Search PubMed⌕ Search

Biomedical subjects

J Bernstein

Publications and source records attributed to J Bernstein.

At least 361 records · Page 20Linked to original sources
PubMedDate not supplied

Providing culturally competent primary care for immigrant and refugee women. A Cambodian case study.

Currently, one of every 13 U.S. residents is foreign born. A 1991 survey of certified nurse-midwives (CNMs) indicated that 51% of the respondents serve immigrant women. Using a case study approach, this article illustrates barriers to health care experienced by foreign-born women and demonstrates how cultural competence increases provider effectiveness in meeting the unique needs of this population. Effective primary care requires understanding the context of the refugee experience and its physical and emotional sequelae; addressing geographic, linguistic, economic, and cultural barriers; and providing high-quality care through the efficient use of resources without unduly controlling women's choices. Providing care within the context of the traditional family structure, gender roles, family support systems, and community services and resources further enhances health care services. Equally important is the establishment of a sustained partnership with clients, based on the support of protective traditional health practices and the recognition that a woman is expert in her own health. By respecting the complex cultural, political, economic, and personal backgrounds that contribute to immigrant women's perceptions of health, illness, and health care needs, culturally competent primary care providers serve diverse populations more effectively and help to enrich the communities in which they live and work.

Adult↗
PubMedDate not supplied

Keeping mammography referral appointments: motivation, health beliefs, and access barriers experienced by older minority women.

Older women of color tend to have much lower rates of regular mammography screening for breast cancer than younger Caucasian women; yet, they have higher rates of mortality. This study was designed to increase mammography rates among inner-city women aged 50 years or older. Another goal was to investigate differences in mammography utilization related to race/ethnicity and language after barriers associated with cost and the difficulty of making an appointment are removed. A peer delivered intervention, which consisted of interview, mammography referral, and the scheduling of a next-day appointment, was conducted among a convenience sample of 151 culturally and racially diverse older women through a primary care referral project operating within an urban emergency department (ED). A brief motivational interview and mammography referral at the time of an ED visit, including scheduling of a next-day no cost appointment, was followed by a cross-sectional telephone survey of utilization and motivating and hindering factors. Follow-up was achieved with 96 women (66%). Fifty-eight women (60%) had a post-intervention mammogram; of those, 69% were first time users. More than 90% planned a repeat mammogram the following year. Of the 27 who did not receive a mammogram, 21 (77%) requested a "second try" appointment. These findings demonstrate that an interactive intervention among older women of color has the potential to dramatically increase mammography rates.

Black or African American↗
PubMedDate not supplied

Dermatological findings in capacitor manufacturing workers exposed to dielectric fluids containing polychlorinated biphenyls (PCBs).

Significant occupational exposure to polychlorinated biphenyls (PCBs) may occur in the manufacturing of capacitors and transformers, in which PCBs are used as electrical insulators. Reports of adverse health effects resulting from PCB exposure have come primarily from an incident resulting from the accidental ingestion of contaminated rice oil in Japan in 1968 ("yusho"). Dermatological findings were prominent features and included pigmentation disturbances and chloracne. To evaluate the dermatological effects of long-term occupational exposure to PCBs, a cross-sectional clinical survey was conducted of 326 capacitor manufacturing workers. A high prevalence (37%) of dermatological abnormalities was found, but typical PCB-associated signs, such as chloracne, were less frequent than among patients with "yusho," despite high concentrations of plasma PCB. As association between dermatological signs and plasma levels of higher homologues of PCBs was suggested, but contaminants which have been reported to be present in commercial PCB mixtures (polychlorinated dibenzofurans) should be considered an etiologic factor or co-factor in the development of "PCB-associated" dermatological findings.

Adult↗
PubMedDate not supplied

Airway disease in non-smoking asbestos workers.

Ninety-seven non-cigarette-smoking white male insulators from the midwestern United States had significantly reduced forced expiratory volume in 1 second (FEV1.0) (P less than .0017) and forced expiratory flow from 75 to 85% of expired volume (FEF75-85) (P less than .042) when compared to a reference population of Michigan male nonsmokers. There were parenchymal opacities with a profusion of 1/0 or greater in 7 and pleural changes in 13 of these 97 nonsmokers. Asbestos, in the absence of cigarette smoke effects and other diseases, appears to decrease airflow, probably by the distortion of small airways (less than 2mm) by peribronchiolar fibrosis. This stiffening of the lung parenchyma protects midflow (FEF25-75) as the fibrosis increases the lung's radial traction on airways larger than 2 mm. This observation contributes to the natural history of physiological impairment due to asbestos disease.

Adult↗
PubMedDate not supplied

Infertility: from a personal to a public health problem.

The inability to conceive a child is most often viewed as a private matter, but public health perspectives and skills can contribute greatly to our knowledge about infertility, and the development of effective and rational public policy for prevention, access to health care, and regulation of new technologies. We offer a primer of public health aspects of infertility in an effort to encourage the broad spectrum of public health professionals to become more knowledgeable about these topics and join in the national debate about preventive strategies, cost-benefit assessment, resource allocation, and ethics.

Costs and Cost Analysis↗
PubMedDate not supplied

Assessment of psychological dysfunction associated with infertility.

