bluuebunny/crossref_metadata_2025 huggingface dataset:
Can a Poor State Afford Not to Expand Medicaid?
Authors: Capilouto Eli , Dailey Theresa A.
Published: July 2012

Some advocates of the uninsured support expansion of Medicaid programs, while others say that expansions are simply unaffordable, especially in poor states. State-level analyses of the costs and consequences of these expansion programs are infrequent. This study evaluates three programs to expand eligibility for Alabama's Medicaid program. The first two programs would raise the Aid to Families with Dependent Children (AFDC) eligibility threshold to 50 and 100 percent, respectively, of the federal poverty level. The third program, currently not available to the states without a federal waiver, would drop all categorical eligibility requirements and base eligibility solely on whether income is below the federal poverty level. Only 10.7 and 18.3 percent, respectively, of Alabama's uninsured would gain health care coverage under the first two programs. The third program would increase the proportion of Alabamians with health coverage to nearly 50 percent. For all of these programs, front-end state costs would be largely countered by federal funding and offsets, such as reductions in uncompensated hospital care and savings realized by former uninsureds from reductions in out-of-pocket expenditures for health services.
Peer Counseling in a Culturally Specific Adolescent Pregnancy Prevention Program
Authors: Ferguson Stephanie L.
Published: July 2012

This study evaluated the effects of peer counseling in a culturally specific adolescent pregnancy prevention program for African American females. A random pretest and multiple posttest experimental and comparison group design was used to obtain data on a sample of 63 female African American adolescents, ages 12 to 16, who lived in four public housing developments. Descriptive data and tests of significance revealed that none of the participants who received peer counseling became pregnant within three months of the intervention. Findings revealed a statistically significant increase in reproductive and other self-related knowledge topics among the experimental group when comparing pretest and eight-week posttest scores. Most participants had not had sexual intercourse; the average age of sexual onset was 12 years in the experimental group and 11 years in the controls. Designing and implementing culturally specific adolescent pregnancy prevention programs for adolescents younger than age 11 and/or before sexually active seems appropriate.
A Proposal to Provide Care to the Uninsured through a Network of Community Health Centers
Authors: Blumenthal Daniel S. , Lukomnik Joanne E. , Hawkins Daniel R.
Published: July 2012

While a national health insurance plan is needed, this alone will not provide access for approximately 30 million persons who face geographic, cultural, language, or health care system barriers, or who live in areas with provider shortages. These barriers often coexist with lack of insurance coverage, but they also affect millions who have public, or even private, coverage. Moreover, large segments of this population suffer from health problems not adequately addressed by the traditional medical model: teenage pregnancy, AIDS, injury, substance abuse, and the like. To provide appropriate care for these underserved persons, we propose to expand the existing network of community health centers over the next 10 years to a total of approximately 3,000. Such an expansion would provide a cost-effective approach to improving provider distribution, increasing consumer input, combining personal health services with health promotion, and removing both financial and nonfinancial barriers to care. This model can be implemented either independent of or in conjunction with other health care system reform efforts.
Measuring Quality in Health Care Reform
Authors: Lavizzo-Mourey Risa
Published: July 2012

President Clinton's American Health Security Act of 1993 is based on six principles: security, savings, simplicity, quality, choice, and responsibility. All six relate to maintaining or enhancing the quality of care. Recognizing the importance of the clinical maxim of first doing no harm, the Administration seeks to safeguard quality by ensuring accessibility to care, improving knowledge, fostering the synthesis of information into clinical practice guidelines, and seeking information on the performance of health plans. Annual report cards will help providers and plans monitor and improve the quality of their care, while enabling consumers to make informed decisions about enrolling in plans.
The Clinton Health-Care Reform Plan: Does it Serve the Underserved?
Authors: Weil Thomas P.
Published: July 2012

During the 1992 presidential campaign, Governor Clinton promised, if elected, to provide leadership from the Oval Office for sweeping, comprehensive reform of the U.S. health-care system to benefit all Americans. The President's ambitious blueprint, as outlined on September 22, 1993, falls short of th is pledge. For the majority of the nation's poor and underserved, the proposed plan insufficiently ensures universal access, social equity, comprehensiveness of benefits, affordability, and high-quality health-care services. Requiring all employers to provide, and employees to share the cost of, health-insurance coverage could decrease take-home pay for many of the working poor. In addition, the President's proposed cost-containment efforts, which include global budgetary targets and reductions in Medicare and Medicaid reimbursement, could result in the elimination of over 1.0 million positions in the health-care field. These potential outcomes are alien to the President's earlier axioms to reform the U.S. health-care system, and to improve the nation's economic climate to foster the creation of more and better-paying jobs.
Managed Competition: A Critical Analysis
Authors: Jackson Alan L.
Published: July 2012

