Luis E Zayas | Grand Canyon University (original) (raw)
Papers by Luis E Zayas
PubMed, Feb 1, 1998
This study was undertaken to explore the prevalence of perceived dysphoria in a poor, urban, pred... more This study was undertaken to explore the prevalence of perceived dysphoria in a poor, urban, predominantly Puerto Rican community. A cross-sectional sample of 704 adult respondents were asked a single validated question, with a five-item Likert scale response, about their level of perceived dysphoria. Chi-squared analysis and Spearman's correlation coefficients were used to assess the association of level of dysphoria with social characteristics, barriers to health care, health status, and substance use. Linear regression modeling was used to control for confounding variables. Twenty percent of the respondents were dysphoric. Respondents with no health insurance or no source of health care were least likely to be dysphoric. Persons who perceived distance to the hospital and the doctor, and understanding language of the doctor and office staff as barriers to care were more likely to be dysphoric. Ethnicity was not correlated with level of perceived dysphoria; however, age, gender, and health status were found to be associated with level of dysphoria after controlling for other correlated variables. These results indicate that the psychological needs of communities need to be understood and interventions that are appropriate for the population need to be devised.
PubMed, 1998
The 1988 Upstate New York Live Birth Certificate was the first to record Hispanic ethnicity and c... more The 1988 Upstate New York Live Birth Certificate was the first to record Hispanic ethnicity and country of origin. This registry was used to compare low birthweight and preterm delivery among non-Hispanic white, non-Hispanic black, and Hispanic infants. Risk of low birthweight and preterm delivery was assessed for Hispanics by country of origin. Unconditional backward elimination logistic regression analysis, controlling for confounders was used to assess risk of low birthweight and preterm delivery of Hispanic subgroups compared to non-Hispanic white and non-Hispanic black mothers. The data showed that non-Hispanic black mothers are at greatest risk of low birthweight and preterm delivery. Hispanics as a group have rates similar to non-Hispanic white mothers, although risk of preterm delivery and low birthweight differs among Hispanic ethnic subgroups. This study supports the need to assess Hispanic subgroups separately rather than as a single entity.
Purpose: Geriatric patients face self-care and chronic illness management challenges. For Latinos... more Purpose: Geriatric patients face self-care and chronic illness management challenges. For Latinos responsive to values of familismo, close relatives are expected to be primary caregivers of the elderly. This study examines social support of Puerto Rican older adults with chronic illness. Method: A concurrent, mixed-methods approach (qualitative and quantitative) was employed with a consecutive sample of geriatric Puerto Rican patients with chronic illness attending an inner-city primary care clinic. Of 49 participants who completed the Instrumental Activities of Daily Living (IADL) assessment, the 40 who needed help with any IADL were probed with open-ended questioning to identify how they addressed IADL needs. Standardized questionnaires captured demographics, socio-economic status, and quality of life. Results: Mean age was 76 (5.3) years; 72% had annual household income of ≤ $15,000 and all had health care insurance (primarily Medicaid, Medicare). Eighty-percent communicated in E...
Journal of the American Geriatrics Society
Latino older adults in the United States have disproportionately high rates of chronic and disabl... more Latino older adults in the United States have disproportionately high rates of chronic and disabling medical conditions. Among Latinos, Puerto Ricans have a higher prevalence of several chronic medical conditions and higher rates of functional disability. Earlier studies documented that Puerto Rican older adults traditionally have relied mostly on family members for assistance with their functional needs, with low utilization of formal support services. However, little is recently known about their functional help needs and caregiving practices. This study examines independent living and caregiving practices among community-dwelling Puerto Rican older adults in Western New York using a mixed-methods approach with a sample of 49 patients attending an inner-city primary care clinic. Standard instruments captured socio-economic and health status and functional ability. Forty participants who needed help with any Instrumental Activities of Daily Living (IADL) were probed qualitatively f...
