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1.
BMC Public Health ; 24(1): 1757, 2024 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-38956532

RESUMEN

BACKGROUND: A growing literature has documented the social, economic, and health impacts of exclusionary immigration and immigrant policies in the early 21st century for Latiné communities in the US, pointing to immigration and immigrant policies as forms of structural racism that affect individual, family, and community health and well-being. Furthermore, the past decade has seen an increase in bi-partisan exclusionary immigration and immigrant policies. Immigration enforcement has been a major topic during the 2024 Presidential election cycle, portending an augmentation of exclusionary policies towards immigrants. Within this context, scholars have called for research that highlights the ways in which Latiné communities navigate exclusionary immigration and immigrant policies, and implications for health. This study examines ways in which Mexican-origin women in a midwestern northern border community navigate restrictive immigration and immigrant policies to access health-promoting resources and care for their well-being. METHODS: We conducted a grounded theory analysis drawing on interviews with 48 Mexican-origin women in Detroit, Michigan, who identified as being in the first, 1.5, or second immigrant generation. Interviews were conducted in English or Spanish, depending on participants' preferences, and were conducted at community-based organizations or other locations convenient to participants in 2013-2014. RESULTS: Women reported encountering an interconnected web of institutional processes that used racializing markers to infer legal status and eligibility to access health-promoting resources. Our findings highlight women's use of both individual and collective action to navigate exclusionary policies and processes, working to: (1) maintain access to health-promoting resources; (2) limit labeling and stigmatization; and (3) mitigate adverse impacts of immigrant policing on health and well-being. The strategies women engaged were shaped by both the immigration processes and structures they confronted, and the resources to which they had access to within their social network. CONCLUSIONS: Our findings suggest a complex interplay of immigration-related policies and processes, social networks, and health-relevant resources. They highlight the importance of inclusive policies to promote health for immigrant communities. These findings illuminate women's agency in the context of structural violence facing immigrant women and are particularly salient in the face of anti-immigrant rhetoric and exclusionary immigration and immigrant policies.


Asunto(s)
Emigrantes e Inmigrantes , Emigración e Inmigración , Humanos , Femenino , Adulto , Emigrantes e Inmigrantes/psicología , Emigrantes e Inmigrantes/estadística & datos numéricos , Persona de Mediana Edad , Emigración e Inmigración/legislación & jurisprudencia , Americanos Mexicanos/psicología , Americanos Mexicanos/estadística & datos numéricos , Michigan , Accesibilidad a los Servicios de Salud , Política Pública , Racismo , Teoría Fundamentada , Investigación Cualitativa , Promoción de la Salud/métodos , Adulto Joven
2.
Health Educ Behav ; 51(2): 218-228, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38083870

RESUMEN

Conceptualizing and testing factors that contribute to the success of community-academic partnerships are critical to understanding their contributions to the health and well-being of communities. Most measures to date focus on factors that contribute to the development of new partnerships, and only a few have been adequately tested and validated. Methods. The Measurement Approaches to Partnership Success (MAPS) study followed a community-based participatory research (CBPR) approach and a multiphase process that included the construction and pilot testing of a questionnaire, and a national survey to validate the psychometric properties of the questionnaire in long-standing CBPR partnerships (existing ≥ six years). All members within partnerships were recruited to complete the survey (55 partnerships with 563 partners). We used confirmatory factor analysis (CFA), Cronbach's alpha statistics, and a pairwise correlations approach to assess discriminant and convergent validity, and assessed internal consistency, and test-retest reliability. Results. All MAPS Questionnaire dimensions demonstrated strong validity and reliability and demonstrated agreement over time. Conclusion. The MAPS Questionnaire includes seven dimensions and 81 items related to the MAPS conceptual model and provides a scientific, in-depth measurement tool that allows long-standing CBPR partnerships to evaluate their work toward achieving health equity.