Proposals for managed competition offered by President Clinton and members of Congress would foster the proliferation of health maintenance organizations, which in turn could increase bureaucracy, reduce patients' choice of providers, restrict providers' medical practices, and benefit already profitable insurance companies. A single-payer alternative presents a more viable way of reducing administrative costs and providing health insurance for all.
Beliefs Concerning Contraceptive Acquisition and Use Among Low-Income Women
Authors: Sable Marjorie R. , Libbus M. Kay
Published: July 2012

Despite the availability of a wide variety of safe and effective contraceptives, unintended pregnancy remains a problem of considerable social and public health concern. This qualitative, descriptive investigation was based on Ajzen's Theory of Planned Behavior. The study examined attitudinal and normative beliefs, as well as perceived control factors that may affect a woman's intention to acquire and use specific contraceptive methods. The study sample consisted of 42 low-income women of reproductive potential. In face-to-face, audiotaped interviews, open-ended questions were used to elicit salient beliefs that affected these women's decision making about contraceptive acquisition and use. Respondents named embarrassment as a factor influencing condom acquisition and use; concerns about potential risks and side effects were a major deterrent to use of hormonal contraceptives. Implications for practitioners and public policy are suggested.
Public/Private Partnerships in Managed Care
Authors: Bredesen Philip
Published: July 2012

Although public/private partnerships are often viewed as mechanisms for using private monies to finance public needs, partnerships among health careproviders, the business and legal communities, and the public sector offer promise as a way to realign the provision of health care to special-needs communities in the present era of managed care. In Nashville, Tennessee, such a partnership promises to provide efficient, state-of-the-art medical care through a centralized city-wide clinic for HIV-positive individuals.
Home Environmental Factors Associated with Asthma Prevalence in Two Buffalo Inner-City Neighborhoods
Authors: Lwebuga-Mukasa Jamson S. , Wojcik Richard , Dunn-Georgiou Elisha , Johnson Caryn
Published: July 2012

To identify factors that may contribute to asthma morbidity, 214 households were surveyed in two Buffalo inner-city neighborhoods. Asthma was reported by 41 percent of households. Race, gender, and age of head of household were significantly associated with prevalence of asthma in a house. Caucasians and Latinos had a significantly higher rate of asthma compared with African Americans. All household triggers were significantly more likely to be present on the west than east side of Buffalo. Overall, smoking, pets, humidifier, and cockroaches were all significantly associated with asthma in the home. There was no significant difference in the treatment for asthma or the age or gender of asthmatics based on residential area. This study suggests that asthma prevalence in the inner city may be affected by multiple factors that must be taken account by policy makers and professionals designing interventions.
The National Drug Control Strategy: The First-Line Approach to Decreasing Violence in Our Communities
Authors: Garcia Fred
Published: July 2012

The National Drug Control Strategy is designed to address all aspects of drug abuse: drug use, drug trafficking, and drug-related crimes. The nine-pronged program encompasses efforts at the federal, state, and local levels, forming a partnership between government and the private and public sectors. The strategy includes prevention initiatives that reduce the demand for drugs; individualized treatment programs for high-risk groups; greater community policing efforts to reduce violent crimes by drug users and pushers; and education aimed at children and adults. It is a national strategy that strives to find solutions at the local level.
Clinical Assessment of Gang Violence Risk Through History and Physical Exam
Authors: Mondragon Delfi
Published: July 2012

Primary-care clinicians can assess gang involvement and gang violence risk during the routine history and physical exam. This paper forwards a model for history and risk assessment. The objective of creating the model was to develop a practical prototype for clinicians to use in this assessment. The history and physical exam variables were determined by a study of the etiology and correlates of gang membership and gang violence. The history and physical risk assessment tool is based on standard patient care algorithms. It works best in a managed care setting with a high incentive for violence prevention and cost reduction, and where access to a broad range of traditional and nontraditional referral sources exists. Representative referrals are discussed.
The Influences of Race, Ethnicity, and Poverty on the Mental Health of Children
Authors: Samaan Rodney A.
Published: July 2012

Sufficient evidence demonstrates that poverty has a negative effect on the psychological well-being of children, but most research has focused only on white populations. The purpose of this literature review is to gain a better understanding of the positive and negative influences of socioeconomic factors, cultural/ethnic characteristics, and racial differences on the mental health of children. A review of the literature on the influence of race, ethnicity, and poverty on the mental health of children found that (1) children whose parents are in poverty or who have experienced severe economic losses are more likely to report or be reported to have higher rates of depression, anxiety, and antisocial behaviors; and (2) after controlling for socioeconomic status, African Americans, Native Americans, and Hispanics are less likely to report or be reported to have such mental health problems. A theoretical construct for this protective effect is related to cultural factors, such as perceived social support, deep religiosity/spirituality, extended families, and maternal coping strategies as buffers against psychological distress.
Exploring the Role of Religiosity in Hypertension Management Among African Americans
Authors: Brown Carolyn M.
Published: July 2012