Journal of the American Geriatrics Society, 2013
Latino older adults in the United States have disproportionately high rates of chronic and disabl... more Latino older adults in the United States have disproportionately high rates of chronic and disabling medical conditions. Puerto Ricans have a higher prevalence of several chronic medical conditions and higher rates of functional disability than other Latinos. Earlier studies have documented that Puerto Rican older adults traditionally have relied mostly on family members for assistance with their functional needs, with low use of formal support services, but little is known about their functional help needs and caregiving practices. This study examined independent living and caregiving practices of community-dwelling Puerto Rican older adults in western New York using a mixedmethods approach with a sample of 49 individuals attending an inner-city primary care clinic. Standard instruments were used to obtain information on socioeconomic and health status and functional ability. Forty participants who needed help with any instrumental activities of daily living (IADLs) were probed qualitatively for how their needs were addressed. Participants averaged six chronic medical conditions, mean age was 76.2 AE 5.3, most reported annual household income of $15,000 or less and had low fluency in English, and all had healthcare insurance. For the most part, participants' children and spouses were primary caregivers, and few used formal support services. Nearly onethird reported having insufficient help. Qualitative findings elucidated how IADL needs were addressed. In this sample of indigent Puerto Rican older adults, most needed help with IADLs. Although family members most often helped, one-third had unmet or undermet needs. Linguistically and culturally congruent formal support services are still needed for Puerto Rican older adults and their family caregivers.
Journal of Asthma, 2015
Objective-Patients' cultural health beliefs and behaviors may conflict with biomedical healthcare... more Objective-Patients' cultural health beliefs and behaviors may conflict with biomedical healthcare values and practices potentially leading to non-adherence with asthma treatment regimens. To optimize shared decision-making, healthcare providers should understand and be sensitive to these cultural beliefs and behaviors and negotiate an asthma management plan acceptable to parents. The purpose of this study was to obtain the perspective of Mexican mothers regarding (1) their experiences of living with a child with asthma, (2) their understanding of the nature of asthma, and (3) how their cultural beliefs influence asthma management. Methods-A qualitative, phenomenological study design was employed to assess mothers' lived experiences with and perceptions of their child's asthma. Individual in-depth interviews were conducted with a purposeful sample of 20 Mexican mothers of children ages 5-17 years with asthma. An inductive, theory-driven, phenomenological analysis approach was used to elicit thematic findings. Results-Mothers expressed a symptomatic perception of asthma and limited understanding of the disease. Most believe the disease is present only when their child is symptomatic. Many are surprised and puzzled by the unpredictability of their child's asthma attacks, which they report as sometimes "silent". The inconsistency of triggers also leads to frustration and worry, which may reflect their concerns around daily controller medication use and preference for alternative illness management strategies.
ABSTRACT Medical repatriations of undocumented and uninsured patients with chronic illnesses or c... more ABSTRACT Medical repatriations of undocumented and uninsured patients with chronic illnesses or catastrophic injuries initiated by American hospitals to Mexico have ramifications for patients and their families. Locating these patients after repatriation is challenging albeit critical to understanding this process and its impact. This report, part of a larger ongoing project, describes participant recruitment efforts with state actors and non-governmental organizations in Mexico that could have encounters with repatriated patients. Following purposeful snowball sampling, contact was established with 5 national NGOs offering migrant services, governmental migrant service offices and hospitals in six states (and DF). Over 5 months, informal interviews and correspondence with health professionals, NGOs, and governmental staff were recorded in field-notes. To map the social and bureaucratic landscape, data was analyzed qualitatively. Early findings suggest recruitment through governmental offices and hospitals yield more participants (6 cases) compared to NGOs. Efforts with NGOs have yielded no participants. Government agencies encounter patients seeking assistance post-repatriation or when Mexican consulates aide with transit visas for patients facing repatriation. Recruitment challenges include little follow-up by American hospitals, no tracking by U.S. authorities, and no patient registry. To overcome challenges, affiliations with a university and NGO were leveraged. Few Mexican officials and healthcare professionals are knowledgeable of medical repatriations and have contact with patients pre/post-repatriation. Nescience of patients' repatriation histories may negatively affect treatment and wellbeing. American hospitals offer minimal coordination with Mexican institutions. Non-involvement by U.S. authorities to track repatriations hinders researchers and policy-makers in assessing the scope and impact of repatriations.
