bluuebunny/crossref_metadata_2025 huggingface dataset:
South African Literary Cartographies: A Post-transitional Palimpsest
Authors: Frenkel Ronit
Published: February 2014

This article investigates three South African novels in an attempt to map the movement between transitional cultural production and post-transitional literature of the present. I briefly outline Phaswane Mpe’s Welcome to our Hillbrow (2001) as a formative text of the South African transitional period before discussing Kgebetli Moele’s Room 207 (2006) and Ceridwen Dovey’s Blood Kin (2007) as post-transitional texts. These novels all circle around issues of place and space, while also revealing the shifts in South African cultural history, as they comprise a set of related perspectives that inscribe meaning across times and spaces. I argue that a palimpsestic reading of this fiction opens up the possibility of reconceptualizing the relationship between space, place, and transnational connectivity. Each of the three texts under discussion writes the space of the city as a type of situated transnationalism where the local and the global exist as coeval discourses of signification. The fecundity of a palimpsestic reading lies in the revelation of how one transitional experience is already present in another. By inscribing one discursive act over another, the ruptures and continuities between textualizations reveal a wealth of imaginaries that, I argue, define the idea of post-transitional South African literature. But perhaps most importantly, the post-transitional can be read as a palimpsestic concept itself, much like the fiction explored in this article, in that it enables a reading of the new in a way in which the layers of the past are still reflected through it. Rather than moving in a temporal linear fashion, post-transitional literature creates a palimpsest in which we can read the imaginaries circulating through and shaping South African cultural formations today.
Women Writing Nationhood Differently: Affiliative Critique in Novels by Forna, Atta, and Farah
Authors: Gagiano Annie
Published: February 2014

The focus of this article is on a discernible trend in contemporary African writing, wherein the fiction by mainly (though not exclusively) diasporic African women authors either explicitly or implicitly claims a nation for its women by highlighting the roles that women play in reimagining the (often shattered, or scattered) nation and place from which they have been separated. The article uses the concept of “affiliative critique” to indicate that these women writers hold the nation to account even as they indicate their continuing allegiance to it in their texts—despite the authors’ physical relocation to other countries and continents. The element of critique is strongly gender-inflected and indicates that gender injustice can be seen as one of the causes as well as one of the symptoms of broader failures of the nation-state in the African country of the authors’ origins. The essay juxtaposes novels by three newer writers: Aminatta Forna (focusing on Ancestor Stones , 2006), Sefi Atta ( Swallow , 2010), and Cristina Ali Farah ( Madre Piccola , 2007—using here the English translation titled Little Mother , 2011). These texts focus, respectively, on Sierra Leone, Nigeria, and Somalia. While sufficiently different in what they portray, these novels serve as examples of the powerful and vividly imagined delineations of their troubled nations provided by contemporary African authors and are fine illustrations of the discerning social analysis, searing critique, self-criticism, and ethical insights that the continent’s trend-setting women writers are producing.
Affiliation, Disavowal, and National Commitment in Third Generation African Literature
Authors: Krishnan Madhu
Published: February 2014

This paper examines the construction of national commitment in third generation African literature through a comparative reading of Binyavanga Wainaina’s literary memoir, One Day I Will Write about this Place , Adaobi Tricia Nwaubani’s I Do Not Come to You by Chance , and Yvonne Vera’s The Stone Virgins . In each text, the relationship between the individual and his or her nation of origin does not function in singular terms, reflecting the multiply-articulated imagined communities in which individual lives exist and the (re)doubled workings of filiation, affiliation, and disavowal at play in contemporary Africa. Like the nations that comprise the continent, then, the idea of the nation in the contemporary African literary work is both variable and shifting, responding to its immediate circumstances and demonstrating the potency of novel paradigms of belonging. Nationalism, like the nation, thus reflects a deep ambivalence that mobilizes multiple affiliations and, nevertheless, does not preclude belonging and commitment. Rather than dismissing the nation, Wainaina’s, Vera’s, and Nwaubani’s works present a new vision of nationhood and national belonging.
Daddy’s Girls?: Father-Daughter Relations and the Failures of the Postcolonial Nation-State in Chimamanda Ngozi Adichie’s Purple Hibiscus and Véronique Tadjo’s Loin de mon père
Authors: Toivanen Anna-Leena
Published: February 2014

Postcolonial theoretical discourses have adopted postnationalist overtones, declaring the obsolescence of the nation and treating dislocation as the paradigmatic condition. Sometimes, however, the claims of postnationalism may seem premature: the nation-state persists in the African literary agenda. When operating within the current paradigm, the notion of cosmopolitanism can serve as a useful tool for understanding contemporary African literatures and the ways in which they negotiate their relation to the local realities of the continent and the world beyond its boundaries. In this article, I read the narrative of the failed post-colonial nation-state through the lens of the father-daughter relations in Chimamanda Ngozi Adichie’s Purple Hibiscus (2003) and Véronique Tadjo’s Loin de mon père (2010). The father-daughter relations are intertwined with the narrative of the postcolonial nation, giving voice to daughterly disillusionment. The texts inscribe the national crisis on a larger map, making it a global rather than simply a local concern. The novels undertake a new attitude toward nationhood while being interested in national issues: their future visions are not in line with the logic of the nation-state but nor are they so with the transnational dimension. Instead, they are equally informed by the unease caused by the failures of the postcolonial nation-state and the unfulfilled hopes of finding both a more favorable socioeconomic situation and a sense of belonging in diaspora.
From Neglected History to Tourist Attraction: Reordering the Past in Zakes Mda’s The Heart of Redness
Authors: Pires Ana Luisa Oliveira Goncalves
Published: February 2014

