Nataniel, NAFTA, and Public Health at the U.S.-Mexico Border

ABSTRACT Advocating overall improvements in health for individuals and communities is a daunting but important task for nurses in particular, and for health care professionals in general. This is particularly true when focusing on the population along the 2,000-mile U.S.-Mexico border, a unique region in which distinct cultures, economies, and political systems meet. The purpose of this paper is to confront the assumption that trade and economic expansion automatically translate into improved public health, and to explore policy implications of the public health situation at the border. It uses a meta-narrative, an overarching story that draws on and illustrates collective stories from 300 participants in a study of mental health disparities, to argue for a more nuanced and complex understanding of health among the largely Hispanic population in this region.     

老年人健康状况及保健需求调查

目的了解老年人的健康状况及对医疗保健的需求,为老年人的健康保健及医疗服务提供参考依据。方法随机对来我院参加健康知识讲座的324名老年人进行问卷调查。调查内容包括健康状况、健康相关行为、医疗服务利用情况、卫生保健需求4个方面。结果老年人身体状况普遍欠佳,在被调查的老年人中,有81.6%的老年人患有高血压、心脏病、糖尿病或其他慢性病;有23.2%的老年人曾因病住院。吸烟、饮酒及少运动是影响老年人身体健康的主要因素。为老年人改善环境、增加安全性、提供日间护理、社区护理、提供健康知识教育是绝大多数老年人的保健需求。结论针对老年人的健康状况及需求,应多提供针对老年人的健康知识讲座,开展健康教育活动,加强社区保健服务,使他们了解自己的健康状况、熟悉自身所患疾病的相关知识,加强自我保健意识,去除不良习惯,以达到免除疾病、减少病痛、增进健康的目的。     

Using participatory action research to provide health promotion for disadvantaged elders in Shaanxi province, China

OBJECTIVES: The objectives of the study were to (a) determine health promotion issues concerning disadvantaged elders, (b) identify social, economic, environmental, and personal factors that adversely influence disadvantaged elders' health, and (c) enable various stakeholders working within a coordinated framework to promote health among elders. DESIGN: A participatory action research (PAR) model was used over a 2-year period in a remote disadvantaged rural village in Shaanxi province, China. SAMPLE: Participants were 20 elders and 5 local administrators including government officers and village leaders. RESULTS: Three themes were identified, including (a) health is the absence of illness and the ability to sustain self-sufficiency; (b) diseases are inevitable among elders; and (c) cost is the key barrier to accessing health services. Action plans were developed and plans were implemented by the participants and project team. CONCLUSIONS: The project demonstrated that PAR is an optimum research method, which allows researchers to facilitate collaboration with all participants through research and supports democratic dialogue and deliberation through the participation process. Interpersonal relationship skills of researchers are crucially important in building cooperation among all stakeholders. Local government mobilization is essential for successful implementation and sustainability of the project.     

Resistance, health, and latent tuberculosis infection: Mexican immigrants at the U.S.-Mexico border

Mexican immigrants living in the U.S.-Mexico border region are confronted with different national explanations about latent tuberculosis infection (LTBI) and preventive treatment. The purpose of this study was to explore how a group of Mexican immigrant women (N = 8) at risk of LTBI treatment failure interpreted and ultimately resisted LTBI preventive treatment. A critical ethnographic methodology, grounded in asymmetrical power relations that are historically embedded within the U.S.-Mexico border culture, was used to examine the encounters between the participants and the health care provider. The study findings are discussed from the perspective of women who experienced oppression and resistance in the U.S.-Mexico border region, providing an account of how Mexican immigrant women become entangled in U.S.-Mexico TB health policies and through resistance manage to assert control over health care choices. In the context of the U.S.-Mexico border region, health care professionals must be skilled at minimizing asymmetrical power relations and use methods that elicit immigrant voices in reconciling differences in health beliefs and practices.     

