PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Cultural Competency”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 649 records · Page 36Linked to original sources

The importance of language and culture in pediatric care: case studies from the Latino community.

BACKGROUND: Few studies have examined culture's effect on pediatric care. OBJECTIVES: To analyze 3 cases illustrating the importance of culture in pediatrics. METHODS: Case analysis with a cultural competency model. RESULTS: No interpreter was available for the parents of a 3-year-old brought to the emergency department because of abdominal pain; she was discharged twice, returned with an acute abdomen, and was hospitalized for treatment of appendiceal rupture and peritonitis. A 2-year-old fractured her clavicle in a fall but was placed in social services' custody because of a pediatrician's misinterpretation. Parents of a ventilation-dependent 2-week-old with encephalopathy, seizures, and renal failure were unaware of the infant's poor prognosis, despite use of an interpreter. CONCLUSIONS: Culture can have a significant impact on pediatric care; use of a simple model can ensure that pediatricians provide culturally competent care.

Abdominal Pain↗

Female genital cutting: clinical and cultural guidelines.

Clinical guidelines for managing women who have undergone female genital cutting are essential in providing appropriate and culturally competent care. The objectives of this study were to review the literature, describe the types of female genital cutting, evaluate its immediate and long-term complications, and provide clinical guidelines for managing women who have undergone this procedure. We conducted an extensive literature search on the MEDLINE database (1966-2003) for articles pertaining to female circumcision/genital mutilation/cutting. The search was extended further by citations in these journals not identified in MEDLINE. National and international nongovernmental organizations provided articles not available in American libraries. The author has developed guidelines based on personal experience and recommendations from the literature. The major inclusion criteria limited the search to: 1) English language, 2) medical journals, 3) WHO publications, 4) medical society publications, 5) case studies and statistical data on medical complications, 6) infertility and sexual issues, 7) U.S. legal practice, and 8) deinfibulation. The exclusion criteria pertained to articles: 1) reviewing the literature, 2) lacking epidemiologic data, 3) addressing political and ethical issues, and 4) discussing international concerns. Immediate complications include hemorrhage, infection, urinary dysfunction, shock, or death. Long-term complications include urinary complications, scarring, pain, infection, and infertility. Obstetric complications include lacerations, wound infections, postpartum hemorrhage, and sepsis. Fetal complications are rarely seen in Western countries. Women who have undergone female genital cutting can experience complications. Practitioners must recognize the type of circumcision, ensure cultural competency, and provide appropriate clinical care.

Circumcision, Female↗

Improving access to and utilization of genetic services in Arizona's Hispanic population.

This abstract presents a model project aimed to train community lay health workers about genetics, increase cultural competency of genetic services providers, and provide local access to genetic services in primarily Hispanic communities in the state of Arizona. Health Start, a community-based prenatal outreach program, served as the basis for providing genetic education and services. A genetics training curriculum was developed and training of community lay health workers was provided. Cultural and Spanish language training was provided for all genetic services providers. Pediatric genetics outreach clinics were established in eight communities. Community-based lay health workers eagerly incorporate genetic information into their public health knowledge base, but this may not lead to acceptance of these personnel by local health care providers as sources of referrals for specialized health services such as genetics. Cultural competence training of genetic service providers is enthusiastically accepted and utilized in the provision of locally accessible genetics clinics.

Journal Article↗

Role of the electrochemical proton gradient in genetic transformation of Haemophilus influenzae.

The uptake of homologous DNA by Haemophilus influenzae was studied as a function of the proton motive force in completely competent cultures in the pH range of 6 to 8. The composition and magnitude of the proton motive force were varied by using the ionophores valinomycin and nigericin (in the presence of various potassium ion concentrations) and by using protonophores. No interaction of the ionophores with the DNA transformation system itself was observed. Either component of the proton motive force, the electrical potential or the pH gradient, can drive the uptake of DNA, and the extent of the uptake of DNA is ultimately determined by the total proton motive force. The transformation frequency increases with the proton motive force, which reaches a maximum value at around -130 mV. These results are consistent with an electrogenic proton-DNA symport mechanism, but direct evidence for such a system is not available. The proton motive force was followed during competence development of H. influenzae at pH 8. In the initial phase (up to 50 min), the proton motive force remained constant at about -90 mV, whereas the transformation frequency rose steeply. In the second phase, the proton motive force increased. The transformation frequency in this phase increased with the proton motive force, as in completely competent cultures. These observations and the observed inhibition by NAD of both the proton motive force and the transformation frequency indicate that structural components of the competent state are formed in the initial phase of competence development, whereas the second phase is characterized by an increase of the proton motive force.