The role of religiosity in hypertension management among African Americans was studied. Data were collected from in-depth, personal interviews with 20 African Americans who had been diagnosed with hypertension for at least one year. A majority of the participants used their religious beliefs as protective, control, and coping mechanisms in the management of hypertension. Their personal religious commitment enabled them to feel protected from immediate and long-term negative consequences of hypertension, as well as find meaning in and exert control over hypertension management. Furthermore, religious beliefs served to enhance their ability to cope with having hypertension. These findings support the utility and value of religiosity in the management of hypertension among African Americans. Implications for hypertension management and educational interventions are offered.
Assessing Health Status in the Elderly: The Nutrition Screening Initiative
Authors: Barrocas Albert , White Jane V. , Gomez Camille , Smithwick Linda
Published: July 2012

The recent dramatic growth in the population aged 65 and over is projected to continue well into the 21st century. While improved health status of most aging Americans is also expected, such is not the case in certain vulnerable subgroups at risk for poor health. This includes older women; minority groups; those aged 85 and above; older persons with limited economic resources, those isolated from family and friends; and older persons with impaired physical, cognitive, or emotional status. These factors, plus the cost implications of caring for a rapidly aging population, provided the impetus for the development of the Nutrition Screening Initiative (NSI). Established in 1990, the goal of the NSI is to promote the incorporation of routine nutrition screening and nutritional care into America's health services delivery system. The NSI has devoted its activities toward increasing the awareness of nutritional factors as they relate to the older population.
Physical Rehabilitation and Violence: Initiatives of the National Institute on Disability and Rehabilitation Research
Authors: Seelman Katherine D.
Published: July 2012

The paper presents an analysis of violence-related data from the National Spinal Cord Injury Database within the context of violence-related projects of the U.S. Department of Education's Office of Special Education and Rehabilitative Services. The National Spinal Cord Injury Database is managed by the Spain Rehabilitation Center at the University of Alabama at Birmingham, which is one of 13 Model Spinal Cord Injury Care System centers funded under a grant from the U.S. Department of Education's Institute on Disability and Rehabilitation Research. There are 1,732 cases of spinal cord injury (SCI) due to violence enrolled in the database. This enrollment provides a longitudinal sample, an analysis of which shows that African American individuals and persons of Hispanic origin represent an increasing percentage of new cases, and that an increasing percentage of individuals within these populations is incurring SCI as a result of violence.
Cancer Control Research and Literacy
Authors: Michielutte Robert , Alciati Marianne Haenlein , Arculli Regina El
Published: July 2012

Low literacy may be an important predictor of increased cancer risk and poor participation in cancer control programs. Results of the National Adult Literacy Survey indicate that about 90 million individuals, slightly less than half of the U.S. adult population, demonstrate low or limited literacy skills. In contrast, the average health education brochure, pamphlet, or instruction sheet requires a 10th-grade or higher level of reading ability to be understood. Guidelines exist for the development of more readable printed materials; studies have also found that nonprint approaches such as video education are viable alternatives to printed materials. Research on patient populations indicates that educational approaches targeted to low-literacy groups can be effective in reaching individuals with cancer control information. This review identifies the most important areas of needed research and makes recommendations for the development of a research agenda on cancer control and literacy.
Medicaid Managed Care and Racial Differences in Satisfaction and Access
Authors: Greenberg Greg , Brandon William P. , Schoeps Nancy , Tingle Lynne R. , Shull Laure D.
Published: July 2012

Many researchers have suggested that the implementation of managed care may lower access to, and quality of, health care services for minorities. However, very little empirical data examining this issue exists. To examine it, the authors used a study design that was both cross-sectional and longitudinal in that they surveyed Medicaid recipients in two counties at two points in time; one of the counties began delivering services through managed care between the two survey periods. Their results indicate that, overall, managed care had neither a positive nor a negative effect on African Americans' access to health care services in either absolute terms or relative to whites'. In addition, race was not found to be associated with satisfaction. However, a Medicaid recipient's race was found to negatively affect his or her access to service under both managed care and fee-for-service systems.
An Overview of Tennessee State Legislation Affecting Violence Prevention
Authors: Deberry Lois M.
Published: July 2012