The Heart of Redness comprises two narrative strands: one which is set only four years after the first democratic elections in South Africa and one that explores the 1856–57 “Cattle Killing Movement” and discloses the early encounters between the Xhosa and the British colonizers. Retrieving the past episode originated in the visions of prophetess Nongqawuse and aligning it with the contemporary discussion surrounding issues of economic and social development raised by the proposal of a tourism project for the village of Qolorha, Mda successfully articulates the complex elements that have marked past and present South African culture and society. In Mda’s novel, the village of Qolorha and the character of Nongqawuse are released from their negative association with one of the most dramatic episodes in the history of the Xhosa and transformed into a tourist attraction that has the potential to contribute to the sustainable development of the local population. Mda’s rescue of Qolorha from the threat of massified tourism, and his recovery of Nongqawuse as a meaningful character for the history of the Xhosa, emphasize the importance of alternative development models and the relevance of revising biased historical narratives that often served manipulative objectives.
Magical Realism: A Narrative of Celebration or Disillusionment? South African Literature in the Transition Period
Authors: Grzęda Paulina
Published: February 2014

This article discusses the emergence of magical realism as a narrative form embraced by a number of South African writers in the transition period and increasingly attuned to South African writing sensibility during this time. I argue that South African magical realism goes beyond the joining of realist and postmodern narrative strands by reconciling realism’s faithfulness to the socio-political context and postmodernism’s devotion to formal experimentation, syncretism, and meta-fiction. Magical realism simultaneously relies heavily on African oral traditions, and in doing so, it not only constitutes a point of confluence for black and white writing of the apartheid era, but it also epitomises the reconciliation of Eurocentric Western rationalism and African tradition. While discussing magic realism in relation to the post-apartheid novels of André Brink and Zakes Mda, this article points towards the possible origins of the proliferation of South African texts embracing this narrative mode in the period directly following the demise of apartheid, as well as the possible reasons behind the gradual abandonment of magical realist narrative strategy in post-millennial South African fiction. Thus, South African magical realist texts will be positioned at the intersection between literature of celebration and literature of disillusionment, emerging out of the short-lived coexistence of the two literary trends in South African literary history.
Hume’s Aesthetic Standard
Authors: Galgut Elisa
Published: February 2014

In his famous essay “Of the Standard of Taste,” Hume seeks to reconcile two conflicting intuitions—the intuition that there is a great variety of taste, on the one hand, and the intuition that there is an artistic standard based on taste that has stood the test of time, on the other—by appealing to the joint verdict of his “true judges” or “ideal critics.” But Hume’s critics have themselves been the objects of criticism as not providing an adequate basis on which to establish a normative aesthetic standard based on taste. In this paper, I defend an interpretation of Hume’s ideal critics as akin to judges in certain common law traditions, and I argue that Hume does satisfactorily resolve conflicting intuitions about the nature of taste.
The Ways of the Wise: Hume’s Rules of Causal Reasoning
Authors: Boyle Deborah
Published: February 2014

In their responses to Hume’s account of causal reasoning, Hume’s own contemporaries and many subsequent readers have tended to focus on the skeptical implications of that account. More recent scholarship has emphasized that Hume’s account of causal inference is not purely skeptical, for Hume often suggests that forming a belief through causal inference based on repeated experience is the right way to form beliefs. One less-noticed feature of Hume’s account of causal inference, however, is that Hume links good causal inference with virtue; thinkers who adopt certain methods of causal reasoning and eschew other methods possess the epistemic virtue that he characterizes as “wisdom” or “good sense.” This paper argues that Hume’s account of causal reasoning and his normative claims about belief can fruitfully be interpreted by focusing on what Hume says about such doxastic wisdom: why he thinks it is better to be wise than unwise; what he means when he characterizes certain methods of belief-formation as wise; how the cognitive habits employed by the wise differ from those of the unwise; and how he thinks someone can who lacks the epistemic virtue of wisdom can come to acquire it. Since much of the secondary literature on Humean virtue has focused on the “moral” rather than “intellectual” virtues (EPM App 4.2; SBN 313), attention to Humean doxastic wisdom also helps to provide a more complete picture of his account of virtue.
Hume’s Conception of Proper Reflection
Authors: Ievers Lisa
Published: February 2014