Disenfranchised ethnic minority communities in the urban United States experience a high burden o... more Disenfranchised ethnic minority communities in the urban United States experience a high burden of asthma. Conventional office-based patient education often is insufficient to pro- mote proper asthma management and coping practices responsive to minority patients' envi- ronments. This paper explores existing and alternative asthma information and education sources in three urban minority communities in western New York State to help
Family Medicine, Jun 1, 2008
BACKGROUND AND OBJECTIVES: Exposure to non-constructive criticism of medical specialties is belie... more BACKGROUND AND OBJECTIVES: Exposure to non-constructive criticism of medical specialties is believed to be fairly common among medical students. Better understanding of this "bashing" phenomenon is needed to promote greater professionalism in medical education and student interest in primary care careers. This study examines exposure and reactions to bashing among third-year medical students in a public university.METHODS: A survey assessing amount, sources, targets, and nature of perceived bashing was completed by 105 students. Three open-ended questions elicited students' experiences, opinions, and recommendations.RESULTS: Students perceived that bashing of other specialties occurred during all clerkships; the most were perceived during the surgery clerkship, for which 87.5% reported such bashing. Specialties perceived as the object of bashing were family medicine (72%), general internal medicine (40%), psychiatry (39%), and general surgery (36%). Sixty-seven percent of students reported personally receiving non-constructive criticism about their preferred specialty. Seventy-nine percent believed bashing was unprofessional behavior. Strategies suggested by respondents to decrease bashing included increasing awareness, highlighting the interdisciplinary nature of medicine, and evaluating professionalism.CONCLUSIONS: Medical students perceived bashing of medical specialties, recognized it as unprofessional behavior, and would be receptive to interventions to reduce bashing. Findings suggest a need to address bashing as part of professionalism curricula in medical training.
Social work
ABSTRACT In the course of investigating barriers to health care in Arizona for Latino families as... more ABSTRACT In the course of investigating barriers to health care in Arizona for Latino families as part of an MSW diversity class project, I happened upon a singularly daunting impediment to medical care: extralegal hospital deportations or the practice of returning uninsured, seriously injured or ill undocumented patients to their countries of origin. As a social work graduate student looking forward to a professional life centered in health care and immigration, learning of this practice was upsetting. This commentary brings some light to these interventions, which are privatized, lack state or federal policy guidance, and have far-reaching repercussions for undocumented patients and their families in Latino communities on both sides of the U.S. Southwest border. It also raises serious implications for social workers who must navigate institutional demands and clients’ rights when involved. There is a need for research and a heightened ethical awareness regarding the practice and consequences of hospital deportations, particularly when medical social workers and hospital caseworkers are charged with obtaining informed consent and facilitating the patient discharge process.
This study examines the problem of development and the transformation of Tamandaré, a coastal fis... more This study examines the problem of development and the transformation of Tamandaré, a coastal fishing district in the municipality of Rio Formoso, Pernambuco, Brazil. During the 1970s, many artisanal fishing communities throughout the Brazilian coast showed signs of profound changes in the economy, social organization and culture. A decade earlier, the federal government had launched a program to develop the country's fishing industry. Some communities also experienced the arrival of summer vacationers. By the early 1980s, artisanal fisheries experienced a decline in production, and were near demise. Motorboat fishing and land speculation prompted fishers to change or alternate fish production modes, change occupation or leave their villages to embark in industrial fishing ventures. Because fishing was not solely an economic activity but also a way of life, changes in the fish production mode and in the role of fishing in the local economy and society also led to significant cha...
Introduction: Type 2 diabetes mellitus (T2) disproportionately affects ethnic minority population... more Introduction: Type 2 diabetes mellitus (T2) disproportionately affects ethnic minority populations, including Latinos of Mexican ethnicity. Proper management is essential to prevent serious health complications; however, little is known about the management practices and challenges faced by this Latino population shortly after diagnosis. This study examined the experiences of Mexican adults living in the U.S. managing and coping with T2 diabetes soon after diagnosis. Methods: A qualitative phenomenological study design was employed with 30 adults of Mexican ethnicity in Maricopa County, AZ, recently diagnosed with T2 diabetes (3-24 months). Individual, semi-structured interviews elicited information about their diabetes-related illness experiences; standardized questionnaires captured socio-economic and health status. Results: The mean age of participants was 47; the majority were female (73%), low income (70% < $20,000 annually), and uninsured (83%). Most had been born in Mexico...
Medical repatriations of undocumented and uninsured patients with chronic illnesses or catastroph... more Medical repatriations of undocumented and uninsured patients with chronic illnesses or catastrophic injuries initiated by American hospitals to Mexico have ramifications for patients and their families. Locating these patients after repatriation is challenging albeit critical to understanding this process and its impact. This report, part of a larger ongoing project, describes participant recruitment efforts with state actors and non-governmental organizations in Mexico that could have encounters with repatriated patients. Following purposeful snowball sampling, contact was established with 5 national NGOs offering migrant services, governmental migrant service offices and hospitals in six states (and DF). Over 5 months, informal interviews and correspondence with health professionals, NGOs, and governmental staff were recorded in field-notes. To map the social and bureaucratic landscape, data was analyzed qualitatively. Early findings suggest recruitment through governmental office...