Homicide is the number one cause of death among African American youth, both male and female. Largely to blame for Black-on-Black violence is the sense of alienation our youth feel from society. To counter this phenomenon of violence it is essential to empower youth. Through education and community-based programs we can draw them away from the materialistic to the realistic. By banding together as mentors to our youth we can provide them with a sense of history and heritage, and thereby equip them with the self-identity originating from self-respect.
Lifetime and Current Abuse, Pregnancy Risks, and Outcomes Among Native American Women
Authors: Bohn Diane K.
Published: July 2012

This study examines the effects of current abuse, battering during pregnancy, and lifetime physical and sexual abuse on pregnancy risks and outcomes among 30 urban Native American women. One-third of the women in this study were battered during the index pregnancy, and nearly two-thirds had been abused by their current partner. All but 3 women had experienced physical or sexual abuse in their lifetime, and nearly three-fourths had been multiply abused. Significant relationships were found between current partner abuse, decreased birth weight, and inadequate prenatal care. The variable, increased lifetime abuse events, was significantly associated with increased risk factors for preterm birth/ low birth weight. High rates of substance use and sexually transmitted diseases were noted among women in this study. Further research is needed to examine abuse and relationships between abuse and pregnancy risks and outcomes among Native American women.
New Insights and Interventions: Churches Uniting to Reach the African American Community with Health Information
Authors: Sanders Edwin C.
Published: July 2012

Effective church-based community health programs must take a holistic approach when dealing with health problems among African Americans. Such an approach emphasizes the relationship between the physiological, psychological, and spiritual selves. These programs must also ensure the complete involvement of clergy and church members, who can participate in programs by providing a certain level of skill, thereby engendering a sense of partnership in the process. Also necessary is an emphasis on healthy living instead of a fear of dying. Rather than framing health issues in mortality statistics, church-based programs need to stress ways to improve the quality of life, in keeping with the messages conveyed by the church. By taking these approaches, health organizations will find a religious community more willing to accept health messages.
Improving the Detection of Drug Abuse, Alcohol Abuse, and Depression in Community Health Centers
Authors: Olfson Mark , Tobin Jonathan N. , Cassells Andrea , Weissman Myrna
Published: July 2012

Up to 35 percent of primary care patients suffer from substance abuse or mental disorders, and most of these patients receive care from general medical professionals rather than mental health specialists. Accumulating evidence suggests that primary care physicians often fail to recognize, diagnose, and treat their patients with mental and substance use disorders; only about 5 percent of primary care visits result in a mental or substance use diagnosis. The goals of this project were to evaluate the feasibility of screening for drug abuse, alcohol abuse, and major depression at two federally funded urban Community/Migrant Health Centers (C/MHCs), in Newark, New Jersey, and Bronx, New York, and to examine the effects of a clinical tool designed to guide primary care clinicians in the identification and treatment of substance use and depression, assess provider perceptions of the screening form, and determine the concordance between provider and patient reports of assessment and management.
Medicare Graduate Medical Education Funding and Rural Hospitals
Authors: Slifkin Rebecca T. , Popkin Benjamin , Dalton Kathleen
Published: July 2012

To assess the importance of medical residents to rural hospitals, and to predict the possible effect of reductions in Medicare graduate medical education (GME) payments, data from Medicare hospital cost reports and from a telephone survey of rural hospitals with residency programs are analyzed. In prospective payment system year 11,70 rural hospitals received more than $80 million in Medicare GME payments. The presence of rural training programs enhanced staff physician recruitment and retention and led to increased numbers of physicians settling in communities surrounding the facilities. Many survey respondents felt that elimination of GME funds would result in downsizing or outright elimination of their training programs. The results support the contention that rural training programs are important to hospitals and their surrounding communities and provide an essential component of the physician supply pipeline to rural areas.
Language Barriers to Health Care: Federal and State Initiatives, 1990-1995
Authors: Fortier Julia Puebla , Strobel Christopher , Aguilera Esther
Published: July 2012

This paper focuses on the legislative and oversight activities of the U.S. Congress from 1990 to 1995—a period of significant activity on the issue of access to health care for underserved and minority populations—and examines a three-step process leading to the development of federal policy on language barriers to health care. The paper begins with an overview of the initial legislation developed on language access to health care and an analysis of its implementation, followed by a review of a congressional inquiry into key federal and state policy activities on language access that formed the basis for the final step of additional legislative actions in 1994. Finally, conclusions are forwarded regarding the potential and limitations of government mechanisms in reducing language barriers.
Tracking and Follow-Up of Marginalized Populations: A Review
Authors: McKenzie Michelle , Tulsky Jacqueline Peterson , Long Heather L. , Chesney Margaret , Moss Andrew
Published: July 2012