Asunto(s)
Investigación Participativa Basada en la Comunidad , Modelos Teóricos , Humanos , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Investigación Participativa Basada en la Comunidad/métodos , Psicometría
4.
Biomedica ; 43(Sp. 1): 32-40, 2023 08 31.
Artículo en Inglés, Español | MEDLINE | ID: mdl-37721920

RESUMEN

Fungemia caused by Geotrichum spp. is rare and highly lethal. The Instituto Nacional de Cancerología in Bogotá reported just two cases: one in the period 2001-2007 and the other in 2012-2018. This type of infection is more common in any kind of immunocompromised patients, so it can occur in those with hematological malignancies. Here we present the case of a 27-year-old man, diagnosed with acute lymphoblastic leukemia in relapse and admitted with polyarthralgia for five days, febrile neutropenia, nonabscessed cellulitis, and bacteremia due to methicillin-sensitive Staphylococcus aureus. The patient received therapy with oxacillin and cefepime, but the febrile neutropenia persisted. A new set of blood cultures was taken, and antifungal treatment was started because of the suspicion of invasive fungal infection. Arthroconidia were identified in blood cultures and Geotrichum spp. was confirmed using matrix-assisted laser desorption-ionization mass spectrometry. The antifungal treatment was adjusted with amphotericin B deoxycholate for 14 days and voriconazole for four weeks, and after a prolonged stay, the patient was discharged. Although the incidence of fungemia caused by Geotrichum spp. is low, it must be considered in patients with hematological malignancies and persistent febrile neutropenia despite the broadspectrum antimicrobial treatment. The confirmation of fungemia causing agents, with proteomic tools such as the mentioned mass spectrometry, allows treatment adjustment and decreases complications, hospital stay, and mortality.


La fungemia por Geotrichum spp. es poco frecuente y altamente letal. En el Instituto Nacional de Cancerología de Bogotá solo se han reportado dos casos: uno entre el 2001 y el 2007, y el otro entre el 2012 y el 2018. Este tipo de infección es más común en pacientes con algún grado de compromiso del sistema inmunitario, por lo que puede presentarse en pacientes con neoplasias hematológicas malignas. Se presenta el caso de un hombre de 27 años con recaída de leucemia linfoblástica aguda, que ingresó con poliartralgias de cinco días de duración. También cursaba con neutropenia febril, celulitis sin abscesos y bacteriemia por Staphylococcus aureus resistente a la meticilina para lo cual recibió terapia con oxacilina y cefepime. Sin embargo, persistía la neutropenia febril por lo que se sospechó una infección fúngica invasora. Se tomó un nuevo set de hemocultivos y se inició tratamiento antifúngico. En los hemocultivos se identificaron artroconidias y mediante espectrometría de masas por láser de matriz asistida de ionización-desorción se confirmó la presencia de Geotrichum spp. Se ajustó el tratamiento antifúngico con deoxicolato de anfotericina B por 14 días y voriconazol por cuatro semanas. Luego de una estancia prolongada se le dio de alta. Aunque la incidencia de la fungemia por Geotrichum spp. es baja, en pacientes con neoplasias hematológicas malignas debe considerarse en el contexto de una neutropenia febril que es persistente a pesar del tratamiento antimicrobiano de amplio espectro.


Asunto(s)
Neutropenia Febril , Fungemia , Geotricosis , Neoplasias Hematológicas , Leucemia-Linfoma Linfoblástico de Células Precursoras , Masculino , Humanos , Adulto , Fungemia/diagnóstico , Fungemia/tratamiento farmacológico , Antifúngicos/uso terapéutico , Proteómica , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Neutropenia Febril/tratamiento farmacológico
5.
J Clin Transl Sci ; 7(1): e2, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36755548

RESUMEN

Introduction: The effectiveness of community-based participatory research (CBPR) partnerships to address health inequities is well documented. CBPR integrates knowledge and perspectives of diverse communities throughout the research process, following principles that emphasize trust, power sharing, co-learning, and mutual benefits. However, institutions and funders seldom provide the time and resources needed for the critical stage of equitable partnership formation and development. Methods: Since 2011, the Detroit Urban Research Center, collaborating with other entities, has promoted the development of new community-academic research partnerships through two grant programs that combine seed funding with capacity building support from community and academic instructors/mentors experienced in CBPR. Process and outcomes were evaluated using mixed methods. Results: From 2011 to 2021, 50 partnerships received grants ranging from $2,500 to $30,000, totaling $605,000. Outcomes included equitable partnership infrastructure and processes, innovative pilot research, translation of findings to interventions and policy change, dissemination to multiple audiences, new proposals and projects, and sustained community-academic research partnerships. All partnerships continued beyond the program; over half secured additional funding. Conclusions: Keys to success included participation as community-academic teams, dedicated time for partnership/relationship development, workshops to develop equity-based skills, relationships, and projects, expert community-academic instructor guidance, and connection to additional resources. Findings demonstrate that small amounts of seed funding for newly forming community-academic partnerships, paired with capacity building support, can provide essential time and resources needed to develop diverse, inclusive, equity-focused CBPR partnerships. Building such support into funding initiatives and through academic institutions can enhance impact and sustainability of translational research toward advancing health equity.