Background: Parents' illness representations (IR) and asthma management strategies impact chi... more Background: Parents' illness representations (IR) and asthma management strategies impact children's health outcomes. IRs are critical in determining whether a parent follows through with the prescribed medication regimen; important when managing a chronic illness that might require lifetime medication use. Parents and healthcare providers (HCPs) think about asthma differently. Parents describe asthma as acute, not readily controllable, and view daily medication use negatively. These are commonly referred to as lay models of IR. Gaps exist in the evidence of ethnic differences in IRs and parents' treatment decisions. Methods: Purposeful sample of 20 Mexican mothers of children with asthma completed in-depth, semi-structured interviews. Recruited from two school-based health clinics in Phoenix, AZ. Interview guide assessed: asthma IRs, cultural beliefs/folk practices, asthma knowledge, impact of asthma, HCP relationship, and healthcare utilization. Results: Mothers did no...
Background: Complementary and alternative medicine (CAM) use in the U.S. has shown significant in... more Background: Complementary and alternative medicine (CAM) use in the U.S. has shown significant increase in recent years, particularly among individuals with chronic illnesses. Little research has been conducted on CAM use among children and adolescents with asthma. Many parents report using CAM as the first treatment for an asthma exacerbation. Studies show that the majority of parents do not disclose CAM use to their child's healthcare provider (HCP). HCPs need to know what CAM therapies are being used in asthma management so they can elicit information on CAM use during contacts with parents. They can then educate parents about the safety, advantages/disadvantages of individual CAM therapies, provide care which is sensitive to parents' ethnomedical beliefs, and improve adherence to the prescribed medication regimen. Purpose: Obtain perspective of Mexican mothers regarding their experience of living with a child with asthma, understanding of the nature of the disease, belie...
Journal of the National Medical Association, 2006
Promoting early interest in healthcare careers among youth from underserved areas is one promisin... more Promoting early interest in healthcare careers among youth from underserved areas is one promising strategy for addressing the health professional shortage in such communities, Most career choice studies try to predict outcomes using such traditional measures as grades and test scores, This study examines experiences influencing healthcare career interest among high-school students participating in health professions introductory programs in underserved communities. The opinions of parents and teachers regarding students' motivations are also considered. Seven focus groups (N=51) were conducted in one rural and two largely minority urban communities in New York State designated as health professional shortage areas. Qualitative data analysis involved a theory-driven, immersion and crystallization approach following the experiential learning model. Constructive experiences with the healthcare system, family role-modeling and support, interactive health-related school activities, ...
Journal of the National Medical Association, 2006
National asthma guidelines are often not translated into practice. Barriers to translation impact... more National asthma guidelines are often not translated into practice. Barriers to translation impactboth provider and patient adherence. This qualitative study describes how perceptions and experiences of patients with asthma or their caregivers affect disease management in a Puerto Rican community in Buffalo, NY. Two community-based asthma workshops following a focus group format were conducted with 22 Puerto Rican adults with asthma or who cared for asthmatic children. A bilingual-bicultural community moderator used a semistructured interview guide to foster discussion on asthma definitions, triggers, management, coping and concerns. Four analysts interpreted data transcripts following the grounded theory approach, identifying salient thematic categories. Multiple analysts and a postsearch for conflicting evidence support analytical trustworthiness. Perceptions of illness revealed concerns about the deceiving character and burden of asthma. Recognition of indoor household triggers un...
Family medicine, 1999
As medical education moves to community settings, the quality of learning is influenced by differ... more As medical education moves to community settings, the quality of learning is influenced by differences in the practice environment, organization, resources, patient case mix, and demographics. This ethnographic study identified experiences and processes that influence student learning in community-based practice settings. Trained field researchers conducted participant observation in eight community teaching sites. Data were analyzed using a qualitative, grounded theory approach. Three dominant themes emerged: 1) the preceptor's role in situating learning opportunities, 2) the learner's role in transforming experience into learning, and 3) the practice organization as a classroom setting. The findings highlight the importance of exploiting learning opportunities and the contributions of other medical staff and patients in facilitating unique learning experiences. This research suggests the need to move beyond the typical student ratings of teacher effectiveness to consider a...