Maintaining study cohorts is a key element of longitudinal research. Participant attrition introduces the possibility of bias and limits the generalizability of a study's findings, but with appropriate planning it is possible to sustain contact with even the most transient participants. This paper reviews the essential elements of tracking and follow-up of marginalized populations, which are (1) collection of contact information, (2) thorough organization of tracking efforts, (3) attention to staff training and support, (4) use of phone and mail follow-up, (5) use of incentives, (6) establishing rapport with participants, (7) assurance of confidentiality, (8) use of agency tracking, (9) use of field tracking, and (10) attention to safety concerns. Diligent application of these tracking strategies allows researchers to achieve follow-up rates of 75 percent to 97 percent with vulnerable populations such as homeless, mentally ill adults, injection drug users, and runaway youth.
A Single Source of Health Care: Does It Affect Health Experiences for Inner-City Children?
Authors: Beal Anne C. , Stein Ruth E. K.
Published: July 2012

This study was designed to determine whether having a single source of health care affects the health experiences of inner-city children. Seventy-five women were interviewed about the health experiences of their preschool-aged children (range 10-58 months) and were asked about utilization, emergency room use, preventive care, delays in care, and availability of a provider for the child's various medical needs. While most (94.7 percent) of the mothers identified a regular source of care for fair child's preventive care, 74.7 percent named the same source for their child's sick care. There were no differences in most measures between mothers with a single source of care and those with multiple sources. However, those with a single source of care reported feeling their providers were more available (p < 0.05). Thus, naming a single source of health care may not be a useful indicator of better health experiences for inner-city children.
Language Barriers to Health Care: An Overview
Authors: Chang Pancho H. , Fortier Julia Puebla
Published: July 2012

Health services should be provided such that patients fully understand the nature and purpose of the services they receive. However, achieving this goal frequently requires trade-offs involving access, cost, and quality of services, particularly when the patient's principal language is not English. This background paper provides context for the discussion of language issues in health care by reviewing federal and state laws and related initiatives; discussing the case history of language access in Seattle, Washington; and surveying the expansion of managed care. It also describes different models of language services and raises issues to be faced in the delivery, financing, and regulation of language services in a managed care environment.
Evaluating Behavioral Health Services in Minnesota's Medicaid Population Using the Experience of Care and Health Outcomes (ECHO™) Survey
Authors: Beebe Timothy J. , Harrison Patricia A. , McRae James A. , Asche Stephen E.
Published: July 2012

Performance data on Medicaid managed behavioral health care are for the most part unavailable. The purpose of the current study is to provide a benchmark of Medicaid enrollees' evaluations of access to, and quality of, behavioral health services and to examine the factors that influence these ratings. Eight hundred eighty-five Minnesota Medicaid managed care enrollees who received behavioral health services in 2000 completed the Experience of Care and Health Outcomes Survey, a multi-dimensional satisfaction survey that included measures of access to services, communication with clinicians, functional improvement, and the effect of treatment. Between 29 and 59 percent of the respondents gave the highest possible ratings to the behavioral health services they received. Access to services and functional improvements were rated less favorably than communication with clinicians and the effects of treatment. Ratings within certain domains varied by age, race, education, and region.
Evaluating the Costs of Bridging Language Barriers in Health Care
Authors: Hornberger John
Published: July 2012

The primary goal of this paper is to present an analytical framework for estimating the costs of methods designed to bridge language barriers in health care. The material presented here is written for health care administrators and public health officials who are evaluating, or who expect to evaluate, the results of analyses and published studies on the economic consequences of language programs in health care. This paper also may be seen as providing guidelines for researchers and students interested in designing and conducting economic studies of such language programs. A taxonomy of methods that have been developed to bridge language barriers in health care is discussed. Economic principles for assessing costs of these methods then are described, as well as their potential applications by health care institutions. Last, these principles are illustrated by comparing the implementation costs of two interpretive services.
Perspectives of Low-Income African Americans on Syphilis and HIV: Implications for Prevention
Authors: Okwumabua Jebose O. , Glover Vincent , Bolden Delois , Edwards Sheron
Published: July 2012

Infectious syphilis disproportionately affects African Americans living in poverty in metropolitan areas in the southeastern United States. In this population, where syphilis persists, the rates of HIV and AIDS are also persistently high. In an effort to facilitate the design of more effective prevention programs, the present investigation employed focus groups to obtain information from low-income African Americans concerning the determinants of high rates of syphilis and HIV/AIDS in their communities. The subjects were 36 African American men and women ages 18 to 56 residing in metropolitan Memphis and surrounding Shelby County, Tennessee. Overall, the authors found significant lack of awareness of the magnitude of HIV/AIDS and syphilis in African American communities and lack of knowledge about the etiology and transmission of syphilis. The investigation points to the important role of women and partnerships of community organizations in preventing the spread of HIV, syphilis, and other sexually transmitted diseases in this population.
Service Learning: A Strategy for Conducting a Health Needs Assessment of the Homeless
Authors: Schaffer Marjorie A. , Mather Susan , Gustafson Vicki
Published: July 2012