Relocating care: negotiating nursing skillmix in a mental health unit for older adults

Mental health care in Australia in the last 20 years has moved from stand-alone psychiatric hospitals to general hospitals and the community. This paper reports an action research project exploring the experiences of nurses on an acute mental health unit for older adults staffed with a skillmix of mental health and general nurses, which recently transitioned from a psychiatric to a general hospital. The new service provides comprehensive health care, including the management of physical co-morbidity and a recovery orientation. Recovery acknowledges the role and rights of consumers and carers in planning and management of care, choice and individual strengths (Shepherd). The new ward received additional resources to establish the model of care, including a broader skillmix. The paper explores the dynamics of development of a new model of care and of bringing together staff with different professional orientations, cultures and priorities. Focus groups and interviews were conducted with 18 staff. Analysis resulted in three themes relating to the impact of competing goals and foci of care upon professional boundaries; competing organisational cultures and the impact of service change upon work practices. The findings are explored in relation to ideas about health care delivery associated with neoliberalism.     

Acceptance of a nutrition curriculum for HIV-positive Latinos Living on the U.S.-Mexico border.

Patient-centered nutrition education and counseling can improve the health of HIV-positive persons. This article describes the development and implementation of a Spanish-language, community clinic-based, individually tailored, and culturally specific nutrition curriculum for HIV-positive Latinos living on the U.S.-Mexico border. Important considerations made in serving this population include low acculturation to U.S. culture, monolingual Spanish speaking, cross-border mobility, and dietary behaviors influenced by access to culturally preferred regional foods, some of which may not be nutritionally optimal. Challenges to curriculum implementation and lessons learned for replication of the curriculum in other clinical settings are discussed.     

U.S. policy for children's mental health

Policy work is demanding and sometimes complicated. There is very little current U.S. activity for children's mental health policy. A review of proposed legislation is not encouraging. This is not unusual. Children are not a voting constituency therefore, nurses must be advocates to ensure services and resources for those from infancy to teenage in need of mental healthcare through policy building and action coalitions.     

Addressing the realties of health care in northern aboriginal communities through participatory action research

To address concerns about disruptions in the continuity of health care delivered to residents in three remote aboriginal communities in northern Ontario, Canada, the local health authority initiated a study in collaboration with the department of Health Canada responsible for ensuring that aboriginal reserves receive mandatory health services, and an inter-disciplinary team of researchers from two universities. The study focussed on the delivery of oncology, diabetes and mental health care, specifically, as well as systems issues such as recruitment and retention of health human resources and financial costs. The paper discusses the procedures involved, the benefits derived and the challenges encountered in doing this as a community driven participatory action research project. It also summarizes the findings that led to community formulated policy and program recommendations.     

Sense of security - searching for its meaning by using stories: a Participatory Action Research study in health and social care in Sweden

petersson p. & blomqvist k. (2010) Sense of security – searching for its meaning by using stories: a Participatory Action Research study in health and social care in Sweden. International Journal of Older People Nursing 6 , 25–32
doi: 10.1111/j.1748‐3743.2010.00211.x Aim. The aim of this study was to make sense of the Swedish concept ‘trygghet’ by using stories from daily life in a Participatory Action Research project. Background. In Sweden, attempts to implement core values to ensure high quality health and social care for older people are given high priority and concepts such as security and dignity are often used. As concepts are abstract they are difficult to transform into practical work. Design. One group of six assistant nurses and one group of five Registered Nurses working in a municipality participated in Story Dialogue Method and four older women were interviewed. Result. ‘Trygghet’ was found to be an internal sense – an intrinsic state based on faith and trust in oneself and others called Sense of security. External factors that strengthened Sense of security were to be part of a community, to recognize and be familiar with things and situations and to use various kinds of aids. Conclusion and relevance to clinical practice. A prerequisite for the professionals being able to support the care receivers adequately is that they have a sense of security themselves, and that they are allowed to operate in a system that facilitates for the care receivers to maintain trustworthy and reliable relations over time.     