Humanity & Society, 2009
Exposure to environmental hazards is hypothesized to play an important role in the development of... more Exposure to environmental hazards is hypothesized to play an important role in the development of autoimmune diseases such as lupus. The Buffalo Lupus Project examined the relationship between a high incidence of disease and exposure to a toxic waste site in a poor, urban minority neighborhood in Buffalo, New York, U.S.A. The purpose of this study is to explore patients&amp;amp;amp;amp;amp;#39;
PubMed, Feb 1, 1998
This study was undertaken to explore the prevalence of perceived dysphoria in a poor, urban, pred... more This study was undertaken to explore the prevalence of perceived dysphoria in a poor, urban, predominantly Puerto Rican community. A cross-sectional sample of 704 adult respondents were asked a single validated question, with a five-item Likert scale response, about their level of perceived dysphoria. Chi-squared analysis and Spearman's correlation coefficients were used to assess the association of level of dysphoria with social characteristics, barriers to health care, health status, and substance use. Linear regression modeling was used to control for confounding variables. Twenty percent of the respondents were dysphoric. Respondents with no health insurance or no source of health care were least likely to be dysphoric. Persons who perceived distance to the hospital and the doctor, and understanding language of the doctor and office staff as barriers to care were more likely to be dysphoric. Ethnicity was not correlated with level of perceived dysphoria; however, age, gender, and health status were found to be associated with level of dysphoria after controlling for other correlated variables. These results indicate that the psychological needs of communities need to be understood and interventions that are appropriate for the population need to be devised.
PubMed, 1998
The 1988 Upstate New York Live Birth Certificate was the first to record Hispanic ethnicity and c... more The 1988 Upstate New York Live Birth Certificate was the first to record Hispanic ethnicity and country of origin. This registry was used to compare low birthweight and preterm delivery among non-Hispanic white, non-Hispanic black, and Hispanic infants. Risk of low birthweight and preterm delivery was assessed for Hispanics by country of origin. Unconditional backward elimination logistic regression analysis, controlling for confounders was used to assess risk of low birthweight and preterm delivery of Hispanic subgroups compared to non-Hispanic white and non-Hispanic black mothers. The data showed that non-Hispanic black mothers are at greatest risk of low birthweight and preterm delivery. Hispanics as a group have rates similar to non-Hispanic white mothers, although risk of preterm delivery and low birthweight differs among Hispanic ethnic subgroups. This study supports the need to assess Hispanic subgroups separately rather than as a single entity.
Purpose: Geriatric patients face self-care and chronic illness management challenges. For Latinos... more Purpose: Geriatric patients face self-care and chronic illness management challenges. For Latinos responsive to values of familismo, close relatives are expected to be primary caregivers of the elderly. This study examines social support of Puerto Rican older adults with chronic illness. Method: A concurrent, mixed-methods approach (qualitative and quantitative) was employed with a consecutive sample of geriatric Puerto Rican patients with chronic illness attending an inner-city primary care clinic. Of 49 participants who completed the Instrumental Activities of Daily Living (IADL) assessment, the 40 who needed help with any IADL were probed with open-ended questioning to identify how they addressed IADL needs. Standardized questionnaires captured demographics, socio-economic status, and quality of life. Results: Mean age was 76 (5.3) years; 72% had annual household income of ≤ $15,000 and all had health care insurance (primarily Medicaid, Medicare). Eighty-percent communicated in E...
Journal of the American Geriatrics Society
Latino older adults in the United States have disproportionately high rates of chronic and disabl... more Latino older adults in the United States have disproportionately high rates of chronic and disabling medical conditions. Among Latinos, Puerto Ricans have a higher prevalence of several chronic medical conditions and higher rates of functional disability. Earlier studies documented that Puerto Rican older adults traditionally have relied mostly on family members for assistance with their functional needs, with low utilization of formal support services. However, little is recently known about their functional help needs and caregiving practices. This study examines independent living and caregiving practices among community-dwelling Puerto Rican older adults in Western New York using a mixed-methods approach with a sample of 49 patients attending an inner-city primary care clinic. Standard instruments captured socio-economic and health status and functional ability. Forty participants who needed help with any Instrumental Activities of Daily Living (IADL) were probed qualitatively f...