An agency providing health care services for homeless persons and a nursing department at a liberal arts college established a service-learning partnership to complete a health needs assessment of homeless persons. Under the guidance of agency staff and a nursing faculty member, seven nursing students surveyed shelter residents ( n = 101) in four urban shelters and conducted a focus group to identify residents' perceptions of health, health care needs, and health care service delivery. The service-learning partnership expanded the agency's services by providing research consultation and data collection that resulted in recommendations to improve health care services for the homeless. The agency contributed to the education of health professionals by providing students with a meaningful community service experience.
Barriers to Follow-Up of Hypertensive Patients
Authors: Mouton Charles P. , Beaudouin Robert , Troutman Adewale , Johnson Mark S.
Published: July 2012

Lack of follow-up care for hypertension adversely affects health in urban communities. The authors designed this study to (1) evaluate the effectiveness of a specialized intervention program for hypertension follow-up and (2) evaluate the associations with loss to follow-up. They evaluated factors related to loss to follow-up to either a routine care medical clinic or a special primary care intervention program (the Competitive Initiative Program [CIP]). They also conducted interviews to provide in-depth information on the barriers to this program. They found that patients referred through the CIP were significantly more likely to receive follow-up care through a primary care provider. Cost of care, long waiting times, lack of physician continuity, and more pressing priorities explained the lack of follow-up care. Despite a program to provide health care at no cost to patients, lack of insurance and worries about cost are described as barriers to adequate follow-up for hypertension treatment.
Culturally Competent Professionals in Therapeutic Alliances Enhance Patient Compliance
Authors: Langer Nieli
Published: July 2012

Medical training has traditionally focused on diagnosis and treatment of disease, with the notion that if these two factors are satisfactorily managed, the desired outcome will inevitably follow. When it does not, failure is often blamed on patient noncompliance. Failure of patients to return for follow-up visits or comply with medication regimens has been shown to be a major barrier to the delivery of effective medical care. However, effective clinical decision making requires that physicians skillfully address not only the biomedical aspects of diseases and their management, but also the sociobehavorial characteristics of patients. The authors maintain that patient participation is necessary for compliance and that a naturally occurring therapeutic alliance between physician and patient incorporates factors such as lifestyle, family, and living circumstances and an awareness of the culturally unique needs of minority patients. Integration of these factors into professional decision making and practical management plans will enhance patient compliance.
Caregivers' Unmet Needs for Support in Caring for Functionally Impaired Elderly Persons: A Community Sample
Authors: Anderson Roger T. , Bradham Douglas D. , Jackson Sharon , Heuser Mark D. , Wofford James L. , Colombo Kelly A.
Published: July 2012

Few estimates have been made of the extent to which the needs of caregivers are met. In addition to the inadequate capacity of services, many caregivers lack adequate financial resources, social resources, or other means to access them. Caregivers who provide services to minority or poor elderly may be particularly needy since their care receivers tend to be less healthy and are less likely to use institutional facilities. To address this issue, the authors studied a community sample of 124 caregivers who identified correlates of their perceived unmet caregiver needs and their use of supportive services available for their caregiving. Results indicated that 51.8 percent of women and 67.4 percent of men reported needs for one or more community services that were not met. It was concluded that caregivers who are poor or who required financial assistance are at the highest risk for needing assistance while providing caregiving services. Community services may more effectively target potential needs of caregivers through routine screenings.
Whether and Where Community Health Center Users Obtain Screening Services
Authors: Frick Kevin D. , Regan Jerrilynn
Published: July 2012

This study measures associations between minority and low socioeconomic status and the use of screening services for secondary prevention among adult community health center users. Among those who obtained timely screening services, the study also measures associations between minority and low socioeconomic status and obtaining these preventive services at a community health center. The data include 1,175 individuals ages 18 and older from a 1995 survey of community health center users. Minority and lower socioeconomic status adult community health center users were not less likely to obtain timely screening services than other adult community health center users. This differs from the trend in the general population. Minority and lower socioeconomic status community health center users who used timely screening services were more likely to obtain them at community health centers, which appear to facilitate the use of timely screening services for minority and low socioeconomic status users.
Russian Immigrant Cardiovascular Risk Assessment
Authors: Mehler Philip S. , Scott June Y. , Pines Irina , Gifford Nancy , Biggerstaff Stacy , Hiatt William R.
Published: July 2012

