Lugares de Vida: places of life

A `new' wave of immigration is challenging our assumptions and understanding of immigrant social integration, family organization and well-being, and mobility. Yet, relatively little attention has been given to the development of new conceptual models that are sensitive to the ecologies of today's immigrants who are predominantly people of color. This study extends current theorizing on immigrant adjustment and acculturation by focusing on a set of socio-structural factors that characterize the Mexican immigrant experience and their places of life. Specifically, the study tests an integrated conceptual model that examines the linkages among the neighborhood social environment, hardships associated with being an immigrant ethnic minority, parental distress, parenting practices, and adolescent internalizing and externalizing. The study further examines if the hypothesized associations vary by neighborhood ethnic concentration. Several important findings emerged from the study. Social cohesion was associated with financial hardship and difficulties with English, and in turn, financial hardship was associated with parental distress. Although perceived discrimination was not significantly associated with neighborhood social capital it was consistently associated with parental distress - and directly with adolescent externalizing behaviors. The study also found that parental distress was associated with parental supervision of adolescent children, and parental supervision was negatively associated with internalizing and externalizing behavior problems. An examination of the moderating effect of neighborhood ethnic concentration showed that the relative influence of neighborhood social capital and/or family on adolescent adjustment varied depending on whether families lived in predominantly Latino neighborhoods or non-Latino neighborhoods. Specifically, parenting practices were directly associated with adolescent adjustment and enforceable trust was associated with adolescent internalizing behaviors, but only in predominantly Latino neighborhoods. The results further suggest that social cohesion and enforceable trust serve different purposes or yield different benefits depending on neighborhood ethnic concentration and the challenges and constraints of each environment. The results of the study have implications for research, policy, and practice

Advanced neonatal medicine in China: Is newborn ward capacity associated with inpatient antibiotic usage?

Previous surveys of neonatal medicine in China have not collected comprehensive information on antibiotic use in newborns. The goal of the present study was to assess the trends in antibiotic use in inpatient newborns from advanced hospitals in mainland China and to evaluate the contributing factors. We extracted retrospective data on newborn clinical units from a database containing key clinical subspecialty area indicators from provincial or ministerial (Class A level III) hospitals over three consecutive years (2008-2010) and in 25 of 31 provincial districts of mainland China. Fifty-five newborn units were included in the study. The results showed that two thirds (65.7% ± 23.1%) of inpatient newborns were prescribed antibiotic products. Antibiotic use rates were significantly different by newborn ward bed capacity (p = 0.023; 60.6% for d capacity (ficant65.7% ± 23-100 beds group, and 77.1% for (ficant65.7% ± 23.1%) of inpatient newb significantly different by type of hospital, geographic area, admission to physician or nurse ratio, or physician or nurse academic degree. Factors contributing significantly to antibiotic use included ward bed capacity, physician to nurse ratio, average hospital stay, and pneumonia to preterm infant ratio. Our data suggested that the use of antibiotics among inpatient newborns in advanced hospitals in mainland China was prevalent and should be subject to rigorous monitoring, and highlighted the need to explore how newborn ward bed capacity potentially impacts antibiotic use

Advanced Neonatal Medicine in China: A National Baseline Database

<div><p>Previous surveys of neonatal medicine in China have not collected comprehensive information on workforce, investment, health care practice, and disease expenditure. The goal of the present study was to develop a national database of neonatal care units and compare present outcomes data in conjunction with health care practices and costs. We summarized the above components by extracting data from the databases of the national key clinical subspecialty proposals issued by national health authority in China, as well as publicly accessible databases. Sixty-one newborn clinical units from provincial or ministerial hospitals at the highest level within local areas in mainland China, were included for the study. Data were gathered for three consecutive years (2008–2010) in 28 of 31 provincial districts in mainland China. Of the 61 newborn units in 2010, there were 4,948 beds (median = 62 [IQR 43–110]), 1,369 physicians (median = 22 [IQR 15–29]), 3,443 nurses (median = 52 [IQR 33–81]), and 170,159 inpatient discharges (median = 2,612 [IQR 1,436–3,804]). During 2008–2010, the median yearly investment for a single newborn unit was US$344,700 (IQR 166,100–585,800), median length of hospital stay for overall inpatient newborns 9.5 (IQR 8.2–10.8) days, median inpatient antimicrobial drug use rate 68.7$8,613 (IQR 8,153–9,216), which was 3.0 times (IQR 2.0–3.2) the average per-capita disposable income, or 63 times (IQR 40.3–72.1) the average per-capita health expenditure of local urban residents in 2011. Our national database provides baseline data on the status of advanced neonatal medicine in China, gathering valuable information for quality improvement, decision making, longitudinal studies and horizontal comparisons.</p></div

Disease expenditures of four common newborn diseases by regions during 2008–2010.