The concept of reflection plays an equivocal role in the Treatise . It is identified as both the key to the formation of more accurate beliefs and the means to the destruction of belief altogether. I attempt to resolve this apparent paradox by showing that there are two distinct kinds of reflection in Book 1: legitimate, or “proper,” reflection and illegitimate reflection. Despite evidence to the contrary—including Hume’s own claim that he cannot establish that excessive reflections (one variant of illegitimate reflection) should not affect our beliefs—I argue that Hume can justifiably draw a distinction between proper and illegitimate reflection based on epistemological grounds available to him that he does not recognize.
Sympathy and the Mechanics of Character Change
Authors: Waldow Anik
Published: February 2014

Sympathy’s susceptibility to interpersonal relations is problematic for Hume because even though sympathy is crucial for making moral judgments, it biases our character judgments in favor of those closest to us. This essay will argue that despite his emphasis on these negative effects and his insistence on the need to correct sympathy in order to attain universal moral judgments, Hume also offers resources for thinking that uncorrected, relation-susceptible sympathy plays a powerful role in the formation of character and in the refinement of one’s character ideals. This positive role emerges from Hume’s claim that close relations to other persons maximize the pains we feel in response to their disapproval, suggesting that our interactions with these persons strongly motivate us to become critical of morally questionable traits and sufficiently determined to abandon them. Focusing on this function of sympathy enables us to understand the importance of situatedness and attachments for our moral development and reveals how spontaneous affections can usefully feed into our more reflective moral insights.
Hume, Malebranche, and the Self-Justification of the Passions
Authors: Le Jallé Éléonore
Published: February 2014

In Book 2 of the Treatise , Hume echoes Malebranche’s Search after Truth in noticing that all our passions tend to justify themselves. I reveal this borrowing and examine how this phenomenon of the self-justification of the passions fits into Malebranche’s and Hume’s different approaches to the passions and their links to judgment and truth. I maintain that whereas Malebranche aims to warn against the errors that passions involve when justifying themselves, Hume only considers the self-justification of the passions as an example of the dynamic nature of the mind, other examples of which are displayed elsewhere in the Treatise . I also show that Hume’s understanding of the self-justification principle illustrates another important theme of Books 1 and 2, namely, the reciprocal influences of the imagination and the passions.
Pediatricians May Address Barriers Inadequately When Referring Low-Income Preschool-Aged Children to Behavioral Health Services
Authors: Brown Courtney M. , Girio-Herrera Erin L. , Sherman Susan N. , Kahn Robert S. , Copeland Kristen A.
Published: February 2014

Background . Low-income parents often seek help from pediatricians for early childhood social-emotional problems but seldom follow through with referrals to behavioral health services. Objective . We sought to understand low-income parents’ experiences seeking help from pediatricians for social-emotional problems and how those experiences influenced decisions about accessing behavioral health services. Methods . We conducted 20 semi-structured interviews with low-income parents with concerns about their children’s behavior or emotions. Participants were asked about experiences seeking help from pediatricians and decision-making about accessing behavioral health services. Results . Three themes emerged: (1) Participants described reluctance to recognize social-emotional problems, which was often reinforced by doctors’ reassurance. (2) Participants reported pediatricians did not meet their expectations about testing, providing explanations/advice, or addressing behavior on-site. (3) Participants had unclear expectations of behavioral health services. Conclusions . Primary care mechanisms that reliably educate parents about behavioral trajectories and the role of behavioral health providers may improve follow-up rates.
Community Health Workers and the Patient Protection and Affordable Care Act: An Opportunity for a Research, Advocacy, and Policy Agenda
Authors: Shah Megha K. , Heisler Michele , Davis Matthew M.
Published: February 2014

Community health workers (CHWs), who have been shown to be effective in multiple roles in the provision of culturally appropriate health care in a variety of settings, have the potential to be important members of an interdisciplinary health care team. Recent efforts have started to explore how best to integrate CHWs into the health system. However, to date, there has been limited policy guidance, support, or evidence on how best to achieve this on a larger scale. The Patient Protection and Affordable Care Act (ACA), through several provisions, provides a unique opportunity to create a unified framework for workforce integration and wider utilization of CHWs. This review identifies four major opportunities to further the research, advocacy, and policy agenda for CHWs.
Patterns of Health Care Utilization among Vulnerable Populations in Central Texas Using Data from a Regional Health Information Exchange
Authors: Schiefelbein Emily L. , Olson Jerome A. , Moxham Jamie D.
Published: February 2014

Purpose . Describe patterns of health care utilization among vulnerable subgroups of an underserved population and identify populations that could benefit from interventions to reduce health care costs and improve quality of care. Methods . Health Information Exchange data focused on underserved patients was used to estimate the risk of an emergency department (ED) or inpatient (IP) visit among vulnerable patients. Results . Approximately 20.9% of the population was vulnerable, with behavioral health being the most predominant. Homeless, disabled, and severe behavioral health patients had an increased risk of ED utilization. Behavioral health, disabled, and near elderly patients had an increased risk of IP utilization. Inpatient risk was even greater for patients with multiple vulnerabilities. Conclusions . Improved primary care services are needed to address both the mental and physical needs of vulnerable populations, particularly people with severe behavioral health conditions. Improved access to services may help reduce the costly burden of providing hospital-based care.
The Severity of Disparity: Increasing Injury Intensity Accentuates Disparate Outcomes Following Trauma
Authors: Losonczy Lia I. , Weygandt P. Logan , Villegas Cassandra V. , Hall Erin C. , Schneider Eric B. , Cooper Lisa A. , Cornwell Edward E. , Haut Elliott R. , Efron David T. , Haider Adil H.
Published: February 2014

