Biomedical subjects

Howard Waitzkin

Publications and source records attributed to Howard Waitzkin.

21 records · Page 2Linked to original sources

PubMedDate not supplied

PTSD and somatization in women treated at a VA primary care clinic.

The authors examined the association between trauma, posttraumatic stress disorder (PTSD), and somatization in 264 women attending a Department of Veterans Affairs primary care clinic. Using a structured computerized interview (Composite International Diagnostic Interview), they found that traumatic events were reported by 81% of the women. The lifetime prevalence of PTSD was 27%; for somatization it was 19%. PTSD was the best predictor of somatization after control for demographic variables, veteran status, and other mood and anxiety disorders. Psychological numbing symptoms of PTSD emerged as a particularly strong predictor of somatization. The link between PTSD and somatization deserves further study.

Adult↗

PubMedDate not supplied

Immunization coverage and Medicaid managed care in New Mexico: a multimethod assessment.

BACKGROUND: We wanted to examine the association between Medicaid managed care (MMC) and changing immunization coverage in New Mexico, a predominantly rural, poor, and multiethnic state. METHODS: As part of a multimethod assessment of MMC, we studied trends in quantitative data from the National Immunization Survey (NIS) using temporal plots, Fisher's exact test, and the Cochran-Armitage trend test. To help explain changes in immunization rates in relation to MMC, we analyzed qualitative data gathered through ethnographic observations at safety net institutions: income support (welfare) offices, community health centers, hospital emergency departments, private physicians' offices, mental health institutions, managed care organizations, and agencies of state government. RESULTS: Immunization coverage decreased significantly after implementation of MMC, from 80% in 1996 to 73% in 2001 for the 4:3:1 vaccination series (Fisher's exact test, P = .031). New Mexico dropped in rank among states from 30th for this vaccination series in 1996 to 50th in 2001. A significant decreasing trend (Cochran-Armitage P = .025) in coverage occurred between 1996 and 2001. Findings from the ethnographic study revealed conditions that might have contributed to decreased immunization coverage: (1) reduced funding for immunizations at public health clinics, and difficulties in gaining access to MMC providers; (2) informal referrals from managed care organizations and contracting physicians to community health centers and state-run public health clinics; and (3) increased workloads and delays at community health centers, linked partly to these informal referrals for immunizations. CONCLUSIONS: Medicaid reform in New Mexico did not improve immunization coverage, which declined significantly to among the lowest in the nation. Reduced funding for public health clinics and informal referrals may have contributed to this decline. These observations show how unanticipated and adverse consequences can result from policy interventions in complex insurance systems.

Anthropology, Cultural↗

PubMedDate not supplied

Mental health research in primary care: mandates from a community advisory board.

PURPOSE: We wanted to obtain the viewpoints of a community advisory board in training junior minority faculty members and graduate students for community-based participatory research (CBPR) on mental health in primary care. METHODS: During training institutes, members of a community advisory board presented plenary sessions on research collaboration with communities. The program director edited the transcribed recordings of the presentations for style but not for content. Advisory board members collaborated in revising the transcripts and summarizing themes. RESULTS: Board members expressed several key themes. Research must take into account traditional healing practices and prior exploitative research. Historical trauma impedes collaborations, which require conflict resolution and departure from traditional definitions of normalcy. Researchers should include communities in formulating research agendas and should take findings back to the communities for critical appraisal and practical applications. Collaborations should address policy issues including interpreter services, Medicaid managed care, and parity in insurance coverage for physical and mental health problems. CONCLUSIONS: Community advisory board members present key concerns that otherwise would not enter into the researchers' training curriculum. Such an advisory board can make important contributions to programs that seek to improve CBPR in mental health and primary care.

Advisory Committees↗