Shahrzad Bazargan-Hejazi

Access to Vision Care in an Urban Low-Income Multiethnic Population

Objective: This study applied a well-known, recently revised theoretical model of healthcare access and utilization, the Behavioral Model for Vulnerable Populations, to examine the relationship between access to care and utilization of eye care services among a mutiethnic, predominately minority sample of residents from low-income public housing. Design: Population-based, cross-sectional survey of community sample. Setting: Urban Public Housing Communities in Los Angeles County, California. Participants: A geographically defined stratified random sample of 152 residents (86% Latino or African American) 40 years of age and older from three urban public housing communities. Results: Only 62% of our sample of persons 40 years and older had received an eye examination within the past 2 years. Sixty-one percent of participants reported having vision care coverage. Yet, one out of four respondents claimed that no health care provider had ever told them that they needed an eye-examination. Applying multiple logistic regression and controlling for a number of predisposing, enabling, and need-for-care characteristics, the variables 1) receiving advice from health care providers for eye examination (OR = 3.9, p < 0.01), 2) possessing coverage for eye-care (OR = 3.2, p < 0.01), and 3) having regular and continuity of medical care (OR = 2.4, p < 0.01) remained significant predictors of eye-examination within the past 2 years. Conclusion: This study documents significantly diminished utilization of eye care services relative to recommended guidelines for a low-income, predominately minority sample of residents from public housing communities. We documented no association between presence of diabetes or hypertension and recency of eye examination. Affordability, continuity, and regular sources of care, as well as receiving physician advice, remain the core factors significantly associated with receiving vision care. These results underscore the need for continued efforts to ensure that the medically underserved minority have access to vision care services. These findings also point toward the urgent need for educational and motivational interventions that encourage health care providers serving underserved communities to promote eye examination, particularly among diabetic patients, hypertensive patients, and other individuals at risk for eye-related disease and complications.

Preventive, Lifestyle, and Personal Health Behaviors among Physicians.

ObjectiveThis study examines personal health behaviors and wellness, health-related lifestyles, and prevention screening practices among licensed physicians.MethodsAn anonymous questionnaire was mailed to a random sample of 1,875 physicians practicing in California. Data from 763 returned questionnaires (41%) were analyzed.ResultsOur data show that 7% of this sample were clinically depressed, 13% reported using sedatives or tranquilizers, over 53% reported severe to moderate stress, and only 38% described their level of daily stress as slight. About 4% self-reported recent marijuana use. More than 6% screened positive for alcohol abuse and 5% for gambling problems. Thirty-five percent of participants reported “no” or “occasional” exercise. About 27% self-reported “never” or “occasionally” eating breakfast. In addition, 34% reported 6 or fewer hours of sleep daily, while 21% self-reported working more than 60 hours per week. Physicians’ excessive number of work hours (more than 65 hours per week) was associated with lack of exercise, not eating breakfast, and sleeping fewer than 6 hours per night. California physicians report breast, cervical, colorectal, and prostate cancer screening behaviors that exceeded population estimates in California and Healthy People 2010 national goals.ConclusionAdditional interventions designed to improve physicians’ lifestyles and personal health behaviors should be encouraged. A focus on creating healthy lifestyles will benefit physicians as much as the general population.

Intravesical Electromotive Botulinum Toxin Type A Administration—Part II: Clinical Application

OBJECTIVES To assess the effect of electromotive botulinum toxin type A administration on urodynamic variables, urinary/fecal incontinence, and vesicoureteral reflux (VUR) due to refractory neurogenic detrusor overactivity in children with myelomeningocele. METHODS A total of 15 children (mean age 7.8 years) were included. Using a specially designed catheter, 10 IU/kg of electromotive botulinum toxin type A was inserted into the distended bladder. While connected to the indwelling catheter and 2 dispersive pads, a pulsed current generator delivered 10 mA for 15 minutes. The urodynamic parameters, including reflex volume, maximal bladder capacity, maximal detrusor pressure, and end-fill pressure, and the urinary/fecal incontinence status and VUR grade were evaluated before and at 1, 4, and 9 months after treatment. RESULTS The mean reflex volume and maximal bladder capacity had increased considerably (99 ± 35 mL versus 216 ± 35 mL and 121 ± 39 mL versus 262 ± 41 mL, respectively; P < .001). In contrast, the mean maximal detrusor pressure and end-fill pressure had significantly decreased (75 ± 16 cm H(2)O versus 39 ± 10 cm H(2)O and 22 ± 7 cm H(2)O versus 13 ± 2 cm H(2)O) after treatment. The difference was statistically significant (P < .001). Urinary incontinence improved in 12 patients (80%). The VUR grade substantially decreased in 7 of the 12 children (mean VUR grade 2.25 ± 1.3 versus 1.37 ± 0.7; P = .001), and none of the children required surgical intervention. Fecal incontinence was alleviated in 10 (83.3%) of the 12 children. Skin erythema and burning sensation were observed in 6 children. CONCLUSIONS The results of our study have shown that electromotive botulinum toxin type A administration is a feasible and safe method with no need for anesthesia. This novel delivery system resulted in considerable improvement in the urodynamic parameters, urinary/fecal incontinence, and VUR in patients with refractory neurogenic detrusor overactivity.

