ABSTRACT
This study aims to identify educational and training modalities that dentists in Puerto Rico (PR) believe will increase the quality and quantity of opportunistic oral cancer screening examinations (OCS) in dental offices on the island. The study was conducted in three phases: a systematic search of relevant literature, an expert review and consensus panel, and focus groups (FG) involving PR general dentists. To increase OCS by dentists in PR, the FG participants proposed a small group, hands-on OCS training, an integrated oral cancer course, and readily available videos, photographs, and computer simulations to further demonstrate OCS performance and facilitate differential diagnosis. OCS training requirements for licensure and re-licensure, improving OCS dentist-patient communication skills, and establishment of an oral lesion referral center were also viewed favorably. In conclusion, general dentists in our FGs believed the quality and quantity of OCS in Puerto Rico can be increased through the application of specific continuing education and training modalities.
Subject(s)
Clinical Competence , Dentists , Education, Continuing , Education, Dental/methods , Mass Screening , Mouth Neoplasms/diagnosis , Attitude of Health Personnel , Focus Groups , Health Knowledge, Attitudes, Practice , Humans , Mouth Neoplasms/prevention & control , Puerto Rico , Surveys and QuestionnairesABSTRACT
Mammography for low-income women is an important intervention issue as it is still under utilized in these sectors. Despite evidence in favor of breast cancer screening with mammograms, research indicates that mammogram compliance among low-income females and women over 50 years of age has been slow. This article revolves around the factors that affect compliance with screening mammograms among low-income women ages 40 to 64 in Puerto Rico once they receive a referral from a physician. Although the multivariate analysis demonstrated that only age, work outside of the home and performing breast self-exams significantly increased the probability for middle-aged, low-income women in Puerto Rico to comply with referrals and have mammograms, this research illustrated that certain factors such as knowledge about the disease and screening practices, a satisfactory perception of the patient-physician relationship, and the performance of a clinical breast exam by a physician influence mammogram compliance.
Subject(s)
Breast Neoplasms/prevention & control , Mammography/statistics & numerical data , Patient Compliance , Adult , Breast Self-Examination/statistics & numerical data , Female , Health Knowledge, Attitudes, Practice , Humans , Mammography/economics , Mass Screening/economics , Mass Screening/statistics & numerical data , Middle Aged , Physician-Patient Relations , Puerto Rico , Socioeconomic FactorsABSTRACT
During the last ten years there has been an interest for determining the prevalence and incidence of dementia among older adults and for cognitive tests that do to discriminate by level of education. This article revolves around the validation of a minimental exam, the Cabán minimental, to measure the cognitive capacity of Spanish-speaking adults 60 years of age and older; a test that is not affected by level of education. The factors measured in the Cabán minimental are: orientation, visual and motor coordination, learning, recent memory and abstraction. The validation process underwent two phases. During the first one, the Cabán test was subjected to construct validation and internal and predictive consistency tests. The second stage comprised a comparison between the Cabán and Folstein minimentals. The Cabán showed a statistically significant difference to discriminate for subjects with dementia. Results also suggest that the Cabán is not as much affected as the Folstein by differences in education.
Subject(s)
Dementia/diagnosis , Psychometrics/methods , Aged , Communication Barriers , Hispanic or Latino , Humans , Middle Aged , ROC Curve , Reproducibility of Results , Sensitivity and Specificity , Severity of Illness IndexABSTRACT
Screening mammogram utilization is a critical issue in early detection of breast cancer. However, it is underutilized by different sectors, particularly low-income women. The objective of this study was to utilize the method known as focus group to probe into obstacles to screening mammogram among low-income women in the ages 40 to 64 in Puerto Rico once they had a physician's referral. The women in the study had knowledge of breast self-examination, clinical breast exam and mammogram as tests to detect breast cancer. Yet, they had no adequate knowledge about current screening guidelines. Attitudes toward pain or discomfort related to the mammogram and fear of a breast cancer diagnosis were the personal reasons most often cited for non-compliance in the focus group discussions. In the case of external or systemic barriers, the most prevalent reasons offered were: cost of the mammogram, transportation, and negative factors associated to the doctor-patient relationship.