<p>(A) Median hospital costs by regions, and the <i>P</i>-values were all less than 0.001for regional comparisons of pneumonia, sepsis, RDS, and VLBW infants. (B) Ratios of median hospital cost to per-capita disposable income of local urban residents by regions, and the <i>P</i>-values for regional comparisons of pneumonia, sepsis, RDS, and VLBW infants were 0.237, 0.026, 0.003, and 0.092 respectively. (C) Ratios of median hospital cost to per-capita health expenditure of local urban residents by regions, and the <i>P</i>-values for regional comparisons of pneumonia, sepsis, RDS, and VLBW infants were 0.111, 0.001, less than 0.001, and less than 0.001 respectively.</p

Disease expenditure of a single hospital stay for common newborn diseases during 2008–2010.

<p>Disease expenditure of a single hospital stay for common newborn diseases during 2008–2010.</p

Distribution of 61 surveyed newborn units in China.

<p>Sixty-one surveyed newborn units were from Class A level III provincial or ministerial affiliated hospitals, distributed in 31 cities of 28 provincial districts among six geographical regions in mainland China. The units were from child hospital (CH), general hospital (GH), and maternal and child hospital (MCH). The city names, hospital types, newborn beds, and newborn bed-population ratios (number in the brackets, for every 100,000 population) were marked respectively. The adapted map is for illustrative purposes only, originally from the free maps website (<a href="http://www.d-maps.com/carte.php?num_car=11572&lang=en" target="_blank">http://www.d-maps.com/carte.php?num_car=11572&lang=en</a>).</p

Newborn unit investment, workforces and health care activities in 61 hospitals during 2008–2010.

<p>Newborn unit investment, workforces and health care activities in 61 hospitals during 2008–2010.</p

Patients' perspectives on how to improve diabetes self-management and medical care: a qualitative study

Background: The experience of living with a chronic disease such as diabetes can provide valuable knowledge about medical care and self-management. Such knowledge may be of use to people seeking to improve diabetes self-management and to health professionals seeking to provide better patient-centered care. Objective: To identify potential areas for improvement in diabetes care from the perspectives of people living with diabetes and their caregivers. Methods: We interviewed 21 people living with diabetes (hereafter called expert patients) who were patient partners in a national Patient-Oriented Research network. Expert patients were men and women from various backgrounds, including Indigenous people and immigrants to Canada. They had significant lived experience of diabetes and were able to offer diverse patient and caregiver perspectives. Three authors independently analyzed videos using inductive framework analysis, identifying themes through discussion and consensus. Results: From expert patients’ perspective, people living with diabetes benefit from acknowledging and accepting the reality of diabetes, receiving support from their family and care team, and not letting diabetes control their lives. To improve diabetes care, health professionals should understand and acknowledge the impact of diabetes on patients and their families, and communicate with patients openly, respectfully, with empathy and cultural competency. Conclusions: From the perspectives of expert patients, there are areas for improvements in diabetes care. These improvements are actionable individually by patients or health professionals and also collectively through collaboration between both groups. Improving the quality of care in diabetes is crucial for improving health outcomes in Canada

Journal of African Christian Biography: v. 8, no. 4 (Oct 2023) A quaterly publication of the Dictionary of African Christian Biography (www.DACB.org)

[This issue of the Journal of African Christian Biography highlights some of the entries in the DACB that profile participants in the twentieth-century ecumenical movement in southern Africa. The overwhelming impression one gets of this subject is that of gaps: there is urgent need for more entries that address the myriad ways in which African Christian leaders engaged the ecumenical movement as a network through which to build social capital during the critical period after the Second World War. As African nations became independent of European colonial control, church-educated leaders often acted as global spokesmen for postcolonial visions of society. They cultivated international support structures and led regional independence movements. Ecumenical networks played crucial roles in maintaining structures for education and peace-building in conflictive situations. Nelson Mandela himself, for example, attended Healdtown, a Methodist mission that became the largest high school in the country and educated many of the most important black nationalist leaders at mid century. The entries highlighted in this issue are the tip of the iceberg of what needs to be researched and written. This issue, then, appeals for scholars and church leaders to step up and to provide biographies of “ecumenists”—those who located their commitment to the Body of Christ in an international vision of peace, equality, and justice, in collaboration with other Christians from across Africa and around the world, as well as those who worked at the local level of cooperative church movements.