• Barriers to Providing And Receiving Adequate Services for Latinos in a New Immigrant Settlement Destination

      Goodman, Marci; Maskell, Erin; Negi, Nalini (2015-03-09)
      AIMS 1. Explore social service providers' experiences serving Latinos in the social and cultural context of Baltimore. 2. Identify service gaps in social service provision for Latino Immigrants in Baltimore BACKGROUND INFORMATION Baltimore is a new immigrant settlement destination. Latinos are the fastest rising ethnic group in Baltimore with census data indicating a doubling of the population from 11,061 in 2000 to 25,960 in 2011. While social service delivery is highly critical in the maintenance of the health of vulnerable populations, little is known about the context of social services in new immigrant settlement destinations. METHODS Social service providers who work with Latino immigrant clients were recruited using purposive theoretical sampling. In--depth qualitative interviews were then conducted and audio recorded and later transcribed. DISCUSSION AND IMPLICATIONS FOR PRACTICE Providers are stretched very thin, as few providers work with limited resources to provide support for a growing number of Latinos: Participants rely on networking and collaboration for strength; Participants report feeling a "sense of duty" to serve the Latino community. More support is needed: Recruitment, training, and retention of Spanish speakers in various health science and service oriented programs is crucial; A focus on curriculum development is needed to better prepare future providers for culturally sensitive practice with Latino immigrants. Continued outreach by Baltimore City: This will help to develop trust with the Latino immigrant community.
    • Exploration of Coping Strategies in Older, Community Dwelling, HIV Positive Individuals in Baltimore

      DeGrezia, Mary G.; Kauffman, Karen (2012)
      Background: The CDC reports that by 2015 50% of HIV-positive individuals in the U.S. will be at least 50 years old. Individuals with HIV develop more comorbid health conditions at an earlier age than those without HIV. Older adults with HIV are a sizeable, growing population. However, published qualitative data on how older adults cope with HIV, comorbid conditions, and related stressors are extremely limited. Objectives: The purpose of this exploratory study was to identify comorbid conditions and other related stressors experienced by HIV-positive community-dwelling older adults in Baltimore and to understand how they cope. Methods: Forty HIV-positive individuals aged 50 and older (range 50-69 years; male, N=17, mean age 55; female, N=23, mean age 56) affiliated with at least one of two Baltimore-based HIV support groups with older adult members were recruited via purposeful sampling and interviewed to the point of data saturation. Data were analyzed using an interpretive hermeneutic methodology and qualitative content analysis. Results: Participants experienced one or more comorbid condition (range 1-18; male mean = 7; female mean = 6). The most frequently reported comorbid conditions for both genders were hypertension 48%, depression 43%, hypercholesterolemia 38%, memory difficulties 35%, Hepatitis C 34%, and anxiety 33%. Related stressors included HIV-related fear, perceived and actual stigma, multiple medications to treat comorbid conditions, and financial concerns. Participants learned to cope with stressors by accessing support, helping selves and helping others, and tapping into one's own spirituality. Employing these strategies helped participants cope, develop hope, and work toward psychological well-being. Conclusions: Participants employed active and meaning-based coping strategies to engage in life despite HIV, comorbid conditions, and related stressors. Findings are significant because this study is among the first to give voice to older HIV-positive community dwelling individuals in Baltimore about how they cope with HIV, comorbidities, and related stressors. Nurses' increased understanding of the impact of HIV, comorbidities, and related stressors in HIV-positive older adults along with knowledge of their active and meaning-based coping strategies can lead to holistic patient care with interventions encouraging hope and psychological well-being.
    • Family analysis of sudden infant death syndrome: Genetic, clinical and epidemiologic risk factors

      Stick, Melissa Jane; Boughman, Joann A. (1993)
      Sudden Infant Death Syndrome (SIDS) is the leading cause of infant death between one month and one year of age. Epidemiological studies have suggested that SIDS is not a single entity, but a heterogeneous group of conditions in which some of the deaths may be preventable through increased awareness of signs indicating a vulnerable infant. The "birth score" approach, developed in England, prospectively attempts to identify newborns at risk for adverse outcome. The current retrospective study was designed to investigate the etiologic effects of environmental, cultural or genetic mechanisms on the occurrence of SIDS. Participating families provided information, via a questionnaire, regarding the pregnancy, medical and family histories for the SIDS infant. The analyses compared these data on SIDS infants with and without a positive family history of SIDS in a 1{dollar}\sp{lcub}\rm st{rcub}{dollar} or 2{dollar}\sp{lcub}\rm nd{rcub}{dollar} degree relative and among cases from different geographic regions. Genetic studies consisted of both nuclear family and complex segregation analyses. Evaluation of "birth scoring" was performed on two cohorts of children who were selected from hospital records at the University of Maryland using established birth score parameters. Analyses comparing various factors between SIDS infants based on their family history and among geographic regions revealed no significant associations. Nuclear family segregation analysis indicated that a recessive hypothesis could not be rejected as a possible explanation for approximately 2.5% of SIDS deaths occurring in this sample population. Complex segregation analysis suggested that familial SIDS was best explained by a recessive model in which p was fixed at 0.0001, there was no ascertainment correction, sex was included as a covariate and the transmission parameters were non-Mendelian. The birth score approach, based on the specific parameters used, was not as effective in identifying at-risk infants in the Baltimore population as elsewhere.;Results of this study indicate that: (1) SIDS has a measurable familial component and (2) "birth scores" need unique modification reflecting the specific population being assessed.
    • Health care utilization by children entering foster care: Factors associated with provider-initiated health referral and referral completion