6.
Am J Public Health ; 113(1): 70-78, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-36516389

RESUMEN

Structural racism causes stark health inequities and operates at every level of society, including the academic and governmental entities that support health research and practice. We argue that health research institutions must invest in research that actively disrupts racial hierarchies, with leadership from racially marginalized communities and scholars. We highlight synergies between antiracist principles and community-based participatory research (CBPR), examine the potential for CBPR to promote antiracist research and praxis, illustrate structural barriers to antiracist CBPR praxis, and offer examples of CBPR actions taken to disrupt structural racism. We make recommendations for the next generation of antiracist CBPR, including modify health research funding to center the priorities of racially marginalized communities, support sustained commitments and accountability to those communities by funders and research institutions, distribute research funds equitably across community and academic institutions, amplify antiracist praxis through translation of research to policy, and adopt institutional practices that support reflection and adaptation of CBPR to align with emergent community priorities and antiracist practices. A critical application of CBPR principles offers pathways to transforming institutional practices that reproduce and reinforce racial inequities. (Am J Public Health. 2023;113(1):70-78. https://doi.org/10.2105/AJPH.2022.307114).


Asunto(s)
Investigación Participativa Basada en la Comunidad , Administración Financiera , Humanos , Antiracismo , Grupos Raciales , Universidades
7.
Biomédica (Bogotá) ; 43(Supl. 1): 32-40, 2023. graf
Artículo en Español | LILACS | ID: biblio-1533890

RESUMEN

La fungemia por Geotrichum spp. es poco frecuente y altamente letal. En el Instituto Nacional de Cancerología de Bogotá solo se han reportado dos casos: uno entre el 2001 y el 2007, y el otro entre el 2012 y el 2018. Este tipo de infección es más común en pacientes con algún grado de compromiso del sistema inmunitario, por lo que puede presentarse en pacientes con neoplasias hematológicas malignas. Se presenta el caso de un hombre de 27 años con recaída de leucemia linfoblástica aguda, que ingresó con poliartralgias de cinco días de duración. También cursaba con neutropenia febril, celulitis sin abscesos y bacteriemia por Staphylococcus aureus resistente a la meticilina para lo cual recibió terapia con oxacilina y cefepime. Sin embargo, persistía la neutropenia febril por lo que se sospechó una infección fúngica invasora. Se tomó un nuevo set de hemocultivos y se inició tratamiento antifúngico. En los hemocultivos se identificaron artroconidias y mediante espectrometría de masas por láser de matriz asistida de ionización-desorción se confirmó la presencia de Geotrichum spp. Se ajustó el tratamiento antifúngico con deoxicolato de anfotericina B por 14 días y voriconazol por cuatro semanas. Luego de una estancia prolongada se le dio de alta. Aunque la incidencia de la fungemia por Geotrichum spp. es baja, en pacientes con neoplasias hematológicas malignas debe considerarse en el contexto de una neutropenia febril que es persistente a pesar del tratamiento antimicrobiano de amplio espectro. La identificación de los agentes causantes de fungemias con herramientas de proteómica, como la espectrometría de masas mencionada, permite ajustar el tratamiento dirigido y reducir las complicaciones, la estancia hospitalaria y la mortalidad.


Fungemia caused by Geotrichum spp. is rare and highly lethal. The Instituto Nacional de Cancerología in Bogotá reported just two cases: one in the period 2001-2007 and the other in 2012-2018. This type of infection is more common in any kind of immunocompromised patients, so it can occur in those with hematological malignancies. Here we present the case of a 27-year-old man, diagnosed with acute lymphoblastic leukemia in relapse and admitted with polyarthralgia for five days, febrile neutropenia, non- abscessed cellulitis, and bacteremia due to methicillin-sensitive Staphylococcus aureus. The patient received therapy with oxacillin and cefepime, but the febrile neutropenia persisted. A new set of blood cultures was taken, and antifungal treatment was started because of the suspicion of invasive fungal infection. Arthroconidia were identified in blood cultures and Geotrichum spp. was confirmed using matrix-assisted laser desorption-ionization mass spectrometry. The antifungal treatment was adjusted with amphotericin B deoxycholate for 14 days and voriconazole for four weeks, and after a prolonged stay, the patient was discharged. Although the incidence of fungemia caused by Geotrichum spp. is low, it must be considered in patients with hematological malignancies and persistent febrile neutropenia despite the broadspectrum antimicrobial treatment. The confirmation of fungemia causing agents, with proteomic tools such as the mentioned mass spectrometry, allows treatment adjustment and decreases complications, hospital stay, and mortality.