Carbonyl Cyanide p-Trifluoromethoxyphenylhydrazone↗

A community approach to addressing excess breast and cervical cancer mortality among women of African descent in Boston.

In 2000, the REACH Boston 2010 Breast and Cervical Cancer Coalition conducted a community needs assessment and found several factors that may have contributed to disproportionately high breast and cervical cancer mortality among black women: (a) Focus group participants reported that many women in their communities had limited awareness about risk factors for cancer as well as about screening. (b) Black women experienced barriers to care related to the cultural competence of providers and of institutions. (c) Black women were not receiving adequate follow-up for abnormal mammograms and Pap smears. The Coalition's Community Action Plan to address disparities includes a model primary care service for black women; scholarships to increase the number of black mammogram technologists; primary care provider and radiology technologist training about disparities and cultural competence; and education to increase awareness among black women and to increase leadership and advocacy skills.

Adult↗

Transformation of group F streptococci by plasmid DNA.

When the Challis strain of Streptococcus sanguis was transformed by the 17 megadalton beta plasmid from Streptococcus faecalis strain DS5, the plasmid underwent a 1.5 megadalton deletion (LeBlanc & Hassell, 1976). Furthermore, the covalently closed circular (CCC) plasmid DNA isolated from Challis transformants was rapidly converted to a linear form which did not possess any detectable transforming activity. To obtain stable CCC plasmid DNA a competent culture of a Lancefield group F streptococcus, strain DL8 (ATCC 12393), was used as a recipient of beta plasmid DNA. The plasmid DNA isolated from group F transformants exhibited the same configuration and size characteristics as the DS5 beta plasmid, and the CCC configuration was stable upon storage. CCC plasmid DNA from a group F transformant was biologically active and, when added to competent cultures of strain DL8, transformed them at frequencies about 100-fold greater than did beta plasmid DNA from DS5. This suggests the existence of a restriction--modification system in strain DL8.

DNA, Circular↗

Implementing the Institute of Medicine's recommended curriculum content in schools of public health: a baseline assessment.

In September 2003, the Association of Schools of Public Health administered an online survey to representatives of all 33 accredited US schools of public health. The survey assessed the extent to which the schools were offering curriculum content in the 8 areas recommended by the Institute of Medicine: communication, community-based participatory research, cultural competence, ethics, genomics, global health, informatics, and law/policy. Findings indicated that, for the most part, schools of public health are offering content in these areas through many approaches and have incorporated various aspects of a broad-based ecological approach to public health education and training. The findings also suggested the possible need for greater content in genomics, informatics, community-based participatory research, and cultural competence.

Curriculum↗

Effectiveness of the New York State Office of Mental Health Core Curriculum: direct care staff training.

The purpose was to study the New York State Office of Mental Health's Core Curriculum training program. The 3-day program included recipient recovery principles, team training, cultural competence, clinical issues, and safety. Exit questionnaires were completed by 3,732 staff members. Additionally, samples of staff and recipients of inpatient care completed pre- and posttraining questionnaires and the Ward Atmosphere Scale. Staff sampled also completed the Work Environment Scale. The training was well attended and well received. There were statistically significant increases in communication and interaction, respect for recipients of inpatient care, and increases in cultural competence levels.

Adult↗

Plasma membrane transglutaminase and cornified envelope competence in cultured human keratinocytes.

When confluent cultures of the transformed human keratinocyte line SV-K14 are shifted to serum-free medium the cells achieve, within 4 days, the ability to synthesize a cornified envelope after challenge with the Ca2+ ionophore A23187. During these 4 days the enzyme transglutaminase (EC 2.3.2.13), which catalyses the cross-linking of different envelope precursor proteins, is partially transferred from the cytosolic pool into the plasma membrane. The association of the enzyme with the plasma membrane proves to be an essential step in the envelope formation since a direct correlation between plasma membrane-bound transglutaminase and envelope competence is observed. Retinoids block the insertion of the enzyme and therefore prevent envelope formation.

Acyltransferases↗

National-level capacity-building assistance model to enhance HIV prevention for Asian & Pacific Islander communities.

