Cultural Competence: New Conceptual Insights into its Limits and Potential for Addressing Health Disparities

The increasing interest in the role of racism and racialization in health disparities, calls for exploring new paradigms in addressing and eliminating health disparities related to race/ethnicity. Cultural competence is conceptualized as one of the keys ways to address racial/ethnic disparities in public health and healthcare. However, for cultural competence to fulfill this role, it requires a critical understanding of the underlying socio-political and economic processes of power, privilege and institutional racism that create, support and maintain existing health disparities. This paper outlines how the concept of cultural competence can be made more robust, by incorporating concepts such as Public Health Critical Race praxis (PHCR) and cultural humility, to more fully tackle the impact of structural inequities on health disparities

Nebraska Sex Trafficking Survivors Speak – A Qualitative Research Study

This exploratory, qualitative research study was conducted by researchers Dr. Shireen S. Rajaram in the College of Public Health at University of Nebraska Medical Center (UNMC) and Ms. Sriyani Tidball in the College of Journalism and Mass Communication at the University of Nebraska at Lincoln (UNL), and was funded by the Women’s Fund of Omaha. The purpose of this study was to document the perspectives of adult women survivors of sex trafficking about the “3Ps” paradigm: to identify strategies to prevent sex trafficking, provide protection and support for survivors and prosecution of the perpetrators to reduce the demand for sex trafficking. The Victims of Trafficking and Violence Protection Act of 2000 defines sex trafficking as a commercial sex act that is induced by force, fraud, or coercion, or when there is a commercial sex act involving a person below 18 years of age. This study is the first of its kind in Nebraska that included the voices of survivors of sex trafficking. Qualitative research through one-on-one interviews provides information directly from survivors in their own words. Our goal was to ensure that the voices of trafficked women were included in on-going efforts to develop a comprehensive statewide plan to effectively combat sex trafficking in Nebraska. While sex trafficking of children and males is a serious issue, this study only focused on adult female sex trafficking survivors (i.e., they were prostituted against their will), 19 years and older, who may or may not have been sex trafficked while they were minors. To avoid re-traumatizing, we only included women who had not been sex trafficked within the past year. Through interviews, researchers obtained detailed, rich, and authentic descriptions from 22 women survivors of sex trafficking in Nebraska. Seventeen women lived in the Omaha-Lincoln area and 5 lived in rural Nebraska. Most women had children. Seven women were currently married. Thirteen women were white-Caucasian, four African American, three mixed race/ethnicity, and two Latino. As children, twelve of the women had been in foster care, and one woman had lived in a group home. The study revealed the complexity of the issue of sex trafficking. The high level of ignorance about sex trafficking among all segments of society allows for it to exist and thrive, largely undetected. Currently, active planning efforts are underway to create a comprehensive statewide plan to combat trafficking in Nebraska. However, given that very little has been done in Nebraska, there is an urgent need to implement strategies to address prevention, protection and prosecution simultaneously. Focusing on only one without the others will not benefit survivors

Incidence of Gastric Cancer in Marrakech and Casablanca, Morocco

Gastric cancer is the fifth most common cancer globally with over 70% of new cases occurring in developing countries. In Morocco, oncologists in Marrakech suspected higher frequency of gastric cancer compared to Casablanca, a city 150 kilometers away. This study calculated age-specific, sex-specific, and total incidence rates of gastric cancer in Marrakech and was compared to the Casablanca population-based cancer registry. Using medical records from Center Hospital University Mohammad VI and reports from 4 main private pathology laboratories in Marrakech, we identified 774 patients for the period 2008–2012. Comparison of rates showed higher age-specific incidence in Marrakech in nearly all age groups for both genders. A higher total incidence in Marrakech than in Casablanca was found with rates of 5.50 and 3.23 per 100,000, respectively. Incidence was significantly higher among males in Marrakech than males in Casablanca (7.19 and 3.91 per 100,000, resp.) and females in Marrakech compared to females in Casablanca (3.87 and 2.58 per 100,000, resp.). Future studies should address possible underestimation of gastric cancer in Marrakech, estimate incidence in other regions of Morocco, and investigate possible risk factors to explain the difference in rates

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Association between leisure time physical activity preference and behavior: evidence from the China Health & Nutrition Survey, 2004–2011

Abstract Background Previous studies have suggested that food preference is a good indicator of actual food intake and that sedentary activity preference is a significant predictor of lower physical activity level. But no studies have examined the direct relationship between leisure time physical activity (LTPA) preferences and actual LTPA behavior, especially studies using longitudinal data. This study seeks to determine the association between these two variables, and to assess whether the association differs between urban and rural areas in China. Methods A total of 2427 Chinese adults were included in the analysis. Spearman correlation coefficients were used to test the association between leisure time physical activity preference and behavior, followed by multiple logistic regressions to further examine the association after adjusting for possible confounding variables. Urban-rural differences in the association were investigated through stratified analysis. Results In the sample, 63.0% were from urban areas, 47.4% were men, and the mean age was 40. Adjusted estimates based on logistic regression show that LTPA preference was a significant predictor of actual LTPA behavior (OR = 1.05, 95% CI = 1.01–1.09). The correlation was found to be significant among urban residents (OR = 1.06, 95% CI = 1.01–1.10), but not in rural residents. Conclusions The study illustrates the predictive value of LTPA preference for actual LTPA behavior. Changing LTPA preference to promote LTPA may be helpful in preventing and controlling chronic disease in China