Asunto(s)
Leucemia-Linfoma Linfoblástico de Células Precursoras , Geotricosis , Anfotericina B , Fungemia , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Voriconazol
8.
Psicol. conduct ; 30(2): 517-532, Sept. 2022. tab
Artículo en Español | IBECS | ID: ibc-208442

RESUMEN

Las variables psicológicas permiten predecir el riego de abuso de los opioidesde prescripción. El objetivo del presente estudio ha sido analizar el valor predictivode algunas de ellas. Concretamente se ha analizado la asociación del humor deautoafirmación, el neuroticismo, la extraversión, la presencia de síntomas deansiedad y/o depresión, y la intensidad de dolor percibido con el potencial abuso yel uso indebido de opioides. Participaron 60 pacientes con dolor crónico nooncológico, con una media de edad de 60 años, en su mayoría mujeres (77%) ycasados (78%). Se realizaron dos análisis de regresión lineal múltiple por pasos. Losresultados señalan a los síntomas de ansiedad y/o depresión como únicas variablesrelacionadas con el potencial abuso y el actual uso indebido de los opioides deprescripción. Se concluye la importancia de llevar a cabo una evaluación psicológicaprevia al inicio de una terapia farmacológica con opioides. Y, en el caso de detectarsíntomas de ansiedad o depresión en estos pacientes, sería necesario solucionarestos problemas antes de la prescripción de opioides. (AU)


Psychological variables can be used to predict the risk of prescription opioidabuse. The aim of the present study was to analyse the predictive value of a set ofthese variables. Specifically, we analysed the association between the potentialabuse and misuse of opioids and self-affirming mood, neuroticism, extraversion,anxiety and/or depression symptoms, and perceived pain intensity. The samplecomprised 60 patients with chronic non-oncological pain (mean age= 60 years;77% women, 78% married). Two stepwise multiple linear regression analyses wereperformed. The results indicate that anxiety and/or depression symptoms were theonly variables associated with the potential abuse and current misuse ofprescription opioids. We suggest the need for prior psychological assessmentbefore deciding to initiate pharmacological therapy with opioids. Any anxiety or depression symptoms in these patients should be addressed before prescribingopioids. (AU)


Asunto(s)
Humanos , Persona de Mediana Edad , Anciano , Dolor Crónico/psicología , Trastornos Relacionados con Opioides , Neuroticismo , Encuestas y Cuestionarios
9.
Matern Child Health J ; 26(Suppl 1): 69-77, 2022 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-35821359

RESUMEN

INTRODUCTION: The Maternal and Child Health (MCH) Pipeline Training Program, promotes development of a diverse health workforce by training undergraduate students from underrepresented minorities. We aimed to evaluate the success of this program based on three domains: (1) demographic characteristics, (2) academic and career development, and (3) attitudes towards the field of MCH and the training programs among graduates. METHODS: Three domains of success were determined through a collaborative effort between current program directors and the funding agency project officers. The survey with questions related to the three domains was distributed via an online platform to graduates from seven sites (one former site and six current sites). Data were analyzed and presented utilizing descriptive statistics. RESULTS: The survey was distributed to 550 graduates, 162 responded (37% response rate). Demographically, 78% were female, 54% were Black/African American, 22% were Latinx and 83% did not report any disability. Eighty percent of respondents applied to graduate/professional schools, 67% received admission. Graduates often continued to work in MCH fields (70%). Majority felt confident and knowledgeable in the field (89%) and agreed the faculty were supportive at their training sites (90%). CONCLUSION: The study highlights successes in recruiting from underrepresented minorities, particularly Black/African Americans and first-time college goers in the family into the MCH Pipeline Training Programs. Programs were successful in furthering academic and career development for most trainees. Attitudes towards MCH and the training programs were overwhelmingly positive. Continued support of these programs is critical in addressing health disparities and achieving health equity.