An Infertility Questionnaire (IFQ) was developed to measure the specific effects of infertility on three major areas: self-esteem, blame/guilt, and sexuality. The Infertility Questionnaire, possibly in combination with a standard instrument to measure psychological distress, appears to offer a simple method of assessing the emotional impairment that accompanies infertility.

Emotions↗
PubMedDate not supplied

Psychological status of previously infertile couples after a successful pregnancy.

Potential long-term effects of psychological dysfunction associated with infertility were investigated in a descriptive study of 32 previously infertile couples. Comparison was made with the performance of 20 never infertile couples matched for age, number of children, education, and income level, using a standard psychological assessment tool, the Hopkins symptom check list. While infertile, women had slightly elevated mean scores on three subscales: depression, interpersonal sensitivity, and hostility. After resolution of infertility, these scores did not improve. In addition, depression scores were elevated among the previously infertile women compared with a matched, never infertile group. Infertile men scored within the normal range for depression and interpersonal sensitivity and had a borderline mean score for hostility, which was markedly reduced after a normal pregnancy.

Depression↗
PubMedDate not supplied

Ectopic pregnancy: a nursing approach to excess risk among minority women.

Ectopic pregnancy rates have quadrupled during the last decade. Although maternal mortality has been reduced for white women, largely because of rapid pregnancy testing and improved ultrasonography, the death rate for minority women is almost twice that of white women, and minority adolescents are almost five times as likely to die of ectopic pregnancy. In this article, causative factors are identified, and the potential for race, gender, and age bias in diagnosis and treatment is discussed. Involvement by nurses in preventive programs, clinical research, and advocacy for policy change may help reduce ectopic pregnancy mortality rates.

Adolescent↗
PubMedDate not supplied

Antibodies against inner-ear proteins in the sera of patients with inner-ear diseases.

Sera from patients with various inner-ear diseases, especially Ménière's disease, were investigated by Western blot against guinea pig inner-ear proteins. Of 45 patients, 24 (53%) with various inner-ear diseases had antibodies against inner-ear proteins, compared with 0 of 10 (0%) in control subjects without inner-ear diseases. Of the 10 proteins that showed a positive reaction with patient sera, the 28-kD band was unique in that it appeared only in the membranous fraction of the inner ear and was highly positive (28%) in reaction with Ménière's disease patient sera. The results in the present study with proteins extracted from guinea pig inner ear were consistent with our previous study using proteins from human inner ear, suggesting that the 28-kD protein may be a candidate for detecting autoimmune inner-ear disease.

Animals↗
PubMedDate not supplied

Test-indication curves.

Test-indication curves (TICs) are tools for determining whether a test is indicated for a given patient. They apply the threshold approach of Pauker and Kassirer in graphic form. These curves are composed of two parts: the raw curve, which plots posttest probability versus pretest probability (given values for specificity and sensitivity); and the final curve, in which three straight lines are added to the raw curve by the clinician to generate a TIC for a given treatment threshold. In the final curve, the complete range of pretest probability is segregated into three zones, corresponding to the three groups described by Pauker and Kassirer: those patients in whom disease is assumed to be present and who are thus best treated empirically; at the other extreme, those who require neither testing nor treatment; and, finally, those in the middle, for whom the test is indicated, since the decision to treat would be based on the test result. Thus the clinician could consult the TIC and determine with certainty whether the test should be employed for a given patient. It also could be modified with ease for a different patient, with a different set of threshold values. TICs provide a complete, visual interpretation of a test's diagnostic power, in the context of a given treatment threshold. They foster an intuitive comprehension of Pauker and Kassirer's method, and offer the clinician a facile means to prove that a test is indicated in a given setting. By promoting the use of exactly those tests that are indicated, TICs can help spare the patient the cost, burden, and risk of unnecessary testing, and help spare the physician the cost, burden, and risk of interpreting inconclusive test results.

Cost-Benefit Analysis↗
PubMedDate not supplied

Public opinion, knowledge, and Medicare reform.

A review of public opinion and focus-group research reveals consistently inadequate understanding of Medicare by the public and misinterpretation of public opinion information by policy advocates. Closer analysis of apparent conflicts in values related to self-sufficiency, personal responsibility, and government, however, reveals strong support for the basic premises of social insurance embodied in Medicare. The likelihood of meaningful policy discussions about Medicare depends, in part, on whether the policy and research communities can find ways to provide the electorate with the knowledge they need to understand the implications of reform.

Attitude to Health↗
PubMedDate not supplied

Urticaria.

Explore the source record for details and available documents.

Acute Disease↗
PubMedDate not supplied

Allergic rhinitis.

Explore the source record for details and available documents.

Adolescent↗
PubMedDate not supplied

Atopic dermatitis.

Explore the source record for details and available documents.

Child↗
PubMedDate not supplied

Atopic dermatitis.

Explore the source record for details and available documents.

Adult↗
PubMedDate not supplied

Evaluation of the proper photographic density range of Lodose mammography.

An underexposed or overexposed mammogram can make it impossible for the radiologist to arrive at the proper diagnosis and may cause unnecessary radiation exposure to the patient. The range of photographic densities that can result in properly exposed, underexposed, or overexposed mammograms when the Lodose system is used has been determined. This study should be of significant value to technologists who do mammography on a routine basis and to those involved in mass screening programs.

Adult↗