than from all natural causes combined. Research indicates a number of factors that can predispose children to a lifetime of violence and criminal activity, including poverty, substance abuse, poor parenting skills, placement outside the home, and improper peer interaction. Evidence also indicates that early intervention through school health programs, community support systems, and, most importantly, proper parental supervision and interaction can reduce the incidence of violence and thereby the negative psychological impact violence has on children.
Psychosocial Characteristics of Psychiatric Inpatients With Reproductive Losses
Authors: Thomas Tommijean , Tori Christopher D. , Wile Joanne R. , Scheidt Susan D.
Published: July 2012

Rising fertility rates among the severely and persistently mentally ill require a better understanding of the family planning needs of this population. In the present study, 82 women hospitalized for major psychiatric disorders were divided into three groups: abortion ( n = 22), relinquishment ( n = 28), and no children ( n = 32). Statistical analyses of demographic, diagnostic, and birth control data showed that those who aborted or relinquished custody of their children were likely to come from ethnic minority populations and have a history of substance abuse. More than 70 percent of the women who had abortions reported sexual and/or physical assaults as either children or adults. Only 34 percent of all participants indicated that they used contraceptives. Increased awareness of reproductive histories and family planning needs of women with major psychiatric disorders is suggested.
The Impact of Housing Status on Health Care Utilization Among Persons With HIV Disease
Authors: Arno Peter S. , Bonuck Karen A. , Green Jesse , Fleishman John , Bennett Charles L. , Fahs Marianne C. , Maffeo Carla , Drucker Ernest
Published: July 2012

This study sought to identify the prevalence of unstable housing situations, and for whom they occurred, and to examine differences in health care utilization by housing status. Housing status and inpatient and outpatient health care utilization of 1,851 HIV-infected individuals was ascertained through interviews. Nine percent of respondents were in unstable housing situations. Unstable housing was associated with significantly lower functional status. The unstably housed were more likely to visit an emergency room (p < 0.05) and had fewer ambulatory visits than persons with stable housing (p < 0.03). They incurred nearly five more hospital days and their average hospitalization was approximately 1.5 days longer than the stably housed, although these differences were not significant. Utilization of ambulatory care is lower among unstably housed persons with HIV disease, which may have led to their increased reliance upon emergency rooms and hospitals. Helping HIV-infected individuals maintain adequate housing could reverse this pattern.
Predictions of County Uninsured Rates: Accuracy and Stability
Authors: Schmidt James R. , Deichert Jerome A.
Published: July 2012

Uninsured rates of all counties in an area can be predicted by combining survey data from a subset of area counties and secondary data on economic indicators that are available for all counties. The authors present a set of indicators that are related to the uninsured rate and develop prediction models from surveys taken two years apart in the same counties. The accuracy and stability of the prediction models are assessed. Accuracy levels are highest when contemporaneous rates are predicted, but accuracy deteriorates when rates in a later time period are predicted using models from a prior period.
Language, Sociodemographics, and Health Care Use of Hispanic Adults
Authors: Schur Claudia L. , Albers Leigh Ann
Published: July 2012

This study examines the role of spoken language in access to health care for Hispanic adults. Analyzing the associations between personal characteristics and the use of Spanish as opposed to English reveals that monolingual Spanish speakers were more likely than others to be older, less educated, in poor health, uninsured, and in poverty. Further, Spanish speakers were less likely than English-speaking Hispanics to have a usual source of health care. Persons with no usual source of care were least likely to have seen a physician or to have had their blood pressure checked, whereas those with a regular doctor appeared to have the greatest access. The authors conclude that, whereas language is certainly associated with many barriers to health care, both economic well-being and having a usual source of care are of paramount importance for the Hispanic American population.
Strategies for Suppression, Containment, and Eradication of Resurgent Tuberculosis
Authors: Young Roscoe C. , Rachal Raylinda E. , Bailey Stephanie B. C. , Tate H. Len , Nelson-Knuckles Bettie
Published: July 2012

This review provides strategies for the suppression, containment, and eventual eradication of resurgent tuberculosis. Some ethnic minority communities are at greatest risk because of the prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome, poverty and malnutrition, congregate living situations, aberrant lifestyles, illegal immigration, and underemployment among these populations. Proposed strategies include the education of the population at risk as well as health care providers to permit the optimization of preventive, diagnostic, and therapeutic technologies. Also necessary is the development of effective, safe, newer medications to enhance patient compliance and decrease drug resistance. Strategic planning embraces national socioeconomic policy to permit adequate resources to combat poverty and malnutrition, to rebuild the infrastructure of the public health system, and to improve access to health care among rural and urban dwellers. It is concluded that these efforts must continue to ensure the eradication of tuberculosis.
Factors Associated with Return Visits to a Homeless Clinic
Authors: Macnee Carol L. , Forrest Lanna J.
Published: July 2012

Associations between characteristics of homeless clients and their return visits to a nurse-managed primary health care clinic were examined using a retrospective chart review of 1,467 records from clients seen between 1991 and 1994. Client characteristics examined included age, education, race, gender, sheltered status, report of chronic disease, and report of family living in the area. Only 47 percent of clients made return visits to the clinic. Logistic regression indicated that those with reported chronic disease, males, whites, and those living on the street were more likely to have returned to the clinic for care than those without chronic illness, females, nonwhites, and those living in some type of shelter. Results suggest the need for program planning and evaluation for this population, which particularly considers women, nonwhites, and those without chronic disease as target groups for services.