Asunto(s)
Salud Infantil , Grupos Minoritarios , Selección de Profesión , Niño , Femenino , Humanos , Masculino , Estudiantes , Encuestas y Cuestionarios , Universidades
10.
Pediatrics ; 149(Suppl 4)2022 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-35363293

RESUMEN

OBJECTIVES: Physical and mental health outcomes of autistic individuals deteriorate during transition to adulthood. The study aims to identify opportunities to improve physician knowledge in health-care transitions (HCT) for autistic individuals by understanding perceived versus experienced facilitators and barriers in overall HCT curriculum implementation in graduate medical education. METHODS: Medicine-Pediatrics program directors participated in a Health Care Transition Residency Curriculum Collaborative Improvement Network and used an iterative process to develop and improve HCT curricula. Pre- and postcollaborative semistructured interviews were administered to program directors. The study occurred over 9 months (July 2018-February 2019). Recurring interview themes were analyzed utilizing Dedoose qualitative coding software and presented utilizing percentages and proportions. RESULTS: Most program directors developed curricula in response to a gap in their current transition curricula. All program directors partially or completely met their goals during the collaborative. The most common types of curricular delivery were didactic (65%) and clinical experience-based (53%). Some tested unique delivery platforms, like the electronic medical record system (29%) and online modules (24%). Program directors often involved residents in the curricular development process and overwhelmingly (65%) felt this was a major facilitator. Competing priorities of faculty (71%) and of residents (53%) were the most common barriers. CONCLUSIONS: Gaps in HCT curricula delivery were primarily attributed to suboptimal health care systems where training occurs, though existing clinical experiences and diverse learning modalities were successfully leveraged. Using a quality improvement framework and actively engaging resident trainees in curriculum development were successful strategies programs used in the development of HCT curricula.


Asunto(s)
Trastorno Autístico , Internado y Residencia , Transición a la Atención de Adultos , Adulto , Niño , Curriculum , Humanos , Transferencia de Pacientes
11.
Matern Child Health J ; 26(7): 1415-1423, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35192126

RESUMEN

INTRODUCTION: The Maternal and Child Health (MCH) Pipeline Training Program, promotes development of a diverse health workforce by training undergraduate students from underrepresented minorities. We aimed to evaluate the success of this program based on three domains: (1) demographic characteristics, (2) academic and career development, and (3) attitudes towards the field of MCH and the training programs among graduates. METHODS: Three domains of success were determined through a collaborative effort between current program directors and the funding agency project officers. The survey with questions related to the three domains was distributed via an online platform to graduates from seven sites (one former site and six current sites). Data were analyzed and presented utilizing descriptive statistics. RESULTS: The survey was distributed to 550 graduates, 162 responded (37% response rate). Demographically, 78% were female, 54% were Black/African American, 22% were Latinx and 83% did not report any disability. Eighty percent of respondents applied to graduate/professional schools, 67% received admission. Graduates often continued to work in MCH fields (70%). Majority felt confident and knowledgeable in the field (89%) and agreed the faculty were supportive at their training sites (90%). CONCLUSION: The study highlights successes in recruiting from underrepresented minorities, particularly Black/African Americans and first-time college goers in the family into the MCH Pipeline Training Programs. Programs were successful in furthering academic and career development for most trainees. Attitudes towards MCH and the training programs were overwhelmingly positive. Continued support of these programs is critical in addressing health disparities and achieving health equity.


Asunto(s)
Salud Infantil , Grupos Minoritarios , Selección de Profesión , Niño , Femenino , Humanos , Masculino , Estudiantes , Encuestas y Cuestionarios , Universidades
12.
J Health Polit Policy Law ; 47(2): 259-291, 2022 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-34522957

RESUMEN

This study examines how Mexican-origin women construct and navigate racialized identities in a postindustrial northern border community during a period of prolonged restrictive immigration and immigrant policies, and it considers mechanisms by which responses to racialization may shape health. This grounded theory analysis involves interviews with 48 Mexican-origin women in Detroit, Michigan, who identified as being in the first, 1.5, or second immigrant generation. In response to institutions and institutional agents using racializing markers to assess their legal status and policing access to health-promoting resources, women engaged in a range of strategies to resist being constructed as an "other." Women used the same racializing markers or symbols of (il)legality that had been used against them as a malleable set of resources to resist processes of racialization and to form, preserve, and affirm their identities. These responses include constructing an authorized immigrant identity, engaging in immigration advocacy, and resisting stigmatizing labels. These strategies may have different implications for health over time. Findings indicate the importance of addressing policies that promulgate or exacerbate racialization of Mexican-origin communities and other communities who experience growth through migration. Such policies include creating pathways to legalization and access to resources that have been invoked in racialization processes, such as state-issued driver's licenses.


