Obstetrician-Gynecologists’ Knowledge of Health Disparities and Barriers among American Indian/Alaska Native Women in Washington State

Background: Health disparities between American Indian/Alaska Native (AI/AN) women and other races/ethnicities have long been noted. Obstetricians-Gynecologists (Ob-Gyn) play a significant role in well-woman care and are often the first and most frequent point of medical contact for women, particularly among minority and low-income women. Objective: This study aimed to assess Ob-Gyns’ knowledge, beliefs, and practices related to health disparities among AI/AN women. Method: A self-administered questionnaire, consisting of questions about knowledge, beliefs, and practices of health disparities among AI/AN women, was mailed to 722 members of The American College of Obstetricians and Gynecologists (ACOG) practicing in the state of Washington in September 2013-February 2014. Results: The majority of respondents were knowledgeable about numerous health care disparities among non-pregnant AI/AN women, while slightly fewer were aware of disparities among pregnant AI/AN patients. Ob-Gyns reported low confidence in their training and knowledge of AI/AN culture and health disparities, but high confidence in their ability to treat AI/AN patients. Participants reported dissatisfaction with their AI/AN patients’ breastfeeding rates. Conclusion: Ob-Gyn knowledge of health disparities among AI/AN women is adequate. In spite of this, barriers to quality care are still present and increased identification and implementation of effective resources is needed

Ethical Decision Making: The Lived Experiences of African American Women Leaders in Western Kentucky

The purpose of the phenomenological qualitative study was to determine the way in which 10 African American women leaders in organizations in Western Kentucky made difficult decisions based on their ethical values. African American. The constructs reviewed in the study include ethics, decision making, leadership, and African American women. Empirical Phenomenology was used as the methodological approach for this qualitative study in order to understand the lived experiences that shaped the ethical values in the workplaces among the women. According to the findings, the seven overarching themes that emerged from the participant narratives are: (1) professing Christian, (2) ethical foundation from parents and/or grandparents, (3) mentorship, (4) values have not changed throughout career, (5) must prove myself as an African American, (6) must work harder than White workers, and (7) few or no other minorities in leadership in my agency. Due to the limited research available regarding American women, recommendations are made for further research on various topics regarding African American women, as well as women from other ethnic groups

Multi-Level Evaluation of a Perinatal Health Program in Rural Southeast Georgia

Problem: Infant mortality has declined steadily in the past decade, however, significant disparities associate with lack of adequate perinatal health services and barriers to access disproportionately impact women residing in rural areas. In Georgia, data suggest significant challenges with respect to birth outcomes, and this problem seems to be exacerbated in rural regions of state. The objective of this presentation is to report on the impact of a regional perinatal health care collaborative implemented in rural southeast Georgia. Method: Analysis of pre-intervention and post-intervention birth outcomes (gestational age, birth weight and infant mortality) served as the focal point programmatic evaluation. Differences in mean gestational age and mean birth weight were analyzed using a t-test (α = 0.05). Proportional differences in low birth weight and infant mortality were assessed using the chi-square test (α = 0.05). Differences were investigated relative to race (white and nonwhite). Results: Analysis of white participants showed no significant difference in any birth outcomes investigated. Furthermore, analysis of non-white PHP participants suggested significant improvements in all birth weight (p \u3c 0.001), gestational age (p = 0.007), low birth weight (p = 0.002), and infant mortality (p = 0.007). Conclusion: The perinatal health program in southeast Georgia demonstrated considerable effectiveness as measured through pre-intervention and post-intervention birth outcomes. The potential for improved health outcomes of high risk pregnant women and infants as a result of adequate perinatal care may also lead to the achievement of Healthy People 2010 within this region

Winery in California

Thesis (M. Arch.)--Massachusetts Institute of Technology, Dept. of Architecture, 1987.MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH.Includes bibliographical references (p. 49).This thesis concerns the design of a winery in the hills of northern California. The winer program was specifically chosen to ensure and illuminate the close partnership between landscape and building. While the industrial nature of the winery might appear antithetical to landscape setting. the production of wine necessitates a dialogue between building and site. The design is an exploration of this tension and interdependence in architectural form. historical movements in European garden design, and the work of contemporary landscape Artists are examined for examples of possible man-made interventions in the landscape. This spectrum of references shares in common the development of the potential of a site through the discernment and analysis of the character of the landscape. The winery site has a clear physical disposition from which the form of the winery and vineyards are generated. The winery design is the result of negotiations with the site, and with the building's requirements as a wine producing facility.by Greta Jones.M.Arch

Managing diabetes in people with dementia: protocol for a realist review

Background Worldwide, the prevalences of diabetes and dementia are both increasing, particularly in older people. Rates of diabetes in people with dementia are between 13 and 20 %. Diabetes management and diabetic self-care may be adversely affected by the presence of dementia. There is a need to know what interventions work best in the management of diabetes in people living with dementia (PLWD) in different settings and at different stages of the dementia trajectory. The overall aim is to develop an explanatory account or programme theory about ‘what works’ in the management of diabetes in people in what context and to identify promising interventions that merit further evaluation. Methods/design This study uses a realist approach including studies on the management of diabetes in older people, medication management, diabetes-related self-care, workforce issues and assessment and treatment. We will use an iterative, stakeholder driven, four-stage approach. Phase 1: development of initial programme theory/ies through a first scoping of the literature and consultation with key stakeholder groups (user/patient representatives, dementia-care providers, clinicians, diabetes and dementia researchers and diabetes specialists). Phase 2: systematic searches of the evidence to test and develop the theories identified in phase 1. Phase 3: validation of programme theory/ies with a purposive sample of participants from phase 1. Phase 4: actionable recommendations for the management of diabetes in PLWD. Discussion A realist synthesis of the evidence will provide a theoretical framework (i.e. an explanation of how interventions work, for whom, in what context and why) for practice and future research work that articulates the barriers and facilitators to effective management of diabetes in people with dementia. By providing possible explanations for the way in which interventions are thought to work and how change is achieved, it will demonstrate how to tailor an intervention to the setting and patient group. The propositions arising from the review will also inform the design of future intervention studies. Systematic review registration PROSPERO registration number CRD42015020625