Objective . Studies have shown disparities in mortality among racial groups and among those with differing insurance coverage. Our goal was to determine if injury severity affects these disparities. Methods . We classified patients from the 2003–2008 National Trauma Data Banks suffering moderate to severe injuries into six groups based on race/ethnicity and insurance, stratifying by injury severity. Logistic regression compared odds of death between races-ethnicities/insurance groups within these strata. We adjusted for age, gender, Injury Severity Score, Glasgow Coma Scale motor component, hypotension, and mechanism of injury. Results . Patients meeting inclusion criteria numbered 760,598. Disparities between races-ethnicities/insurance groups increased as injury severity worsened. Odds of death for uninsured Black patients compared with insured Whites increased from 1.82 among moderately injured patients to 3.14 among severely injured, hypotensive patients. A similar pattern was seen among uninsured Hispanic patients. Conclusions . Disparities in trauma mortality suffered by minority and uninsured patients, when compared with non-minority and insured patients, worsen with increasing injury.
Federal Health Insurance Reform and “Exchanges”: Recent History
Authors: Brandon William P. , Carnes Keith
Published: February 2014

The major national innovation of the Affordable Care Act (ACA) is the insurance exchange or health insurance marketplace (HIM). We begin by briefly reviewing the ACA’s chief features and detailing its HIM provisions. Section two explores the policy history of exchanges, beginning with Clinton’s proposals and Massachusetts’ Connector and concluding by contrasting the House-passed bill with one national exchange and the Senate bill with state-based exchanges. The Senate bill became the ACA. The evolution of policy ideas about exchanges suggests three critical conditions for a successful exchange: commodification (of insurance products), competition (between insurers), and communication (to potential buyers and the public about insurance). The penultimate section compares the rollout of the state-run Kentucky exchange and the federally facilitated exchange in North Carolina in light of what we will call the 3 Cs . The conclusion reflects more widely upon the unique form that the pro-competition or deregulatory strategy has taken in health policy.
Community Based Health Insurance Schemes: Lessons from Rural Kenya
Authors: Kamau Njoroge , Njiru Haron
Published: February 2014

Background . Health care costs are often a hindrance to seeking health care. Community-based health care insurance schemes (CBHIS) is a suitable alternative to conventional health insurance schemes which are often beyond the budget of majority of rural residents in Africa. Following establishment of a model CBHIS in the Samburu district in northern Kenya in 1988, initial membership rose from 12 to 218 households within 18 months but dropped to below 50 households by end of the 18th year. Samburu residents are mainly semi-nomadic pastoralist people dispersed into small nomadic communities across vast stretches of difficult terrain. Objective . The objective of the survey was to assess Samburu CBHIS and give recommendations on how to rejuvenate the scheme. Design . A cross-sectional study was conducted using qualitative and quantitative methods. Results . The community has a poor understanding of the mechanism of CBHIS; little trust for scheme; and believes the scheme is expensive. Conclusions . There is need to create awareness on the operations of a health insurance scheme and engage community in redesigning of the scheme.
Poverty Blindness: Exploring the Diagnosis and Treatment of an Epidemic Condition
Authors: Ventres William , Gusoff Geoff
Published: February 2014

Despite the historical and social significance of poverty, scholars from varied ideological and philosophical disciplines have often observed that its most notable feature is its invisibility. We suggest that poverty is not excluded from view, but rather from consciousness. This lack of consciousness is due to a subjective “poverty blindness” on the part of those who fail to take the poor into account. In this article we explore this new concept of “Poverty Blindness” (PB) using a clinical approach. We review the clinical manifestations of PB and the associated condition of Poverty Acuity Disorder (PAD). We conclude by suggesting that the ability to see these circumstances and consequences of poverty is not some ambiguous externalized concept, but lies within our own consciousnesses and consciences. Only through recognizing this are we able to assess honestly the realities of poverty or debate how to go about its alleviation.
A Systematic Review of Factors Affecting Migrant Attitudes Towards Seeking Psychological Help
Authors: Selkirk Mhairi , Quayle Ethel , Rothwell Neil
Published: February 2014