Asunto(s)
Emigrantes e Inmigrantes , Emigración e Inmigración , Femenino , Humanos , Michigan , Políticas
13.
Health Educ Behav ; 48(5): 553-558, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-33813932

RESUMEN

For decades, marginalized communities have been naming the harms of policing-and the systemic racism that undergirds it-for health and well-being. Only recently have policing practices and racism within policing gained more widespread attention in public health. Building on social justice and emancipatory traditions in health education, we argue that health educators are uniquely prepared to use the evidence base to reframe narratives that drive aggressive policing and their disproportionate impacts on communities of color, promote disinvestment in militarized policing, and build relationships with community-based organizations and community organizers developing community-centered approaches to safety. Using public health institutions and institutions of higher education as examples, we suggest specific strategic actions that health educators can take to address policing as a public health issue. Health educators are uniquely poised to work with diverse community and institutional partners to support social movements that create community-centered, equitable approaches to public safety and health.


Asunto(s)
Educadores en Salud , Equidad en Salud , Racismo , Humanos , Policia , Salud Pública
14.
Am J Community Psychol ; 66(3-4): 427-438, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-32744781

RESUMEN

Understanding what contributes to success of community-based participatory research (CBPR) partnerships is essential to ensuring their effectiveness in addressing health disparities and health inequities. Synergy, the concept of accomplishing more together than separately, is central to partnership effectiveness. However, synergy specific to long-standing, equity-focused CBPR partnerships has not been closely examined. To address this, we defined and developed measures of partnership synergy as one dimension of a participatory mixed methods study, Measurement Approaches to Partnership Success (MAPS), to develop a validated instrument to measure success in long-standing CBPR partnerships. Framed by a conceptual model and scoping literature review, we conducted in-depth interviews with a national panel of academic and community experts in CBPR and equity to develop partnership synergy measures. Items were refined through an iterative process, including a three-stage Delphi process, comparison with existing measures, cognitive interviews, and pilot testing. Seven questionnaire items were developed to measure synergy arising from equitable partnerships bringing together diverse partners across power differences to promote equity. Defining and measuring synergy in the context of long-standing partnership success is central to understanding the role of synergy in collaborative approaches to research and action and can strengthen CBPR partnerships to promote healthy communities and advance health equity.


Asunto(s)
Investigación Participativa Basada en la Comunidad/métodos , Relaciones Comunidad-Institución , Equidad en Salud , Conducta Cooperativa , Humanos , Encuestas y Cuestionarios
15.
Health Place ; 65: 102391, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32738606

RESUMEN

OBJECTIVE: Previous studies have demonstrated associations between race-based residential segregation, neighborhood socioeconomic and physical environmental characteristics, and mortality. Relatively few studies have examined independent and joint effects of these multiple neighborhood characteristics and mortality, including potential mediating pathways. In this study we examine the extent to which associations between race-based residential segregation and all-cause mortality may be explained by multiple socioeconomic indicators and exposure to air pollutants. METHODS: Drawing on data from multiple sources, we assessed bivariate associations between race-based residential segregation (operationalized as percent non-Hispanic Black), education (percent with graduate equivalency degree), poverty (percent below poverty), income inequality (GINI coefficient) and air pollution (ambient PM2.5) and age adjusted all-cause, all race mortality (henceforth all cause mortality) at the census tract level in the Detroit Metropolitan Area. We used inequality curves to assess the (in)equitable distribution of economic and environmental characteristics by census tract racial composition. Finally, we used generalized estimating equations (GEE) to examine independent and joint associations among percent NHB, education, income inequality, and air pollution to all-cause mortality, and test for mediating effects. RESULTS: Bivariate associations between racial composition, education, poverty, income inequality, PM2.5 and all-cause mortality were statistically significant. Census tracts with higher concentrations of NHB residents had significantly lower educational attainment, higher poverty, and greater exposure to PM2.5. In multivariate models, education, income inequality and PM2.5 fully attenuated associations between racial composition and all-cause mortality. CONCLUSIONS: Results are consistent with the hypothesis that race-based residential segregation is associated with heightened all-cause mortality, and that those effects are mediated by education, income inequality, and exposure to air pollution at the census tract level. Public health and cross-sector interventions to eliminate race-based residential segregation or to eliminate the maldistribution of educational and economic resources, and environmental exposures, across census tracts could substantially reduce regional inequities in all-cause mortality.