Treatment of self-reported depression among Hispanics and African Americans

This study applied the Behavioral Model for Vulnerable Populations framework to examine the correlates of depression and the receipt of medical treatment among low-income Hispanics and African Americans residing in public housing. We compared three groups: those who reported (1) self-diagnosed but without physician-diagnosed depression, (2) depression diagnosed by a physician but who did not receive pharmaceutical treatment, and (3) depression diagnosed by a physician and antidepressant pharmacotherapy consumed by patient. Random samples of 287 adults from three public housing communities were surveyed. Over 48% of this sample reported that they were suffering from depression. One out of three people who reported being depressed also said that a physician had never diagnosed his or her condition. Only 40% of those who said that a physician had diagnosed depression also reported taking antidepressant medication. Untreated depression among underserved racial and ethnic minorities is alarming and points to an urgent need for intervention.

Patterns of Intimate Partner Violence: a study of female victims in Malawi

Abstract: Background: The term “intimate partner violence” (IPV) encompasses physical, sexual and psychological violence, or any combination of these acts, and globally is the most common type of violence against women. This study aims to examine the lifetime prevalence of different types of intimate partner violence (IPV) among Malawi women ages 15 to 49, and its association with age, education, and living in rural versus urban areas. Methods: Data was obtained from a cross-sectional study of data as part of the 2004 Malawi Demographic and Health Survey. Women were eligible for the study if they met the following criteria: 1) lived in one of the 15,041 households randomly selected from 522 rural and urban clusters located in 10 large districts of Malawi; 2) were married or cohabitating; and 3) were between the ages of 15 and 49 years. Consenting, eligible women responded to a comprehensive questionnaire covering demographic factors, health issues, as well as items related to physical, emotional and sexual IPV. To assess bivariate associations, chi-squared tests and multivariate logistic regressions were conducted. Results: Among the 8291 respondents, 13% reported emotional violence; 20% reported being pushed, shaken, slapped or punched; 3% reported experiencing severe violence, such as being strangled or burned, threatened with a knife, gun or with another weapon; and 13% reported sexual violence. Data showed women ages 15 to 19 were significantly less likely to report emotional IPV, women ages 25 to 29 were significantly more likely to report being pushed or shaken, slapped or punched (OR 1.35; CI: 1.05-1.73), and women ages 30 to 34 were significantly more likely to report sexual IPV, compared to women ages 45 to 49 (OR 1.40; CI: 1.03-1.90). Finally, women who had no ability to read were less likely to report sexual IPV than their counterparts who could read a full sentence (OR 0.76; CI: 0.66-0.87). Conclusions: The prevalence of different types of IPV in Malawi appears slightly lower than that reported for other countries in sub-Saharan Africa. Further studies are needed to assess the attitudes and behaviors of Malawi women towards acceptability and justification of IPV as well as their willingness to disclose it.

The Immigrant and Hispanic Paradoxes: A Systematic Review of Their Predictions and Effects.

A survey of the literature indicates that reported advantages of the Immigrant and Hispanic Paradox are inconsistent and equivocal. The healthy migrant hypothesis also suggests that current research approaches consider only “healthy” groups. Other methodological concerns include the simple underreporting of deaths, and that commonly used databases may not include all significant attributes and characteristics. We conducted a systematic review, synthesizing and identifying themes not explicitly found in the current literature. We also employ a simple quantitative index to assess the scholarly strength of references. Paradox protection appears uneven and is not generalizable across races, ethnicities, age groups and genders. In addition, acculturation, health behaviors and diet, ethnicity, acculturative stress, adolescence, undocumented and uninsured status, age of arrival in the United States and length of exposure, gender and age appear to be significant in predicting any beneficial effects.

Psychiatric Disorders (Axis I and Axis II) and Self‐Immolation: A Case–Control Study from Iran*

Abstract:  The objective of this study was to investigate preexisting psychiatric disorders in self‐immolation patients. In a case–control study, 30 consecutive cases of deliberate self‐inflicted burns, admitted to the regional burn center, were compared with 30 controls. Mental disorders were assessed via detailed clinical interview. Descriptive data revealed that 67% of self‐immolation patients had adjustment disorder (all female), 10% drug and alcohol abuse/dependence (all male), 7% dysthymia, 3% major depression, 3% anorexia nervosa, 3% primary insomnia, 7% borderline personality disorder (50% male), 7% depressive personality disorder (100% female), and 3% antisocial personality disorder. In bivariate comparisons, adjustment disorders emerged as related to risk of self‐immolation (odds ratio = 13.00). This study suggests that adjustment disorder is a risk factor for self‐immolation. As a result, it has been suggested that increasing education about problem‐solving approaches, and coping skills for females and at‐risk groups are appropriate prevention programs and strategies in Iranian communities.