Research indicates that service utilization rates in migrant groups are low, although levels of distress appear high when compared with host populations. This paper systematically reviews quantitative and qualitative literature on factors associated with attitudes toward seeking psychological help among working age migrants. Data were extracted from MEDLINE, EMBASE, PsycINFO, Science Direct and SAGE databases. Eight quantitative studies and 16 qualitative studies met the inclusion and exclusion criteria. The majority of studies were conducted in North America (67%). Although results of quantitative studies were heterogeneous, stronger identification with host than heritage culture, fluency in host country language, psychological attributions of distress, higher educational levels, higher socioeconomic status, female gender, and older age were associated with more favourable attitudes toward help-seeking in some migrant groups. Three major themes emerged from the qualitative literature: logistical barriers, cultural mismatch between service providers and participants, and preferences for other sources of assistance.
High Rates of Depressive Symptoms in Low-Income Urban Hispanics of Caribbean Origin with Poorly Controlled Diabetes: Correlates and Risk Factors
Authors: March Dana , Luchsinger José A. , Teresi Jeanne A. , Eimicke Joseph P. , Findley Sally E. , Carrasquillo Olveen , Palmas Walter
Published: February 2014

Little is known about diabetes and depression in disadvantaged urban Hispanic subgroups, particularly those of Caribbean origin. Using data from 360 urban Hispanics of Caribbean origin with poorly controlled diabetes, our objectives were to examine the prevalence and correlates of depressive symptoms and depression using the Euro-D, and the association of depressive symptoms and depression with diabetes self-management and clinical parameters of diabetes control, employing multivariate analyses. The prevalence of depression was 52.8%. Higher levels of depressive symptoms were related to female gender (p < .0001), antidepressant use (p < .0001), stressful life events (p < .0001), SSI (p = .0011), lower education (p < .0001), lower statin use (p = .0014), and less walking (p = .0152). Depression (Euro-D > 3), was associated significantly with female gender (OR = 2.30, 95%CI = 1.38– 3.82), SSI (OR = 2.44, 95%CI = 1.45–4.12), antidepressant use (OR = 2.94, 95%CI = 1.54–5.64), and stressful life events (OR = 1.93, 95%CI = 1.52–2.44). Depressive symptoms and depression were related to markers of adversity and two indicators of diabetes self-management, but not clinical parameters of diabetes control.
Incentives among Health Workers in a Remote Kenyan District: Implications for Proposed County Health System
Authors: Njuguna John , Mwangi Pius , Kamau Njoroge
Published: February 2014

Introduction . Attracting and retaining health workers in remote rural areas is a challenge in Kenya. Devolution of the Kenyan health system may negatively affect worker retention; incentives may play a role in retaining health workers. Methods . Semi-structured questionnaires were administered to health workers and human resource data reviewed. Analysis was for descriptive and emerging themes. Results . Health workers were employed under three different terms of service. The majority receive a monthly hardship allowance in the range of $7.5–94. Only five percent of health workers were able to engage in private practice. Available housing, water supply, electricity supply, and educational facilities were cited as inadequate. With the proposed devolution to county governments, 97.3% of respondents preferred to work in a different county. Conclusion . There may be need to harmonize the terms of service, improve the incentives, and amenities available to health workers in remote Kenyan counties in order to improve retention.
Pediatric Ocular Injuries in a Resource-Deficient Rural Mission Eye Hospital in Southeastern Nigeria
Authors: Okoye Obiekwe , Ubesie Agozie , Ogbonnaya Chimdia
Published: February 2014

Introduction . Pediatric ocular trauma is a significant worldwide problem of public health importance being a leading cause of non-congenital unilateral blindness. This study evaluated the proportion, type and causes of ocular injuries among children in a rural hospital of Nigeria. Methods . Children (<16 years) presenting with ocular trauma at the Eye clinic of the Presbyterian Joint Hospital, Ohaozara, Ebonyi state, Nigeria, between November 2011 and May 2012 were studied. Participant’s socio-demographics, type of trauma, cause of trauma, and occupation of parents were collected and analysed. Results . The Proportion of ocular injuries was 26.4%. Injuries were more common among males (P=.041) and children from lower social class (P=.026). Injuries occurred more frequently during farm work (59.4%) and play (21.9%). The most common causes of injury were stick (34.4%) and stones (21.8%). Conclusion . The proportion of ocular injuries among children at the rural hospital is high. Most causes are preventable.
Refugees in Denver and Their Perceptions of Their Health and Health Care
Authors: Elwell David , Junker Sarah , Sillau Stefan , Aagaard Eva
Published: February 2014

Background . Colorado receives approximately 2,500 refugees each year from countries all over the world. We assessed the self-perceived health of and barriers to care for refugees in the Denver metro area in order to understand better the needs of this population. Methods . A 61-item questionnaire was completed by a convenience sample of 120 local refugees between June and December of 2009. Results . Only 10% of respondents reported their health as excellent, while 31% rated it as either poor or fair. The most prominent barriers to care included unemployment (91%), language (46%), lack of health insurance (41%), lack of transportation (43%), and distrust of doctors (22%). Conclusions . Our study suggests that refugees in Denver face significant barriers that affect their access to health care. Recommendations include improved job and language skill programs, a health navigator program, and health care provider training on culturally effective care of this population.
English Language Proficiency and Physical Activity among Mexican-Origin Women in South Texas and South Carolina
Authors: Salinas Jennifer J. , Hilfinger Messias DeAnne K. , Morales-Campos Daisy , Parra-Medina Deborah
Published: February 2014