Asunto(s)
Población Negra/estadística & datos numéricos , Ambiente , Mortalidad , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , Adulto , Contaminación del Aire , Censos , Investigación Participativa Basada en la Comunidad , Femenino , Humanos , Masculino , Michigan , Persona de Mediana Edad , Pobreza , Segregación Social
16.
Artículo en Inglés | MEDLINE | ID: mdl-32610649

RESUMEN

Transportation infrastructure decisions contribute to social, economic, and health inequities in the U.S. Health Impact Assessments (HIAs) may improve understanding of potential strategies to mitigate adverse effects on quality of life from planned developments. We use the Gordie Howe International Bridge (GHIB), currently under construction in southwest Detroit, MI, as a case study to examine 15 years of community mobilization, which resulted in community benefits that included an HIA. We describe community engagement processes, household survey methods, and select findings of the baseline HIA, with a focus on their application to inform recommendations to promote quality of life. Baseline HIA results indicated significantly higher self-reported asthma rates among children living within 500 feet of trucking routes. Residents reported substantial economic (e.g., decreased home values), health (e.g., adverse outcomes, lack of health care access), and environmental (e.g., air pollution) concerns related to the GHIB. We discuss specific recommendations, based on HIA results, to reduce adverse impacts of the GHIB. These recommendations will inform ongoing community benefits negotiations. This case study provides lessons for community, academic, and government partners conducting HIAs, especially during building and operation of major infrastructure, and discusses their potential role in improving community engagement opportunities towards environmental justice.


Asunto(s)
Exposición a Riesgos Ambientales/estadística & datos numéricos , Evaluación del Impacto en la Salud , Adolescente , Contaminación del Aire , Asma , Niño , Femenino , Humanos , Masculino , Calidad de Vida , Encuestas y Cuestionarios
17.
Health Educ Behav ; 47(4): 519-524, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32408770

RESUMEN

In this Perspective, we build on social justice and emancipatory traditions within the field of health education, and the field's long-standing commitment to building knowledge and shared power to promote health equity, to examine lessons and opportunities for health education emerging from the COVID-19 pandemic. Examining patterns that emerged as the pandemic unfolded in Metropolitan Detroit, with disproportionate impacts on African American and low-income communities, we consider conditions that contributed to excess exposure, mortality, and reduced access to critical health protective resources. Using a life course framework, we consider enduring impacts of the pandemic for health equity. Finally, we suggest several strategic actions in three focal areas-environment, occupation, and housing-that can be taken by health educators working in partnership with community members, researchers, and decision makers, using, for example, a community-based participatory research approach, to reduce adverse impacts of COVID-19 and promote long-term equity in health.


Asunto(s)
Infecciones por Coronavirus/etnología , Educación en Salud/organización & administración , Equidad en Salud/organización & administración , Neumonía Viral/etnología , Determinantes Sociales de la Salud/etnología , Betacoronavirus , COVID-19 , Ambiente , Vivienda/organización & administración , Humanos , Michigan/epidemiología , Pandemias , SARS-CoV-2 , Factores Socioeconómicos
18.
Prog Community Health Partnersh ; 14(1): 129-140, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32280130

RESUMEN

BACKGROUND: Numerous conceptual frameworks have been developed to understand how community-based participatory research (CBPR) partnerships function, and multiple measurement approaches have been designed to evaluate them. However, most measures are not validated, and have focused on new partnerships. To define and assess the meaning of success in long-standing CBPR partnerships, we are conducting a CBPR study, Measurement Approaches to Partnership Success (MAPS). In this article we describe the theoretical underpinnings and methodological approaches used. OBJECTIVES: The objectives of this study are to 1) develop a questionnaire to evaluate success in long-standing CBPR partnerships, 2) test the psychometric qualities of the questionnaire, 3) assess the relationships between key variables and refine the questionnaire and theoretical model, and 4) develop mechanisms and a feedback tool to apply partnership evaluation findings. METHODS: Methodological approaches have included: engaged a community-academic national Expert Panel; conducted key informant interviews with Expert Panel; conducted a scoping literature review; conducted a Delphi process with the Expert Panel; and revised the measurement instrument. Additional methods include: conduct cognitive interviews and pilot testing; revise and test final version of the questionnaire with long-standing CBPR partnerships; examine the reliability and validity; analyze the relationship among variables in the framework; revise the framework; and develop a feedback mechanism for sharing partnership evaluation results. CONCLUSIONS: Through the application of a theoretical model and multiple methodological approaches, the MAPS study will result in a validated measurement instrument and will develop procedures for effectively feeding back evaluation findings in order to strengthen authentic partnerships to achieve health equity.