Immigration from the former Soviet Union has been increasing. In 1990, there were 454,000 Russian immigrants living in the United States. Lifestyle habits prevalent in Russia, including smoking, alcoholism, and little preventive health, are compelling medical and economic reasons to understand the health status of this population. This study identified a cohort of Russian-born subjects living in Denver to characterize their cardiovascular risk profile. Using a risk assessment questionnaire, 204 Russian immigrants were screened. Seventy-one percent had Medicaid insurance; 14 percent were medically indigent. Those aged 55 to 64 years had a higher prevalence of hyperlipidemia (p < 0.04) and hypertension (p < 0.03) than U.S. counterparts; those age 20 to 34 and 65 to 74 years had a higher prevalence of hypertension (p < 0.00001). Almost half of the participants had two or more cardiac risk factors. Cardiac risk factor identification and intervention programs may help to reduce the health care costs for these patients.
Eating Socioeconomic Rights: The Usefulness of Rights Talk in Alleviating Social Hardship Revisited
Authors: Pieterse Marius
Published: July 2012

This article considers anew the utility of rights-discourse in alleviating social hardship. It revisits the Critical Legal Studies-inspired debates on the topic, but in the context of justiciable socioeconomic rights, such as those found in the South African Constitution. The article explains the "emptiness" of the socioeconomic rights jurisprudence of the South African Constitutional Court by comparing the South African socioeconomic rights narrative to Peter Gabel's account of the manner in which rights discourse enables the status quo to assimilate and defeat social movements. By doing this, the article shows that socioeconomic rights are accomplices to, rather than victims of, the sidelining of the needs they represent, despite their transformative potential. However, since rights remain one of the only viable political tools through which denial of socioeconomic needs may effectively be confronted, we should not abandon rights-discourse but should instead attempt to translate abstract socioeconomic guarantees into concrete legal entitlements. [End Page 796]
Do Human Rights Violations Cause Internal Conflict?
Authors: Thoms Oskar N. T , Ron James
Published: July 2012

This article outlines a human rights framework for analyzing violent internal conflict, "translating" social-scientific findings on conflict risk factors into human rights language. It is argued that discrimination and violations of social and economic rights function as underlying causes of conflict, creating the deep grievances and group identities that may, under some circumstances, motivate collective violence. Violations of civil and political rights, by contrast, are more clearly identifiable as direct conflict triggers. Abuse of personal integrity rights is associated with escalation, and intermediately repressive regimes appear to be most at risk. Denial of political participation rights is associated with internal conflict because full democracies experience less conflict. Yet democratization itself is dangerous, since regime transition is also a major conflict risk factor.
Islam, "War on Terror" and the Future of Muslim Minorities in the United Kingdom: Dilemmas of Multiculturalism
Authors: Rehman Javaid
Published: July 2012

British Muslims have substantial claims of social ostracism, discrimination, and denials of a right to identity. There is increasing anger and frustration at the United Kingdom's pursuit of the global "war on terror." The draconian legislation and administrative policies of the recent Labour Governments overtly target Muslim minorities. This article critically analyzes the issues confronted by British Muslim communities in the context of a socially and politically strained environment since the 7 July 2005 London bombings. The article laments the increasing negativity about "multiculturalism," and argues that Muslim identities deserve an affirmed and celebrated position within the matrix of contemporary British society.
The West, Economic and Social Rights, and the Global Human Rights Regime: Setting the Record Straight
Authors: Whelan Daniel J , Donnelly Jack
Published: July 2012

This article challenges the widespread belief that Western countries have been antagonistic to economic and social human rights. Examining wartime planning, drafting the Universal Declaration and the Covenants, and the development of functional regimes for money, trade, and workers' rights as well as the European regional human rights regime, we show that Western advocacy of economic and social rights was strong, consistent, and essential to creating the post-war international order, which was intended to consolidate and strengthen Western welfare states. We conclude by considering the sources of the myth of Western opposition and its contemporary implications.
Divus Dionysius: Authority, Self, and Society in John Colet's Reading of the Ecclesiastical Hierarchy
Authors: Lochman Daniel T
Published: July 2012

As a reader of Dionysius the Areopagite’s Ecclesiastical Hierarchy, John Colet encountered a theology, liturgy, and social framework that seemed absent from the rites and doctrines of the Tudor church. Dionysius’s orderly ecclesia embodied a social perfection that Colet idealized as a Christian "republic." He reacted to ecclesiastical lapses from this model by writing with passionate indignation and, in public venues, by pronouncing bold challenges to clerical misbehavior. Writing for a small audience and adhering to an increasingly doubted authority, Colet responds to Dionysius with a sense of tragically changed historical circumstances, and he assumes the role of an admonishing prophet.
Poverty, Inequality, and Democracy (II): Does Electoral Democracy Boost Economic Equality?
Authors: Bermeo Nancy
Published: July 2012