Health care users residing on the Mexican border. What factors determine choice of the U.S. or Mexican health system?

Using multivariate analytic techniques, this article examines the factors influencing choice of the Mexican or U.S. health care system by service users residing on the Mexican border. Data were obtained from a 1987 binational health survey of 660 households, conducted in Tijuana. The sample consisted of 1,162 household members who reported having used health services in the U.S. and/or Mexico in the 6 months prior to the interview. The findings indicate that out of all the health care users in a 6-month interval, 7% sought services in the United States and 93% sought services only in Mexico. A weighted logistic regression on entry into care shows that, after adjusting for all the other variables in the model, U.S. insurance coverage, transportation, older age, and male gender were the most significant predictors. U.S. insurance, the strongest predictor of access, was associated with a labor history and legal residence across the border. Among U.S. users, the average number of visits was 2.6 (SD = 2.7). Sex, transportation, and socioeconomic status were significant predictors of volume of visits, in a weighted least squares regression analysis. The probability of more contacts among women is linked to their reproductive needs. An increasing use of U.S. health care is expected as a consequence of the new immigration law.     

Associations of employment frustration with self-rated physical and mental health among Asian American immigrants in the U.S. Labor force

ABSTRACT Objective: This study examined the associations between employment frustration and both self‐rated physical health (SRPH) and self‐rated mental health (SRMH) among Asian American immigrants. Design and Sample: A cross‐sectional quantitative analysis was conducted utilizing data from 1,181 Asian immigrants participating in the National Latino and Asian American Study. Measures: Employment frustration was measured by self‐report of having difficulty finding the work one wants because of being of Asian descent. SRPH and SRMH were each assessed using a global one‐item measure, with responses ranging from poor to excellent. Control variables included gender, age, ethnicity, education, occupation, income, whether immigrated for employment, years in the United States, English proficiency, and a general measure for everyday discrimination. Results: Ordered logistic regression showed that employment frustration was negatively associated with SRPH. This relationship, however, was no longer significant in multivariate models including English proficiency. The negative association between employment frustration and SRMH persisted even when including all control variables. Conclusions: The findings suggest that Asian immigrants in the United States who experience employment frustration report lower levels of both physical and mental health. However, English proficiency may attenuate the relationship of employment frustration with physical health.     

Undiagnosed patients and patients at risk for COPD in primary health care: early detection with the support of non-physicians

Given the increasingly heavy workload in the primary health care sector, the option of allocating activities involving the management of chronic diseases to non-physicians has recently come under scrutiny. The purpose of this study was to assess the feasibility of the support provided by non-physicians to general practitioners (GPs) in the early detection of chronic obstructive pulmonary disease (COPD). A convenience sample consisting of 231 patients [40-70 years; >10 pack years (number of packs of cigarettes smoked per day multiplied by the number of years the individual has smoked)] from eight general practices in the Maastricht region in the southern Netherlands, who consulted their GP for reasons unrelated to respiratory diseases, were assessed for their respiratory function. Prior to the first assessment, patients were interviewed about their medical history and symptoms. By taking the results of the lung function measurement as the starting point, the predictive value of medical history and symptoms in the identification of patients at risk for airflow obstruction or of COPD was assessed and compared with findings in the literature. Seventeen patients (7.4%) were diagnosed with COPD, 11 patients (4.8%) with asthma. In addition to age and moderate smoking history, breathlessness and a history of heavy smoking were identified as risk factors for airflow limitation and COPD. Early detection of COPD in primary health care by non-physicians is feasible and should be considered for middle aged, moderate and heavy smokers experiencing breathlessness.     