The frequency and predictors of helmet use among Iranian motorcyclists: A quantitative and qualitative study

OBJECTIVE This study examines the rate of helmet use and identifies barriers and facilitators of wearing helmets among Iranian motorcyclists. A mixed-method approach was used, including a structured seasonal survey with specific observations of a random sample of 6010 riders and qualitative methods that included 29 in-depth interviews and seven focus groups (n=31). RESULTS Only 10% of motorcyclists wear a standard helmet while riding. However, another 23% of motorcyclists used non-standard or partial helmets that covered only part of the head and do not prevent head trauma injuries effectively. We observed only 2 of 264 child passengers and 22 of 1951 adult passengers wearing helmets. Almost no one used protective pants or clothing made to be more visible in traffic. Themes emerged from qualitative interviews and were grouped into three main categories: (1) helmet characteristics; (2) social and cultural factors; and (3) personal and psychological factors. CONCLUSION Overall, the motorcyclists in our study believed that wearing a safety helmet protects them against serious injuries or death during a crash; however, only a small percentage of the motorcyclists used safety helmets. National intervention programs addressing motorcycle safety should aim to overcome barriers to and promote facilitators of helmet use, including providing inexpensive standard helmets, banning manufacturing/using unsafe partial or dummy helmets, as well as enforcing helmet use on a consistent basis.

Using the Information-Motivation Behavioral Model to Predict Sexual Behavior among Underserved Minority Youth.

BACKGROUND Testing, refining, and tailoring theoretical approaches that are hypothesized to reduce sexual risk behaviors among adolescent subpopulations is an important task. Relatively little is known about the relationship between components of the information-motivation-behavior (IMB) model and sexual behaviors among underage minority youth. Using the IMB model, this study examines predictors of risky sexual behavior among underserved Hispanic and African-American youth. METHODS This cross-sectional study was conducted with a sample of 380 youths aged 11-17 years recruited in Los Angeles, California, and utilized latent variable models to examine interrelationships and predictive relations among IMB model variables associated with risky sexual behavior. RESULTS Sixty percent of the participants aged 15-17 and 1 out of 10 participants aged 11-12 reported prior sexual intercourse. Of the sexually active, more than half reported having unprotected sex and 11% had sexual intercourse with 4 or more partners. Results of the structural equation model indicated that older age and attitudes against sexual activities had significant, direct impacts on risky sexual behaviors. Behavioral refusal skills, positioned as an intervening variable, also significantly predicted less risky sex. Knowledge, attitudes against sexual activities, and perceived peer pressure against sexual behavior predicted sexual refusal skills. Additionally, there were significant indirect effects on risky sexual behavior mediated through behavioral refusal skills. CONCLUSION A large number of disadvantaged minority urban youth are engaged in risky sexual behaviors. Intervention programs, particularly those targeting preadolescents, should focus on building long-lasting behavioral skills that emphasize the reduction of peer pressure and normative influences on risky sexual behaviors. Components of the IMB model clearly have a role in the design of efficacious interventions.

Correlates of complementary and alternative medicine utilization in depressed, underserved african american and Hispanic patients in primary care settings.

OBJECTIVES This study seeks to examine the correlates of complementary and alternative medicine (CAM) use in depressed underserved minority populations receiving medical care in primary care settings. METHODS A prospective study using interviewer-administered surveys and medical record reviews was conducted at 2 large outpatient primary care clinics providing care primarily to underserved African American and Hispanic individuals located in Los Angeles, California. A total of 2321 patients were screened for depression. Of these, 315 met the Patient Health Questionnaire-9 criteria for mild to severe depression. RESULTS Over 57% of the sample reported using CAM sometimes or often (24%) and frequently (33%) for treatment of their depressive symptoms. Controlling for demographic characteristics, lack of health care coverage remained one of the strongest predictors of CAM use. Additionally, being moderately depressed, using psychotherapeutic prescription medications, and poorer self-reported health status were all associated with increased frequency of CAM utilization for treating depression. CONCLUSIONS The underserved African American and Hispanic individuals meeting the diagnostic criteria for depression or subsyndromal depression use CAM extensively for symptoms of depression. CAM is used as a substitute for conventional care when access to care is not available or limited. Since CAM is used so extensively for depression, understanding domains, types, and correlates of such use is imperative. This knowledge could be used to design interventions aimed at improving care for depression.