Abstract: Inequalities seem ubiquitous, despite the spread of electoral democracy and what were, until recently, positive rates of economic growth. These seemingly mismatched trends should not surprise us. The advance of democracy entails a decrease in political inequality but does not guarantee decreases in inequalities of other sorts. Economic (and other) inequalities have historically followed their own dynamic, independent of whether electoral democracy exists. The same generalization holds for electoral democracy and poverty. Collective action challenges mean that rising economic inequalities will not be easily reversed. This may harm the quality of contemporary democracies, but is unlikely to cause massive collapse.
An Accidental Advance? South Africa's 2009 Elections
Authors: Friedman Steven
Published: July 2012

South Africa's April 2009 parliamentary and provincial elections may prove an important democratic breakthrough, not because high-minded leaders sought to deepen democracy, but because competition for power and influence opened new democratic avenues. If we understand democracy purely as a set of "negative" freedoms that protect individuals from arbitrary government power, South Africa's democracy has done much better than expected since its inception in 1994. But if we see democracy also as positive liberty, then progress is far more modest. In light of the economic crisis, effectual government performance will be the key issue of Zuma's presidency. In the end, South Africa's ability to weather the storm will depend in part on whether governing-party politicians take the election result as a cause for self-congratulation or as a warning.
A New Approach to Postwar Reconstruction
Authors: Galtung Fredrik , Tisné Martin
Published: July 2012

Abstract: In countries emerging from war, the immediate post-war period rarely lives up to the hopes and expectations of the country's citizens or the international community. An upsurge in corruption and a lack of accountability, which frequently become entrenched during this time, can erode trust in democracy and its institutions, thereby eating away at the legitimacy of the postwar state. The authors argue that an anticorruption approach that builds on local resources and competencies in distinctive ways and that emphasizes local accountability such as citizen-based monitoring is more likely to succeed in stemming corruption as well as increase participation and trust in the reconstruction process.
The Democracy Barometers (Part II): Latin America's Diversity of Views
Authors: Lagos Marta
Published: July 2012

Abstract: In the twelve years since the inception of the LatinobarÃ³metro, Latin American societies have evolved politically and economically, sometimes considerably, but they have not been transformed. Levels of public support for democracy, underlying attitudes toward the democratic regimes in the region, and individual feelings and anxieties about politics and governance have changed in some countries, but only very gradually and unevenly in the region overall. While there are some signs of democratic progress and hope, more striking is the perception of democracy as being unresponsive and elite-dominated. In general, democratization in the region has been slow and heterogeneous; although citizens recognize some positive changes, so far these have been insufficient to achieve the kind of transformation in governance or social and economic structures that would help consolidate democracy.
Morocco's Elections: Questions for the Future
Authors: Filali-Ansary Abdou
Published: July 2012

Abstract: Morocco offers one of the most promising contexts for democratic transition not merely in the Arab-Muslim world but in the entire developing world today. Yet at the same time it is a place where generalized disenchantment seems as if it may be threatening to overwhelm organized politics, to take on shapes that go well beyond politically framed opposition, and to reach out beyond ideologies and institutions to shake the very foundations of the social and political order.
Turkey Divided
Authors: Baran Zeyno
Published: July 2012

Abstract: The period leading up to the July balloting exposed a key fault line in Turkish society. On one side of the divide were those who supported the economic and political reform process that the AKP had undertaken since coming to power in the elections of November 2002. The main objective of the second of the "two Turkeys" is the preservation of the Republic as a unitary, strictly secular, and nationalist country rather than one which adopts federal or confederal arrangements to accommodate the Kurds, permits Islam to make its weight felt in the public sphere, and opens itself up decisively to transnational influences.
"Mother Power": The Movement for Welfare Rights in Washington, D.C., 1966-1972
Authors: Valk Anne M
Published: July 2012

This article analyzes the concepts of motherhood
that framed welfare rights campaigns in Washington, D.C., from 1966 to
1972. Throughout President Lyndon Johnson's War on Poverty, President
Richard Nixon's attempts to reform welfare, and debates between policy
makers regarding allegedly dysfunctional black families, public assistance
recipients based their demands for changing welfare policies on their
status as mothers. In so doing, they infused policy debates and mobilized
grassroots activists with their particular vision of maternity. The
responses of government officials and welfare administrators to
these de-mands reflected traditional ideas about women's roles and
perpetuated stereotypes about black women's sexual immorality. Ultimately,
the focus on motherhood and the conflicting views about black
women led to limited reform and eclipsed broader efforts to transform
the welfare system.