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In this special issue, top researchers from a diversity of disciplines provide an overview of and insights into the major social, cultural, and structural variables that play a role in Black women's poor health, and differential morbidity and mortality. The articles focus on the major threats to Black women's health such as diabetes, obesity, cancer, violence, and AIDS, and utilize a wide range of qualitative and quantitative methods from medicine, psychology, sociology, and feminist analysis. Among the articles are: * An examination of the role of Black women's cultural and ethnomedical beliefs in their use of cancer screening by Laurie Hoffman-Goetz and Sherry Mills of the National Cancer Institute; * An empirical analysis of Black women's utilization of health services entailing more than 18,000 women by Lonnie Snowden and his colleagues at the University of California-Berkeley Center for Mental Health Services Research; * A comprehensive review and empirical analysis of the role of violence in Black women's health by Nancy Felipe Russo (Arizona State University), Mary Koss (University of Arizona), and Gwen Keita (APA Office on Women); * An empirical investigation of the role of social and contextual variables in HIV risk among low-income Black women by Kathleen Sikkema, Timothy Heckman, and Jeffrey Kelly of the Center for AIDS Intervention Research, Medical College of Wisconsin. Other articles include comprehensive and critical analyses and reviews of diabetes, breast cancer risk perceptions, and obesity among Black women, as well as analyses of Black women's exclusion from research in medicine, women's health, health psychology, and behavioral medicine. The first issue of any psychology journal to be devoted to the health of Black women, this special issue is a step in the direction of redressing the long-overdue neglect of Black women's health. It provides a cogent overview of the state of Black women's health, numerous empirical investigations, and clear suggestions for future research.
African-American women have a 40% higher mortality rate from breast cancer than White women. While there are many factors contributing to this disparity, the timely initiation of treatment is growing area of interest. Certain treatments are associated with increased survival for women with a breast cancer diagnosis, yet evidence suggests that African American women use these treatments less frequently compared to White women with similar tumor characteristics. An under-explored area of attention for scientific studies is how to identify and engage in care women who do not follow up with treatment following a suspicious finding. To date these women have not been included in research focused on understanding treatment decisions and patient engagement in care decisions. Often these are among the most marginalized women of our society who have some of the highest rates of mortality from many different health related outcomes. This study helps to fill this gap by identifying and engaging these women in research. This study explored in-depth the lived experience of eight African American women, living in a socially and economically isolated environment in a large metropolitan area. In all cases the initiation of treatment was delayed for more than six-months, with a delay in the initiation of treatment of more than a year in three of the eight examples and more than two years in one of the eight examples. In accordance with phenomenological qualitative methodology, the interviews were open-ended, allowing for rich, in-depth data to emerge relatively unbiased by the assumptions and expectations of the researcher. The research questions for this study were: (1) What are the lived experiences of African American women who had not followed up with care for a diagnosis of breast cancer for 6-months or more following a suspicious finding? (2) How does she apply meaning to the process of deciding whether or not to initiate treatment? and (3) Under what socioeconomic circumstances does the phenomenon (a delay in treatment initiation) persist? Key findings suggest that engaging patients in health care decision making necessitates a better understanding of the processes involved in treating breast cancer, the impact that the side-effects may have on her quality of life, and access to patient support services to counter these side-effects. Also, the findings from this study highlight that most of the communication about treatment initiation occurred at the primary care level, prior to initiating contact with oncology services. Primary care proved to be the most important provider-patient relationship for these women. It is where they go with initial concerns about their breasts and where they return for more information about treatments and patient support for side-effects. Furthermore, the context within how they experienced the phenomenon is structured by underlying conceptualizations of chronic traumatic events coupled with community resource deserts. Finally, all of the women reported keeping their illness to themselves and described social and cultural barriers to utilizing available support systems to assist with unmet needs. All of these situations taken together allowed the delay in the initiation of treatment for breast cancer to persist. These results indicate that future interventions focused on engaging women in care decisions and decreasing socioeconomic barriers to the initiation of the treatment for breast cancer should take place between primary care providers, oncologists, and their patients and focus on de-mystifying the process of treatment. Incorporating this information, as a type of barrier-focused community-based intervention, or improved case management services to assist cancer patients in the primary care setting, would impact cancer mortality outcomes.
The focus of this descriptive-comparative study was to investigate the relationships between potential access (race, age, socioeconomic status (SES), and the means of discovery of breast cancer), realized access (the length of time between discovery of breast abnormality and diagnosis of breast cancer, and the length of time between diagnosis and initiation of breast cancer treatment), and stage at diagnosis of breast cancer, in African American and Caucasian women, receiving care within an equal economic access health care system. The research questions were answered through secondary analysis, using data obtained from the tumor registry records of 62 African American and 573 Caucasian women diagnosed with breast cancer within the Department of Defense Military Health System, from January 1, 1988 through December 31, 1997. Descriptive statistics were used to describe the sample and the study variables; and independent samples chi-square tests, t-tests, Mann Whitney U tests, analysis of variance, multiple regression, and logistic regression were used to analyze the data. Results indicate that, when compared to Caucasian women, African American women: (a)were diagnosed at a significantly later stage of breast cancer, (b)were significantly younger at the time of diagnosis, (c)were from a significantly lower SES, (d)had a significantly higher percentage of incidental breast self exam (BSE) discovered breast abnormalities, and (e)had a significantly lower percentage of mammogram. discovered breast abnormalities. Women with breast abnormalities discovered by incidental BSE were almost six times more likely to be diagnosed in late stage breast cancer than women with mammogram discovered breast abnormalities. There were no significant differences noted between African American and Caucasian women in length of time between discovery and diagnosis, and length of time between diagnosis and treatment.
CSA Sociological Abstracts abstracts and indexes the international literature in sociology and related disciplines in the social and behavioral sciences. The database provides abstracts of journal articles and citations to book reviews drawn from over 1,800+ serials publications, and also provides abstracts of books, book chapters, dissertations, and conference papers.
"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/
To maintain their own health and the health of their families and communities, consumers rely heavily on the health information that is available to them. This information is at the core of the partnerships that patients and their families forge with today's complex modern health systems. This information may be provided in a variety of forms â€" ranging from a discussion between a patient and a health care provider to a health promotion advertisement, a consent form, or one of many other forms of health communication common in our society. Yet millions of Americans cannot understand or act upon this information. To address this problem, the field of health literacy brings together research and practice from diverse fields including education, health services, and social and cultural sciences, and the many organizations whose actions can improve or impede health literacy. Health Literacy: Prescription to End Confusion examines the body of knowledge that applies to the field of health literacy, and recommends actions to promote a health literate society. By examining the extent of limited health literacy and the ways to improve it, we can improve the health of individuals and populations.
For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.