Social science & medicine
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Social science & medicine · Dec 2004
Preferences in end-of-life care of older persons: after-death interviews with proxy respondents.
This population-based study employing after-death interviews with proxies describes older persons' preferences regarding medical care at the end of life. Interviews were held with 270 proxy respondents of 342 deceased persons (age range 59-91) in the Netherlands, The deceased were respondents to the Longitudinal Aging Study Amsterdam. The prevalence of advance directives (ADs), preferences for medical decisions at the end of life (i.e. withholding treatment, physician-assisted suicide euthanasia) and preferences about the focus of treatment in the last week of life (i.e. comfort care versus extending life) were examined. ⋯ The knowledge of the proxy regarding the older person's preference for the focus of treatment was dependent on the patient's symptom burden as perceived by the proxy. The majority of older persons had died without either an AD, or having expressed preferences for end-of-life care. Stimulating the formulation of ADs may help professionals who work with older people to understand these preferences better, especially in the case of non-cancer patients and those with low PSE.
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Social science & medicine · Dec 2004
Randomized Controlled Trial Clinical TrialShort-term effects of moving from public housing in poor to middle-class neighborhoods on low-income, minority adults' outcomes.
This study reports results from a quasi-experimental residential mobility study in Yonkers, NY, in which low-income minority families residing in public and private housing in high-poverty neighborhoods were randomly assigned via lottery to relocate to publicly funded attached rowhouses in seven middle-class neighborhoods. One hundred seventy-three Black and Latino families who moved and 142 demographically similar families who remained in the original high-poverty neighborhoods were interviewed approximately 2 years after movers relocated; no baseline data were available. ⋯ No program effects were found on adults' symptoms of depression and anxiety. These early program effects inform housing policy initiatives for low-income families.
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Social science & medicine · Dec 2004
Randomized Controlled Trial Clinical TrialDrug name confusion: evaluating the effectiveness of capital ("Tall Man") letters using eye movement data.
Medication errors commonly involve confusion between drug names that look or sound alike. One possible method of reducing these errors is to print sections of the names in "Tall Man" (capital) letters, in order to emphasise differences between similar products. This paper reports an eye-tracking experiment that evaluates this strategy. ⋯ The target pack was replaced by a similar distractor in the array. Participants made fewer errors when the appearance of the names had been altered, that is, they were less likely to incorrectly identify a distractor as the target drug. This result was reflected in the eye movement data.
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Social science & medicine · Dec 2004
Cultural competence among physicians treating Mexican Americans who have diabetes: a structural model.
Latinos, who constitute the fastest growing ethnically distinct US group, experience disproportionately high rates of type 2 diabetes. At the same time, linguistic and economic barriers, differing cultural expectations between patients and physicians, provider reactions based on stereotypes, and managed healthcare shortfalls limit diabetes care. Such trends highlight physicians' need to consider culture in the delivery of effective services. ⋯ Diverse educational experiences appear particularly helpful in this process. Community clinic settings also help practitioners gain cultural knowledge. While Latino ethnicity predicted cultural awareness, results also suggest that all physicians can take steps towards increasing their cultural competence.