Objectives . To examine the relationship between English language proficiency (ELP), physical activity, and physical activity-related psychosocial measures (i.e., exercise self-efficacy, exercise social support, perceptions of environmental supports) among Mexican-origin women in South Carolina and Texas. Design . Adjusted robust regression and interaction modeling to evaluate baseline questionnaire data on self-reported ELP with CHAMPS leisure-time moderate-to-vigorous physical activity (MVPA), accelerometry data, Physical Activity Self-Efficacy, Physical Activity Social Support, and Environmental Support for Physical Activity in 118 Mexican-origin women. Results . The adjusted regression revealed a significant association between ELP and perceived physical activity self-efficacy (β = 234.2, p = .004), but not with physical activity social support. In South Carolina, CHAMPS leisure-time MVPA (411.4 versus 114.3 minutes, p < .05) was significantly different between women in the high ELP quartile and those in the very low quartile. Among high ELP Mexican-origin women, participants in Texas reported significantly higher MVPA measured by accelerometry (p = .042) than those in South Carolina. Conclusion . Our findings indicate that ELP was associated with physical activity and that contextual factors may also play a role.
Examining the Use of HIT Functions among Physicians Serving Minority Populations
Authors: Tarver Will , Menachemi Nir
Published: February 2014

The Institute of Medicine highlighted the fact that the U.S. health care system does not provide consistent, high quality medical care to all people. The routine use of health information technology (HIT) that includes certain key functions may be critical in reducing such disparities. We used logistic regression analyses to examine differences when it comes to the routine use of key HIT functions that are linked to improvements in clinical care. Physicians predominantly serving Black patients were more likely than physicians predominantly serving White patients to routinely use HIT to generate reminders for clinicians and patients about preventive services. Similarly, physicians predominantly serving Hispanic patients were more likely than physicians predominantly serving White patients to routinely use HIT to access patients’ preferred language. Importantly, although minority-serving institutions have lower adoption rates overall, differences exist in the routine use of key HIT functions that have the potential to reduce health disparities.
A Systematic Review of Innovative Diabetes Care Models in Low-and Middle-Income Countries (LMICs)
Authors: Esterson Yonah B. , Carey Michelle , Piette John D. , Thomas Nihal , Hawkins Meredith
Published: February 2014

Background . Over 70% of the world’s patients with diabetes reside in low-and middle-income countries (LMICs), where adequate infrastructure and resources for diabetes care are often lacking. Therefore, academic institutions, health care organizations, and governments from Western nations and LMICs have worked together to develop a variety of effective diabetes care models for resource-poor settings. Methods . A focused search of PubMed was conducted with the goal of identifying reports that addressed the implementation of diabetes care models or initiatives to improve clinical and/or biochemical outcomes in patients with diabetes mellitus. Results . A total of 15 published manuscripts comprising nine diabetes care models in 16 locations in sub-Saharan Africa, Latin America, and Asia identified by the above approach were systematically reviewed. The reviewed models shared a number of principles including collaboration, education, standardization, resource optimization, and technological innovation. The most comprehensive models used a number of these principles, which contributed to their success. Conclusions . Reviewing the principles shared by these successful programs may help guide the development of effective future models for diabetes care in low-income settings.
Race and Socioeconomic Differences in Obesity and Depression among Black and Non-Hispanic White Americans
Authors: Lincoln Karen D. , Abdou Cleopatra M. , Lloyd Donald
Published: February 2014

Obesity and depression often co-occur; however, the association between these conditions is poorly understood, especially among racial/ethnic minority groups. Using multinomial logistic regression and data from the National Survey of American Life, the relationships between race, ethnicity, and sociodemographic factors to the joint classification of body mass index categories and depression among African Americans, Caribbean Blacks, and non-Hispanic Whites were examined. Differential risk for the combination of obesity and depression by sociodemographic status was found. Being African American, female, young, married, or having low income or education increases the risk for obesity without depression. Risk factors for obesity with depression include being female, young, married and having a low income. Race was not a significant predictor of obesity with depression relative to normal weight without depression status. However, racial differences were observed among the non-depressed. Non-depressed African Americans were more likely than non-depressed Whites or Caribbean Blacks to be obese.
A Description of an Urban Transitions Clinic Serving Formerly Incarcerated People
Authors: Fox Aaron D. , Anderson Matthew R. , Bartlett Gary , Valverde John , MacDonald Ross F. , Shapiro Lauren I. , Cunningham Chinazo O.
Published: February 2014

Chronic health conditions are overrepresented among jail or prison inmates but often go untreated during incarceration and following release. We describe the Bronx Transitions Clinic, a partnership between a community-based organization and an academic medical center, which facilitates connections to medical care for formerly incarcerated people.
Incorporation of Socioeconomic Status Indicators into Policies for the Meaningful Use of Electronic Health Records
Authors: Chen Candice , Weider Katie , Konopka Kristen , Danis Marion
Published: February 2014