Journal of the American Geriatrics Society, 2013
Latino older adults in the United States have disproportionately high rates of chronic and disabl... more Latino older adults in the United States have disproportionately high rates of chronic and disabling medical conditions. Puerto Ricans have a higher prevalence of several chronic medical conditions and higher rates of functional disability than other Latinos. Earlier studies have documented that Puerto Rican older adults traditionally have relied mostly on family members for assistance with their functional needs, with low use of formal support services, but little is known about their functional help needs and caregiving practices. This study examined independent living and caregiving practices of community-dwelling Puerto Rican older adults in western New York using a mixedmethods approach with a sample of 49 individuals attending an inner-city primary care clinic. Standard instruments were used to obtain information on socioeconomic and health status and functional ability. Forty participants who needed help with any instrumental activities of daily living (IADLs) were probed qualitatively for how their needs were addressed. Participants averaged six chronic medical conditions, mean age was 76.2 AE 5.3, most reported annual household income of $15,000 or less and had low fluency in English, and all had healthcare insurance. For the most part, participants' children and spouses were primary caregivers, and few used formal support services. Nearly onethird reported having insufficient help. Qualitative findings elucidated how IADL needs were addressed. In this sample of indigent Puerto Rican older adults, most needed help with IADLs. Although family members most often helped, one-third had unmet or undermet needs. Linguistically and culturally congruent formal support services are still needed for Puerto Rican older adults and their family caregivers.
Journal of Asthma, 2015
Objective-Patients' cultural health beliefs and behaviors may conflict with biomedical healthcare... more Objective-Patients' cultural health beliefs and behaviors may conflict with biomedical healthcare values and practices potentially leading to non-adherence with asthma treatment regimens. To optimize shared decision-making, healthcare providers should understand and be sensitive to these cultural beliefs and behaviors and negotiate an asthma management plan acceptable to parents. The purpose of this study was to obtain the perspective of Mexican mothers regarding (1) their experiences of living with a child with asthma, (2) their understanding of the nature of asthma, and (3) how their cultural beliefs influence asthma management. Methods-A qualitative, phenomenological study design was employed to assess mothers' lived experiences with and perceptions of their child's asthma. Individual in-depth interviews were conducted with a purposeful sample of 20 Mexican mothers of children ages 5-17 years with asthma. An inductive, theory-driven, phenomenological analysis approach was used to elicit thematic findings. Results-Mothers expressed a symptomatic perception of asthma and limited understanding of the disease. Most believe the disease is present only when their child is symptomatic. Many are surprised and puzzled by the unpredictability of their child's asthma attacks, which they report as sometimes "silent". The inconsistency of triggers also leads to frustration and worry, which may reflect their concerns around daily controller medication use and preference for alternative illness management strategies.
ABSTRACT Medical repatriations of undocumented and uninsured patients with chronic illnesses or c... more ABSTRACT Medical repatriations of undocumented and uninsured patients with chronic illnesses or catastrophic injuries initiated by American hospitals to Mexico have ramifications for patients and their families. Locating these patients after repatriation is challenging albeit critical to understanding this process and its impact. This report, part of a larger ongoing project, describes participant recruitment efforts with state actors and non-governmental organizations in Mexico that could have encounters with repatriated patients. Following purposeful snowball sampling, contact was established with 5 national NGOs offering migrant services, governmental migrant service offices and hospitals in six states (and DF). Over 5 months, informal interviews and correspondence with health professionals, NGOs, and governmental staff were recorded in field-notes. To map the social and bureaucratic landscape, data was analyzed qualitatively. Early findings suggest recruitment through governmental offices and hospitals yield more participants (6 cases) compared to NGOs. Efforts with NGOs have yielded no participants. Government agencies encounter patients seeking assistance post-repatriation or when Mexican consulates aide with transit visas for patients facing repatriation. Recruitment challenges include little follow-up by American hospitals, no tracking by U.S. authorities, and no patient registry. To overcome challenges, affiliations with a university and NGO were leveraged. Few Mexican officials and healthcare professionals are knowledgeable of medical repatriations and have contact with patients pre/post-repatriation. Nescience of patients' repatriation histories may negatively affect treatment and wellbeing. American hospitals offer minimal coordination with Mexican institutions. Non-involvement by U.S. authorities to track repatriations hinders researchers and policy-makers in assessing the scope and impact of repatriations.