OBJECTIVES: Asian & Pacific Islander (A&PI) communities in the United States face increasing risk for HIV, yet have limited access to US culturally competent HIV prevention services. We describe a national HIV prevention capacity-building program for A&PI communities using a multitiered approach addressing systems, institutional, and individual level outcomes. METHODS: The program developed a national network of A&PI HIV and health-focused institutions, and conducts regional-level replication and dissemination of this model to support four areas of capacity building. This network is led by two national organizations coordinating the planning, implementation, and evaluation of the National Capacity-Building Assistance Program. RESULTS: Baseline data are compared with the last 2 years of preliminary data that show increased capacity among community-based organizations and health departments to strengthen culturally competent models of HIV prevention. Systems-level outcomes so far show enhanced leadership skills for HIV-related advocacy efforts, increased ability to leverage the media, and stronger partnerships between peer providers, health departments, and community leaders. CONCLUSION: This program model preliminarily demonstrates that national capacity-building initiatives can foster coalition development, replication of program models, materials sharing, and new leadership that improve HIV-related prevention services for A&PI communities.

Asian↗

Listening to the quiet voices of Hispanic migrant children about health.

There is a paucity of literature related to school-aged migrant children's perceptions of their own health. To best provide culturally competent care, more information is needed about migrant children's experiences. Focus-group methodology allowed the voices of migrant children to be heard by primary health care providers at a summer school program for children of migrant farm workers in south Georgia. Seventy-three children participated in 14 focus-group sessions. Six themes emerged from the data that were analyzed by using a qualitative software system. They are healthy behaviors, acculturation issues, environmental influences, health care actions, health behavior outcomes, and learning needs. Emerging patterns within each theme render insight about these migrant children. The findings suggest implications for pediatric nurses related to culturally competent care.

Acculturation↗

The evolution of the Fenway Community Health model.

Fenway Community Health was founded by community activists in 1971 in the Fenway neighborhood of Boston, Mass, and within a decade had rapidly expanded its medical services for gay men in response to the AIDS epidemic. Increased expertise and cultural competence in lesbian, gay, bisexual, and transgender (LGBT) care led to expansion of medical services to address broader community concerns, ranging from substance use to parenting issues to domestic and homophobic violence, as well as specialized programs for lesbians, bisexuals, and transgendered individuals. Fenway began as a grassroots neighborhood clinic. In 1975, the center recorded 5000 patient care visits; in 2000, Fenway's clinical departments recorded 50,850 visits by 8361 individuals, including more than 1100 individuals receiving HIV-associated care. The center now has more than 170 staff people responsible for clinical programs, community education, research, administration, planning, and development. Over the past few years, Fenway's annual budget has exceeded $10 million. Fenway has established standards for improved cultural competence about LGBT health issues for other health providers and has developed programs to educate the general community about specific LGBT health concerns. This health center may provide a model of comprehensive LGBT health services that have a local impact.

Acquired Immunodeficiency Syndrome↗

Mini-immersion in medical Spanish for family practice residents.

BACKGROUND: Residency programs vary widely in types of training to increase cultural competency and sensitivity. Moreover, few empirical studies exist regarding effectiveness of these experiences. The purpose of our study was to offer and evaluate a linguistic mini-immersion, !Español Rápido!, required of 8 new family practice interns during their orientation month at the University of North Carolina. DESCRIPTION: The curriculum was based on accelerative learning, a pedagogy that considers all parts of the brain, the paraconscious, and the role of the emotions. EVALUATION: Pretests and posttests and a postimmersion and 6-month follow-up evaluation indicated that the mini-immersion was successful. A simple t test for paired samples showed a significant improvement in interns' comprehension after the 6-day immersion, t(7)=11.399, p<.000. CONCLUSION: This brief experience should be viewed only as a first step in a long-term plan for a comprehensive curriculum to prepare family practice residents as culturally competent practitioners.

Family Practice↗

Ethnicity and diagnostic patterns in veterans with psychoses.

BACKGROUND: Differential diagnosis of schizophrenia and bipolar disorder is a challenging but important task. These conditions often exhibit overlapping clinical symptomatology, but have different prognoses and pharmacological management strategies. Factors other than clinical presentation may influence diagnosis. Past studies suggest that ethnicity is one such factor, with variations observed in diagnostic rates of serious mental illness (SMI). With increasing attention paid to provider cultural competency, we investigate current diagnostic practices within a veteran population. METHOD: Controlling for patient need characteristics and illness severity, we examine whether ethnic differences in diagnosis continue to exist. If so, race may adversely enter the evaluation process. A national database of all SMI veterans explores the relationship between ethnicity and diagnosis. The role of symptomatology is also examined. Given minimal variation in veteran socioeconomic status, the Department of Veterans Affairs (VA) provides a natural setting to address this confounding factor. The 1999 National Psychosis Registry provides a sample of 134,523 veterans diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. Multinomial logistic regression yielded odds ratios (OR) for being diagnosed with schizophrenia versus bipolar disorder; the schizoaffective versus bipolar risk was likewise assessed, exploring theoretical aspects of a psychosis-affective 'continuum'. RESULTS: Small effects were observed for being male, single or rural resident. However, the demographic characteristic most strongly associated with a schizophrenia diagnosis was race. The OR for African Americans was 4.05, and 3.15 for Hispanics. Similar though less dramatic results were revealed for schizoaffective disorder. CONCLUSIONS: This study confirms continued ethnic disparities in diagnostic patterns, and highlights the importance of recognizing ethnic differences in symptom presentation while emphasizing greater cultural competency.