Socioeconomic status (SES) has an important effect on health. Individuals with lower SES experience more chronic disease, are less likely to receive preventive care, and have shorter life expectancies. As the Affordable Care Act is implemented and increasing numbers of previously uninsured people gain access to health care, the imperative to recognize patients’ SES and develop health initiatives that account for the social determinants of health increases. Health care providers across the nation are adopting electronic health records (EHRs). Policies such as Meaningful Use offer opportunities systematically to incorporate the collection of standardized SES indicators into EHRs in ways that improve health, increase the understanding of the relationship between SES and health, and inform future policies. This paper examines the use of SES indicators in research, national surveys, and federal programs and finds adding an income question is the most feasible and optimal SES indicator for the inclusion in EHRs.
The Health and Health Behaviors of a Sample of African American Pastors
Authors: Baruth Meghan , Wilcox Sara , Evans Rebecca
Published: February 2014

There is growing concern for the health status of clergy in light of recent studies showing high rates of chronic health conditions and obesity. This manuscript examined the health and health behaviors of South Carolinian African Methodist Episcopal (AME) pastors (n = 40). A majority of pastors were overweight or obese (93%) with hypertension (68%); half had two or more chronic health conditions, 35% had high cholesterol, 30% arthritis, and 20% diabetes. On average, pastors had a waist circumference that put them at an increased risk for disease. Yet, with the exception of fruit and vegetable consumption (mean = 3.4 ± 4.0 cups/day), pastors generally engaged in positive health behaviors. Understanding where the greatest needs lie is the first step in developing programs that can improve pastor health, which may ultimately improve the health of their congregations.
Breast Cancer and Mammography: Knowledge, Attitudes, Practices and Patient Satisfaction Post-mammography at the San Fernando General Hospital, Trinidad
Authors: Gosein Maria A. , Pereira Snehal M. Pinto , Narinesingh Dylan , Ameeral Anthony
Published: February 2014

Self-administered questionnaires were completed by 314 Trinidadian women, 40 years and older, to ascertain their breast cancer knowledge, attitudes, and practices. Those with higher education had greater knowledge of the benefits of early breast cancer detection (p < .01) and knew that an abnormal mammography result (p = .01) or recall (p < .01) was not necessarily indicative of breast cancer. Inaccurate beliefs particularly that breast compression causes cancer were more likely among those with the least education (p = .04). Obesity and alcohol were identified as risk factors by 29.3% and 12.4%, respectively. Over two-thirds (70%) of mammograms were primarily the doctor’s decision. Over 90% of women were satisfied post-mammography, most (94.6%) with plans for future use. Some (15.6%) reported pain and 48.7% reported discomfort, with over 70% of these finding the examination less painful than anticipated. Targeted culturally sensitive awareness campaigns are needed. Clinicians must be sensitized to their importance in recommending mammography. Data on patient satisfaction and pain perception can be publicized to encourage women who are hesitant about mammography.
The Effects of a Culturally Sensitive, Empowerment-Focused, Community-Based Health Promotion Program on Health Outcomes of Adults with Type 2 Diabetes
Authors: Tucker Carolyn M. , Lopez Manuel Thomas , Campbell Kendall , Marsiske Michael , Daly Katherine , Nghiem Khanh , Rahim-Williams Bridgett , Jones Jessica , Hariton Eduardo , Patel Avani
Published: February 2014

The purpose of the present study was to test the effects of a culturally sensitive, health empowerment-focused, community-based health promotion program tailored to adult patients with type 2 diabetes on these patients’ body mass index (BMI), blood pressure, and self-reported blood glucose levels, treatment adherence, and stress levels. Study participants (N = 130) consisted mostly of African Americans (70%) and Hispanic/Latinos (22.3%) who were divided almost evenly between an intervention group and wait-list control group. The tested health promotion program is informed by Health Self-Empowerment Theory. At post-test, program participants in the intervention group as compared to those in the control group demonstrated significantly lower levels of BMI, diastolic blood pressure, and physical stress. Implications of these study findings for future similar programs and research are discussed.
Impact of Depression on the Intensity of Patient Navigation for Women with Abnormal Cancer Screenings
Authors: De La Cruz Ignacio I , Freund Karen M , Battaglia Tracy A , Chen Clara A , Bak Sharon , Kalish Richard , Lottero Barbara , Egan Patrick , Heeren Tim , Kronman Andrea C
Published: February 2014

Patient navigation is increasingly being used to support vulnerable patients to receive timely and quality medical care. We sought to understand whether patients with depression utilize additional patient navigation services after abnormal cancer screening. We compared depressed and non-depressed women using three different measures of intensity of patient navigation: number of patient-navigator encounters, encounter time, and number of unique barriers to care. The study population consisted of 1,455 women who received navigation after abnormal screening for breast or cervical cancer at one of six community health centers in Boston. Navigators spent a median of 60–75 minutes over one or two encounters per participant, with 49% of participants having one or more documented barrier to care. Depressed women did not differ in total numbers of encounters, encounter time, or unique barriers compared with non-depressed women. Our findings suggest that pre-existing depression does not predict which women will utilize additional navigation services.
Coverage Isn’t Enough: Building Primary Care Capacity in the Setting of Health Reform
Authors: Block Lauren , Cook Barbara G. , Hanyok Laura A. , de la Torre Desiree , Rogers Michael M. , Noronha Gary , Sylvia Martha
Published: February 2014