Disenfranchised ethnic minority communities in the urban United States experience a high burden o... more Disenfranchised ethnic minority communities in the urban United States experience a high burden of asthma. Conventional office-based patient education often is insufficient to pro- mote proper asthma management and coping practices responsive to minority patients' envi- ronments. This paper explores existing and alternative asthma information and education sources in three urban minority communities in western New York State to help
Family Medicine, Jun 1, 2008
BACKGROUND AND OBJECTIVES: Exposure to non-constructive criticism of medical specialties is belie... more BACKGROUND AND OBJECTIVES: Exposure to non-constructive criticism of medical specialties is believed to be fairly common among medical students. Better understanding of this "bashing" phenomenon is needed to promote greater professionalism in medical education and student interest in primary care careers. This study examines exposure and reactions to bashing among third-year medical students in a public university.METHODS: A survey assessing amount, sources, targets, and nature of perceived bashing was completed by 105 students. Three open-ended questions elicited students' experiences, opinions, and recommendations.RESULTS: Students perceived that bashing of other specialties occurred during all clerkships; the most were perceived during the surgery clerkship, for which 87.5% reported such bashing. Specialties perceived as the object of bashing were family medicine (72%), general internal medicine (40%), psychiatry (39%), and general surgery (36%). Sixty-seven percent of students reported personally receiving non-constructive criticism about their preferred specialty. Seventy-nine percent believed bashing was unprofessional behavior. Strategies suggested by respondents to decrease bashing included increasing awareness, highlighting the interdisciplinary nature of medicine, and evaluating professionalism.CONCLUSIONS: Medical students perceived bashing of medical specialties, recognized it as unprofessional behavior, and would be receptive to interventions to reduce bashing. Findings suggest a need to address bashing as part of professionalism curricula in medical training.
Social work
ABSTRACT In the course of investigating barriers to health care in Arizona for Latino families as... more ABSTRACT In the course of investigating barriers to health care in Arizona for Latino families as part of an MSW diversity class project, I happened upon a singularly daunting impediment to medical care: extralegal hospital deportations or the practice of returning uninsured, seriously injured or ill undocumented patients to their countries of origin. As a social work graduate student looking forward to a professional life centered in health care and immigration, learning of this practice was upsetting. This commentary brings some light to these interventions, which are privatized, lack state or federal policy guidance, and have far-reaching repercussions for undocumented patients and their families in Latino communities on both sides of the U.S. Southwest border. It also raises serious implications for social workers who must navigate institutional demands and clients’ rights when involved. There is a need for research and a heightened ethical awareness regarding the practice and consequences of hospital deportations, particularly when medical social workers and hospital caseworkers are charged with obtaining informed consent and facilitating the patient discharge process.
This study examines the problem of development and the transformation of Tamandaré, a coastal fis... more This study examines the problem of development and the transformation of Tamandaré, a coastal fishing district in the municipality of Rio Formoso, Pernambuco, Brazil. During the 1970s, many artisanal fishing communities throughout the Brazilian coast showed signs of profound changes in the economy, social organization and culture. A decade earlier, the federal government had launched a program to develop the country's fishing industry. Some communities also experienced the arrival of summer vacationers. By the early 1980s, artisanal fisheries experienced a decline in production, and were near demise. Motorboat fishing and land speculation prompted fishers to change or alternate fish production modes, change occupation or leave their villages to embark in industrial fishing ventures. Because fishing was not solely an economic activity but also a way of life, changes in the fish production mode and in the role of fishing in the local economy and society also led to significant cha...
Introduction: Type 2 diabetes mellitus (T2) disproportionately affects ethnic minority population... more Introduction: Type 2 diabetes mellitus (T2) disproportionately affects ethnic minority populations, including Latinos of Mexican ethnicity. Proper management is essential to prevent serious health complications; however, little is known about the management practices and challenges faced by this Latino population shortly after diagnosis. This study examined the experiences of Mexican adults living in the U.S. managing and coping with T2 diabetes soon after diagnosis. Methods: A qualitative phenomenological study design was employed with 30 adults of Mexican ethnicity in Maricopa County, AZ, recently diagnosed with T2 diabetes (3-24 months). Individual, semi-structured interviews elicited information about their diabetes-related illness experiences; standardized questionnaires captured socio-economic and health status. Results: The mean age of participants was 47; the majority were female (73%), low income (70% < $20,000 annually), and uninsured (83%). Most had been born in Mexico...
Medical repatriations of undocumented and uninsured patients with chronic illnesses or catastroph... more Medical repatriations of undocumented and uninsured patients with chronic illnesses or catastrophic injuries initiated by American hospitals to Mexico have ramifications for patients and their families. Locating these patients after repatriation is challenging albeit critical to understanding this process and its impact. This report, part of a larger ongoing project, describes participant recruitment efforts with state actors and non-governmental organizations in Mexico that could have encounters with repatriated patients. Following purposeful snowball sampling, contact was established with 5 national NGOs offering migrant services, governmental migrant service offices and hospitals in six states (and DF). Over 5 months, informal interviews and correspondence with health professionals, NGOs, and governmental staff were recorded in field-notes. To map the social and bureaucratic landscape, data was analyzed qualitatively. Early findings suggest recruitment through governmental office...