Risk factors for persistent frequent use of the primary health care services among frequent attenders: A Bayesian approach

Abstract

Objectives . The aim of this study was to examine risk factors that predict persistent healthcare frequent attendance among a frequent attender (FA) population. Design. Prospective cohort study without intervention. Setting. Primary healthcare centre in Tampere, Finland. Subjects. A total of 85 primary healthcare working-age patients participated in the study. All participants were FAs in the first study year. Main outcome measures. We identified two groups of patients: temporary FAs and persistent FAs. A patient was considered as a persistent FA if he or she visited the health centre at least eight times a year for at least three out of four follow-up years. Some 59 different variables were examined as potential risk factors for persistent FA. P-course, a web-based Na ï ve Bayesian classification tool, was used for the modelling of the data. Results. In our model, the most influential predictive risk factors for persistent frequent attendance in an FA population were female gender, body mass index above 30, former frequent attendance, fear of death, alcohol abstinence, low patient satisfaction, and irritable bowel syndrome. New observations were high body mass index, alcohol abstinence, irritable bowel syndrome, low patient satisfaction, and fear of death. Conclusions. In FA analyses, distinction between temporary and persistent frequent attendance should be made. Our Bayesian model could be used for identifying persistent FAs in uncertain situations. The model can quite easily be further developed as a practical decision support tool for general practitioners. However, before its use in practice, the external validity of the model will need to be defined.     

The opportunity for collaborative care provision: the presence of nursing home/hospice collaborations in the U.S. states

This study estimated the proportion of U.S. nursing homes (NHs) collaborating with Medicare hospices and identified state-level factors associated with this collaboration. Collaboration was classified as present when at least one of a NH's residents dying in July through December, 2000 received hospice. Seventy-six percent of NHs (n = 12,174) had hospice collaborations, with proportions ranging from 37% in Wyoming to 96% in Florida. State-level factors associated with greater collaboration included having a lower proportion of persons 65+ residing in rural areas, lower NH occupancy and larger hospices, and Medicaid NH reimbursement which was not case-mixed and was paid directly to NHs (not to hospices) for hospice-enrolled residents. Considering the high amount of estimated NH/hospice collaboration, care provision by both NHs and hospices appears to be a potentially viable approach for providing comprehensive end-of-life care in the majority of U.S. NHs. Findings suggest the rural composition of a state as well as its policies and healthcare market characteristics either foster or discourage NH/hospice collaboration.     

Invisible nursing: exploring health outcomes at a global level. Relationships between infant and under-5 mortality rates and the distribution of health professionals, GNP per capita, and female literacy

AIMS: To explore the relationship between the global distribution of health professionals (physicians and nurses), gross national product per capita (GNP), female literacy and the health outcome indicators of infant, and under-5 mortality rates using available data from United Nations' (UN) sources. To consider the reliability and validity of the variables included, and the implications of the findings for health policy and practice, and for further research.DESIGN: Using a database on 155 countries, regression analyses were performed using GNP, female literacy, numbers of physicians per 1000 population and numbers of nurses per 1000 population as independent variables, and infant mortality (IMR) and under-5 mortality rates (u5MR) as dependent variables. RESULTS: Linear regression analyses give R2 values for the two mortality indicators (IMR and u5MR) of 63% and 66% for physicians and 51% and 52% for nurses. Multiple linear regression analyses reveal a more complex picture. Countries with high ratios of physicians and nurses to population relative to their GNP also tend to show low IMRs and u5MRs. However, when female literacy is included in the model, the majority of these outlying countries move back towards the regression line. Nurses disappear from the model altogether when regressed with physicians, GNP per capita and female literacy for both outcome indicators. CONCLUSIONS: Despite the acknowledged need for caution in the validity and reliability of the UN data sources used in the analyses, interesting positive relationships are identified between the input variables and mortality outputs. The implications for future health policy, practice and research are considered. These include the need for more reliable, comprehensive and up-to-date data sets.     

Predictive Validity of the STarT Back Tool for Risk of Persistent Disabling Back Pain in a U.S. Primary Care Setting

Objective

To examine the predictive validity of the Subgrouping for Targeted Treatment (STarT Back) tool for classifying people with back pain into categories of low, medium, and high risk of persistent disabling back pain in U.S. primary care.