Asunto(s)
Investigación Participativa Basada en la Comunidad/organización & administración , Evaluación de Programas y Proyectos de Salud/métodos , Encuestas y Cuestionarios/normas , Investigación Participativa Basada en la Comunidad/normas , Relaciones Comunidad-Institución , Conducta Cooperativa , Humanos , Evaluación de Programas y Proyectos de Salud/normas , Psicometría , Reproducibilidad de los Resultados , Universidades/organización & administración
19.
Ethn Health ; 25(3): 323-341, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-29355028

RESUMEN

Objectives: The 21st century has seen a rise in racism and xenophobia in the United States. Few studies have examined the health implications of heightened institutional and interpersonal racism. This study examines changes in reported discrimination and associations with blood pressure over time among non-Latino Blacks (NLBs), Latinos, and non-Latino Whites (NLWs) in an urban area, and variations by nativity among Latinos.Design: Data from a probability sample of NLB, Latino, and NLW Detroit, Michigan residents were collected in 2002-2003, with follow-up at the same addresses in 2007-2008. Surveys were completed at 80% of eligible housing units in 2008 (n = 460). Of those, 219 participants were interviewed at both time points and were thus included in this analysis. Discrimination patterns across racial/ethnic groups and associations with blood pressure were examined using generalized estimating equations.Results: From 2002 to 2008, NLBs and Latinos reported heightened interpersonal and institutional discrimination, respectively, compared with NLWs. There were no differences in associations between interpersonal discrimination and blood pressure. Increased institutional discrimination was associated with stronger increases in systolic and diastolic blood pressure for NLBs than NLWs, with no differences between Latinos and NLWs. Latino immigrants experienced greater increases in blood pressure with increased interpersonal and institutional discrimination compared to US-born Latinos.Conclusions: Together, these findings suggest that NLBs and Latinos experienced heightened discrimination from 2002 to 2008, and that increases in institutional discrimination were more strongly associated with blood pressure elevation among NLBs and Latino immigrants compared to NLWs and US-born Latinos, respectively. These findings suggest recent increases in discrimination experienced by NLBs and Latinos, and that these increases may exacerbate racial/ethnic health inequities.


Asunto(s)
Presión Sanguínea/fisiología , Factores de Riesgo de Enfermedad Cardiaca , Racismo/estadística & datos numéricos , Discriminación Social/etnología , Población Urbana , Adulto , Negro o Afroamericano/estadística & datos numéricos , Investigación Participativa Basada en la Comunidad , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Estudios Longitudinales , Masculino , Michigan , Persona de Mediana Edad , Autoinforme , Encuestas y Cuestionarios , Población Blanca/estadística & datos numéricos
20.
Health Promot Pract ; 21(4): 552-563, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-30596283

RESUMEN

Community-based participatory research (CBPR) is an equitable partnership approach that links academic researchers, community organizations, and public health practitioners to work together to understand and address health inequities. Although numerous educational materials on CBPR exist, few training programs develop the skills and knowledge needed to establish effective, equitable partnerships. Furthermore, there are few professional development opportunities for academic researchers, practitioners, and community members to obtain these competencies in an experiential co-learning process. In response, the Detroit Community-Academic Urban Research Center developed the CBPR Partnership Academy, an innovative, yearlong capacity-building program facilitated by experienced community and academic partners, involving an intensive short course, partnership development, grant proposal preparation and funding, mentoring, online learning forums, and networking. Three diverse cohorts (36 teams) from 18 states and 2 tribal nations have participated. We describe the rationale and components of the training program and present results from the first two cohorts. Evaluation results suggest enhanced competence and efficacy in conducting CBPR. Outcomes include partnerships established, grant proposals submitted and funded, workshops and research conducted, and findings disseminated. A community-academic partner-based, integrated, applied program can be effective for professional development and establishing innovative linkages between academics and practitioners aimed at achieving health equity.


Asunto(s)
Investigación Participativa Basada en la Comunidad , Relaciones Comunidad-Institución , Equidad en Salud , Creación de Capacidad , Humanos , Michigan , Investigadores
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