Background: Parents' illness representations (IR) and asthma management strategies impact chi... more Background: Parents' illness representations (IR) and asthma management strategies impact children's health outcomes. IRs are critical in determining whether a parent follows through with the prescribed medication regimen; important when managing a chronic illness that might require lifetime medication use. Parents and healthcare providers (HCPs) think about asthma differently. Parents describe asthma as acute, not readily controllable, and view daily medication use negatively. These are commonly referred to as lay models of IR. Gaps exist in the evidence of ethnic differences in IRs and parents' treatment decisions. Methods: Purposeful sample of 20 Mexican mothers of children with asthma completed in-depth, semi-structured interviews. Recruited from two school-based health clinics in Phoenix, AZ. Interview guide assessed: asthma IRs, cultural beliefs/folk practices, asthma knowledge, impact of asthma, HCP relationship, and healthcare utilization. Results: Mothers did no...
Background: Complementary and alternative medicine (CAM) use in the U.S. has shown significant in... more Background: Complementary and alternative medicine (CAM) use in the U.S. has shown significant increase in recent years, particularly among individuals with chronic illnesses. Little research has been conducted on CAM use among children and adolescents with asthma. Many parents report using CAM as the first treatment for an asthma exacerbation. Studies show that the majority of parents do not disclose CAM use to their child's healthcare provider (HCP). HCPs need to know what CAM therapies are being used in asthma management so they can elicit information on CAM use during contacts with parents. They can then educate parents about the safety, advantages/disadvantages of individual CAM therapies, provide care which is sensitive to parents' ethnomedical beliefs, and improve adherence to the prescribed medication regimen. Purpose: Obtain perspective of Mexican mothers regarding their experience of living with a child with asthma, understanding of the nature of the disease, belie...
Journal of the National Medical Association, 2006
Promoting early interest in healthcare careers among youth from underserved areas is one promisin... more Promoting early interest in healthcare careers among youth from underserved areas is one promising strategy for addressing the health professional shortage in such communities, Most career choice studies try to predict outcomes using such traditional measures as grades and test scores, This study examines experiences influencing healthcare career interest among high-school students participating in health professions introductory programs in underserved communities. The opinions of parents and teachers regarding students' motivations are also considered. Seven focus groups (N=51) were conducted in one rural and two largely minority urban communities in New York State designated as health professional shortage areas. Qualitative data analysis involved a theory-driven, immersion and crystallization approach following the experiential learning model. Constructive experiences with the healthcare system, family role-modeling and support, interactive health-related school activities, ...
Journal of the National Medical Association, 2006
National asthma guidelines are often not translated into practice. Barriers to translation impact... more National asthma guidelines are often not translated into practice. Barriers to translation impactboth provider and patient adherence. This qualitative study describes how perceptions and experiences of patients with asthma or their caregivers affect disease management in a Puerto Rican community in Buffalo, NY. Two community-based asthma workshops following a focus group format were conducted with 22 Puerto Rican adults with asthma or who cared for asthmatic children. A bilingual-bicultural community moderator used a semistructured interview guide to foster discussion on asthma definitions, triggers, management, coping and concerns. Four analysts interpreted data transcripts following the grounded theory approach, identifying salient thematic categories. Multiple analysts and a postsearch for conflicting evidence support analytical trustworthiness. Perceptions of illness revealed concerns about the deceiving character and burden of asthma. Recognition of indoor household triggers un...
Family medicine, 1999
As medical education moves to community settings, the quality of learning is influenced by differ... more As medical education moves to community settings, the quality of learning is influenced by differences in the practice environment, organization, resources, patient case mix, and demographics. This ethnographic study identified experiences and processes that influence student learning in community-based practice settings. Trained field researchers conducted participant observation in eight community teaching sites. Data were analyzed using a qualitative, grounded theory approach. Three dominant themes emerged: 1) the preceptor's role in situating learning opportunities, 2) the learner's role in transforming experience into learning, and 3) the practice organization as a classroom setting. The findings highlight the importance of exploiting learning opportunities and the contributions of other medical staff and patients in facilitating unique learning experiences. This research suggests the need to move beyond the typical student ratings of teacher effectiveness to consider a...
Humanity & Society, 2009
Exposure to environmental hazards is hypothesized to play an important role in the development of... more Exposure to environmental hazards is hypothesized to play an important role in the development of autoimmune diseases such as lupus. The Buffalo Lupus Project examined the relationship between a high incidence of disease and exposure to a toxic waste site in a poor, urban minority neighborhood in Buffalo, New York, U.S.A. The purpose of this study is to explore patients&amp;amp;amp;amp;amp;#39;