The Access Partnership is a program linking uninsured patients with primary and specialty care. Expansion of primary care access resulted in an influx of patients with multiple chronic conditions, causing the primary care practice to reach capacity after seven months. Our program may provide lessons in ensuring primary care access as the Affordable Care Act is implemented.
Health Care Information in African American Churches
Authors: Harmon Brook E. , Kim Sei-Hill , Blake Christine E. , Hébert James R.
Published: February 2014

Churches are a trusted resource in African American communities; however, little is known about their presentation of health care information. This study characterized health care information disseminated by 11 African American churches. Content analysis conducted on print media systematically collected over one year used a coding scheme with .77 intercoder reliability. Health care information was identified in 243 items and represented three topics (screening, medical services, health insurance). Screening was the most common topic (n = 156), flyers/handouts most often used (n = 90), and the church the most common source (n = 71). Using chi-square tests, information was assessed over time with health insurance information showing a statistically significant increase (χ 2 = 6.08, p < .05). Study churches provided health care information at varying levels of detail with most coming from church and community publications. Future research should examine additional characteristics of health care information, its presence in other churches and community settings, and how exposure influences behaviors.
Women’s Education Level, Antenatal Visits and the Quality of Skilled Antenatal Care: A Study of Three African Countries
Authors: Babalola Stella
Published: February 2014

Many pregnant women in Africa who access professional antenatal care do not receive all the WHO-recommended components of care. Using Demographic and Health Survey (DHS) data from Kenya, Malawi and Nigeria, this study assesses the relationship of education level with the quality of antenatal care received and highlights how the number of antenatal visits mediates this relationship. The results show that a large proportion of the effect of education level on quality of care is direct, while only a small portion is mediated through the number of antenatal visits. Efforts to improve pregnancy outcomes for under-privileged women should focus on removing structural barriers to access, strengthening the technical and interpersonal skills of providers, and addressing providers’ biases and discriminatory practices towards these women. Such efforts should also seek to empower underprivileged women to insist on quality antenatal care by explaining what to expect during an antenatal visit.
Race/Ethnicity and the Socioeconomic Status Gradient in Women’s Cancer Screening Utilization: A Case of Diminishing Returns?
Authors: Monnat Shannon M.
Published: February 2014

Using three years (2006, 2008, 2010) of nationally representative data from the Behavioral Risk Factor Surveillance System, I assessed the socioeconomic status (SES) gradient for odds of receiving a mammogram in the past two years and a Pap test in the past three years among White, Black, Hispanic, and Asian women living in the U.S. Mammogram and Pap test utilization were less likely among low-SES women. However, women of color experience less benefit than Whites from increasing SES for both screenings; as income and education increased, White women experienced more pronounced increases in the likelihood of being screened than did women of color. In what might be referred to as paradoxical returns , Asian women actually experienced a decline in the likelihood of obtaining a recent Pap test at higher levels of education. My findings suggest that women of color differ from Whites in the extent to which increasing socioeconomic resources is associated with increasing cancer screening utilization.
Emergency Department Charges for Asthma-Related Outpatient Visits by Insurance Status
Authors: Wang Tiffany , Srebotnjak Tanja , Brownell Julia , Hsia Renee Y.
Published: February 2014

Though Americans make 1.8 million asthma-related outpatient visits to the emergency department (ED) annually, little is known about the episodic charges for asthma care in the ED. We therefore sought to assess the bills patients could face for acute asthma incidents by examining hospital charges for asthma-related outpatient ED visits. We performed a nationwide, cross-sectional study of 2.9 million weighted asthma-related outpatient ED visits from 2006–2008 using data from the Medical Expenditure Panel Survey. We found that the average charge for an outpatient ED visit was $1,502 (95% CI $1,493–$1,511). The charges did not vary significantly by insurance group but did increase significantly with age. Our results indicate that the financial burden of ED care for asthma may take a severe toll on low-income populations who have limited ability to pay, especially patients who must pay undiscounted charges, including the uninsured and those on high-deductible health plans.
Strengthening the Role the Workforce Plays in Health Policy Engagement in Underserved Communities: Lessons from a Multi-site Federally Qualified Health Center
Authors: Jepeal Nicole , Zlateva Ianita , Wang Jackie , Olayiwola J. Nwando
Published: February 2014

Studies on the engagement of the CHC workforce in health policy are limited. Most uninsured Americans do not understand how the ACA affects them. We assessed knowledge and interest of our workforce in health policy, and applied the Socio-Ecological model to a plan for engagement, sharing strategies for similar settings.