      Risley-Curtiss, Christina; Combs-Orme, Terri (1993)
      Because of the events that precipitate entry into foster care, of social characteristics, and of the trauma associated with placement, foster children represent one of America's most vulnerable groups in terms of their health needs. Unfortunately, prior research has demonstrated that the probability of the health needs of these children being met is poor. Additionally, the Maryland Department of Human Resources has been sued for, among other things, failure to provide adequate health care to foster children. The resulting consent decree requires that children entering foster care receive a health assessment within five days of entry and a more comprehensive assessment after 30 days. The primary purpose of this study was to determine the ability of selected factors to explain (1) provider-initiated health referrals, and (2) the completion of those referrals for a cohort of children entering foster care in Baltimore. Multivariate analyses techniques were used with data from nonprobability samples of 1910 children entering care (#1) and 262 children in care for at least 30 days (#2). Consistent with previous studies, this study found that the sample children had multiple health problems. More than 70% of the children had 2 or more problems and 98.4% had at least one referral for additional services. Moreover, the children continue to have unmet health needs with only 45% of non-routine referrals completed during the study period. Age, race, sexual abuse, number of mental health problems, number of physical health problems and sexual activity explained 39% of the variance in number of referrals while age and completion time explained 9% of the variance in referral completion. Age was the best predictor of both number of referrals and referral completion. Age and number of mental health problems predicted type of referral (dental, medical or mental health). This study demonstrates that despite a lawsuit and new health project, foster children are still not getting their health needs met. It is critical that child welfare personnel recognize the need for comprehensive health care for foster children. More research in health care utilization by foster children is needed; this study demonstrates the applicability of the Aday/Andersen model of health utilization and multivariate analysis techniques to that study.
    • Racism, place, and health of urban black elders

      Ryder, Priscilla Tankersley; Gruber-Baldini, Ann L. (2007)
      It has been found that older African Americans have more co-morbidity and lower physical function than European Americans of similar ages. They are also more likely to have been exposed to a lifetime of unfair race-based treatment, and to live in deprived neighborhoods. This investigation examines self-rated health (SRH) of urban African American elders using their reactions to unfair treatment and neighborhood health effects as study variables. Ninety-five community-dwelling, English-speaking, self-identified African Americans ages 60 years and older were recruited from neighborhoods in western Baltimore, using random digit dialing (RDD) and community outreach. Participants were largely poor, high comorbidity, reporting an average of six out of 25 diagnoses, but with high function and high health optimism. A majority (69.5%) reported a history of unfair race-based treatment, most frequently at work (43.0%) or while shopping (40.4%). Forty-four (46.3%) were classified as having an active response to unfair treatment (confronting the person who was treating him/her unfairly), and 17 (17.6%) as denying unfair treatment (reported never thinking of own race in the previous year and not ever experiencing discrimination). SRH was not related to any reaction-to-unfair treatment variable. In two-way analysis using chi2 and t-tests, higher SRH was associated with older age, frequent church attendance, fewer annual health care visits, higher life satisfaction, reporting fewer diagnoses, less bodily pain and depression, higher physical or social function and vitality, and less food insufficiency. In the best individual-level logistic regression model, higher SRH was significantly associated with lower modified CES-D scores (OR=0.89, 95% CI 0.83, 0.95), higher age in years (OR=1.01, 95% CI 1.01, 1.19), male gender (OR=0.24, 95% CI 0.06, 0.95), and more healthcare visits (OR=0.92, 95% CI 0.85, 0.99), adjusting for bodily pain. Although neighborhood deprivation was significantly associated with SRH (OR=0.987, 95% CI 0.978, 0.997), its effect was attenuated when individual-level factors were included in a multilevel logistic regression model. We were unable to demonstrate independent neighborhood health effects; it is likely that neighborhood effects are mediated indirectly through other SRH determinants (e.g., depression, bodily pain). Null results may be due to the small number of participants that were recruited.