Health Disparities

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Andrew Solomon at TEDMED 2013Many affected by illness and disability find profound meaning, inspiration and identity in their differences, says author Andrew Solomon, who holds that it is diversity that truly unites us all.

These live graphic recordings were created for nurses attending the “Creating Culturally Safe Spaces: What it Takes” workshop prior to the 20th Annual Conference of the Canadian Association of Nurses in AIDS Care (CANAC/ACIIS), hosted by the Center for Aboriginal Health Research (CAHR) at the University of Victoria.

Cultural competency in Aboriginal health care is described by CAHR as “respectful care that is based on a community framework of health, including integrating traditional health and healing knowledge to inform service delivery.” The speakers shared many stories about best practices, recommendations, and ways to move forward with culturally competent health care.

Facebook users must make choices about level of self-disclosure, and this self-disclosure can influence perceptions of the profile's author. We examined whether the specific type of self-disclosure on a professor's profile would affect students' perceptions of the professor and expectations of his classroom. We created six Facebook profiles for a fictitious male professor, each with a specific emphasis: politically conservative, politically liberal, religious, family oriented, socially oriented, or professional. Undergraduate students randomly viewed one profile and responded to questions that assessed their perceptions and expectations. The social professor was perceived as less skilled but more popular, while his profile was perceived as inappropriate and entertaining. Students reacted more strongly and negatively to the politically focused profiles in comparison to the religious, family, and professional profiles. Students reported being most interested in professional information on a professor's Facebook profile, yet they reported being least influenced by the professional profile. In general, students expressed neutrality about their interest in finding and friending professors on Facebook. These findings suggest that students have the potential to form perceptions about the classroom environment and about their professors based on the specific details disclosed in professors' Facebook profiles

Creating an environment in which U.S. children and youth can grow up healthy should be a high priority for the nation. Yet the prevailing pattern of food and beverage marketing to children and youth in America represents, at best, a missed opportunity, and at worst, a direct threat to the health prospects of the next generation.

Dietary patterns begin in childhood and shape the health of Americans, which result from an interplay of many factors--genetics and biology, culture and values, economics, physical and social environments, and commercial media environments. Ensuring that environments are supportive of good health is a fundamental responsibility, requiring leadership and action from all sectors.

How marketing influences children and youth is the focus of the IOM report, Food Marketing to Children and Youth: Threat or Opportunity? The report provides the most comprehensive review to date of the scientific evidence on the influence of food marketing on diets and diet-related health of children and youth. The study was requested by Congress and sponsored by the U.S. Centers for Disease Control and Prevention (CDC). 

The report finds that current food and beverage marketing practices puts children's long-term health at risk. If America's children and youth are to develop eating habits that help them avoid early onset of diet-related chronic diseases, they have to reduce their intake of high-calorie, low-nutrient snacks, fast foods, and sweetened drinks, which make up a high proportion of the products marketed to them.

The report provides recommendations for different segments of society to guide the development of effective marketing and advertising strategies that promote healthier foods, beverages, and meal options to children and youth. Recommendations are provided for

The report offers guidance on research activities necessary to chart the path of future improvements, and the capacity to monitor and track improvements in marketing practices that have an influence on children's and youth's diets and diet-related health. The recommendations reflect the current context and information in a rapidly changing environment, and should be implemented together as a package to support and complement one another.

The invention of cancer as psychological trauma

It may come as a surprise that the connection between cancer and psychological trauma only appeared in the scientific literature around 1990. A search of “cancer” AND “(psychological trauma or PTSD)” on Thomson Reuters Web of Science can be used to create a graphic display in which only a few studies in the early 90s steadily increase thereafter.

Publications per year Cancer + Trauma

The notion that cancer is traumatic came into play in the late 1980s when changes were contemplated to the DSM criteria for posttraumatic stress disorder (PTSD). Diagnosis of PTSD previously required exposure to an event outside the range of normal human experience. The DSM-III specifically ruled out chronic illness as such an event. However, it was anticipated that this exclusion would be removed in the next revision of DSM. The assumption was not that physical illness was necessarily traumatic, but if certain criteria were met, that physical illness could be considered a cause of PTSD.

In this emerging field, like others, it is important to develop shared language that enables communication and collaboration across sites, disciplines, and time. The Academy’s Lexicon is a set of concepts and definitions developed by expert consensus for what we mean by behavioral health and primary care integration—a functional definition —what things look like in practice. This consensus Lexicon enables effective communication and concerted action among clinicians, care systems, health plans, payers, researchers, policymakers, business modelers, and patients working for effective, widespread implementation on a meaningful scale.

The original version of the Academy’s Lexicon was developed through an Agency for Health Research and Quality (AHRQ) small conference grant in 2009 to develop a National Research Agenda for Collaborative Care. Through the planning process for that meeting, it was clear that the experts used the same words to refer to different concepts or practices and struggled to communicate effectively. After the meeting’s pilot work to develop a shared understanding, participants agreed that the Lexicon was an important, even critical, advancement for the field but that it needed further refinement. To that end, AHRQ funded an R-13 grant that enabled C.J. Peek and the University of Minnesota to collaborate with the Academy’s National Integration Advisory Council (NIAC) to provide expert consensus and further refine the Lexicon. The current lexicon is the culmination of that effort.

The authors of the guidance statement recommend that men between the age of 50 and 69 years should be fully informed of the benefits and harms of screening, and the decision to have a PSA test should be based on the patient’s overall health, life expectancy, risk for prostate cancer and preferences. The guidelines advise that “the harms of screening for prostate cancer outweigh the benefits in average-risk men younger than 50 years, men older than 69 years, or men who have a life expectancy less than 10 to 15 years.” However, the decision to undergo a PSA test is extremely preference-sensitive and some men may place more value on the limited potential benefits and less value on the harms associated with the test.

This research review summarizes the academic and industry literature on trends in food marketing to children and adolescents, as well as policy initiatives undertaken to address the contribution of marketing practices to the childhood obesity epidemic, from March 2011 to May 2012.

This review finds that self-regulation by the food and beverage industry is not likely to reduce marketing of unhealthy foods to children and adolescents significantly.

The review also finds that the food and beverage industry can exert significant influence on government efforts to reduce the marketing of unhealthy foods to children and adolescents.