Black or African American↗

Inherited retinal degeneration: basic FGF induces phagocytic competence in cultured RPE cells from RCS rats.

In RCS rats, the retinal pigment epithelium (RPE) is defective in phagocytosis of photoreceptor membranes. We have previously shown reduced expression of basic fibroblast growth factor (bFGF) in the RPE of 7-10-day-old RCS rats. This study using primary RPE cultures from rats of this age demonstrates that the phagocytic defect in the mutant RPE can be overcome by treatment with bFGF, by a mechanism involving gene transcription and that normal RPE phagocytosis, also requiring transcription, is blocked by a bFGF neutralizing antibody. The combined data point to a role for bFGF in the normal mechanism of RPE phagocytosis and the RCS defect.

Animals↗

Differential effects of octylphenol, 17beta-estradiol, endosulfan, or bisphenol A on the steroidogenic competence of cultured adult rat Leydig cells.

In the current studies, we evaluated the effects of 4-tert-octylphenol (OP), endosulfan, bisphenol A (BPA), and 17beta-estradiol on basal or hCG-stimulated testosterone formation by cultured Leydig cells from young adult male rats. Exposure of Leydig cells to increasing concentrations of OP (1 to 2000 nM), 17beta-estradiol (1 to 1000 nM), endosulfan (1 to 1000 nM) or BPA (1 to 1000 nM), alone or with 10 mIU/mL hCG for 4 or 24 h, did not lower ambient testosterone levels, although cells exposed to higher OP concentrations + hCG for 24 h often had modest declines in testosterone (10 to 20%). Of interest, exposure to the highest concentration OP (2000 nM) alone for 4 or 24 h increased testosterone levels (approximately 2-fold in 4-h exposed cells). Whether prior exposure to OP + hCG for 24 h affects the subsequent conversion of steroid substrates to testosterone over 4 h was evaluated. Progressive declines in 1 microM 22(R) hydroxycholesterol, 1 microM pregnenolone, or 1 microM progesterone conversion to testosterone was observed beginning at 100 to 500 nM OP exposure (maximal declines of 40 to 12% of controls were observed); however, the conversion of 1 microM androstenedione to testosterone was not affected by OP. These results suggested that 24-h exposure to OP + hCG has no effect on 17beta-hydroxysteroid dehydrogenase, which converts androstenedione to testosterone, but that it inhibits the 17alpha-hydroxylase/C17-20 lyase step, which converts progesterone to androstenedione. In addition, potentially, OP could inhibit cholesterol side/chain cleavage activity, which converts cholesterol to pregnenolone, and/or 3beta-hydroxysteroid dehydrogenase, which converts pregnenolone to progesterone. Of interest, exposure to increasing concentrations of 17beta-estradiol (1 to 1000 nM), endosulfan (1 to 1000 nM), or BPA (1 to 1000 nM) + hCG for 24 h had no effect on subsequent conversion of 22(R)hydroxycholesterol to testosterone. Furthermore, the inhibiting effects of OP + hCG exposure on subsequent conversion of progesterone to testosterone was unaffected by concomitant exposure to the pure estrogen antagonist, ICI 182,780, or the antioxidants, ascorbate or dimethyl sulfoxide, suggesting that the actions of OP are not mediated through binding to estrogen receptor alpha or beta or by free radical induced damage to steroidogenic enzymes, respectively. These results demonstrate that direct exposure of adult Leydig cells to OP may have subtle effects on their ability to produce testosterone, which may not be detected by measuring ambient androgen levels. In addition, the effects of OP on Leydig cell testosterone formation appear to be different from those of the native estrogen, 17beta-estradiol, and from other reported weak xenoestrogens such as endosulfan and BPA.

Androstenedione↗