Subject(s)
Mammography/statistics & numerical data , Mass Screening/statistics & numerical data , Patient Compliance/statistics & numerical data , Poverty/statistics & numerical data , Adult , Age Factors , Breast Neoplasms/diagnosis , Breast Neoplasms/prevention & control , Breast Self-Examination/statistics & numerical data , Female , Fibrocystic Breast Disease/diagnosis , Humans , Mammography/economics , Middle Aged , Physician-Patient Relations , Risk Factors , Transportation , VocabularyABSTRACT
This article focuses on the development of a health promotion model programme for elderly Puerto Rican women intended to minimize barriers for early detection of breast cancer and to increase women's compliance with recommended guidelines. The programme was designed based on the findings of a national sample to assess knowledge, beliefs and practices of breast cancer early detection in Puerto Rican elderly women and their perceptions of barriers associated with non-compliance. It involves the combination of educational and environmental support for actions and conditions conducive to health behaviour and consists of the following components: (i) a culture- and cohort-sensitive health education programme for elderly women on breast cancer screening and assertive strategies for client-physician relationship; (ii) training for primary-care providers on current guidelines and barriers affecting compliance among older women in Puerto Rico; and (iii) coordination of necessary support services to facilitate access to clinical breast exams and mammograms. Programme implementation considers appropriate theories for health promotion and education in the older population. Evaluation measured progress in the plan implementation by assessing immediate products and long-term impact of the programme. Results of the pilot programme revealed a slight increase in knowledge and a significant decrease (p < 0.05) in beliefs after the health education sessions. Interventions in breast cancer early detection practices showed significant changes (p < 0.05) for mammogram and clinical breast examination. Different strategies must be combined to increase older women's compliance with breast cancer screening. Health system and access barriers to preventive care must be addressed.
Subject(s)
Breast Neoplasms/diagnosis , Health Knowledge, Attitudes, Practice , Health Promotion/methods , Aged , Female , Health Education/methods , Humans , Mammography , Outcome and Process Assessment, Health Care , Pilot Projects , Puerto Rico , Surveys and QuestionnairesABSTRACT
This article summarizes a presentation on the meanings and implications that crossing the old-age threshold has on the self-perception of the older adult. It draws from anthropological studies on the meaning of old age and sickness in old age that emphasize that meaning in old age for the older adult is the outcome of his/her considerations on aging in terms of individual experiences and the continuity of identity amidst the social and biological changes associated with old age. Implications for decision-making about medical treatment, the right to privacy, and the right to receive care in the less-restrictive possible environment for patient autonomy as well as interpretations about self-respect and self-determination are discussed.
Subject(s)
Humans , Anthropology , Ethics , GeriatricsABSTRACT
This paper presents the results of the validation process to determine the concepts for knowledge and beliefs about breast cancer early detection practices among Puerto Rican elderly women. An initial questionnaire was designed based on the scientific literature review and focus group experiences. To determine its reliability and validity, 50 elderly women, stratified by type of profession and place of residence, were interviewed twice. Consistency of the questionnaire was analyzed using binomial test, matched t-test, Pearson correlation coefficient, and Cronbach's coefficient effect. Factor analysis (FA) was the statistical technique used to analyze the grouping of the knowledge and beliefs statements. FA indicated that three scales for knowledge and one for beliefs can be constructed. The purpose of the scales was to identify differences among groups, according to breast cancer early detection practices. Construct validity was performed to determine the number of statistical associations between the scales and these practices. The results showed that beliefs scales was associated with practice of mammogram (p < 0.05), and visit to the gynecologist (p < 0.05) while the knowledge scale for early-detection was associated with the clinical breast examination (p < 0.05). The beliefs scale had better consistency than the knowledge scale. The Cronbach's alpha was 0.75 for the beliefs' scale and 0.30, 0.41 and 0.43 for each defined knowledge scale, respectively.
Subject(s)
Humans , Female , Aged , Breast Neoplasms/prevention & control , Health Knowledge, Attitudes, Practice , Age Factors , Aged, 80 and over , Attitude to Health , Education , Factor Analysis, Statistical , Interviews as Topic , Mammography , Medicare , Models, Theoretical , Puerto Rico , Surveys and Questionnaires , Risk Factors , United StatesABSTRACT
Elderly women are a forgotten topic in women's research and in feminist issues. This article presents a concise summary of gerontological research on women's issues in Puerto Rico. Research is divided in two main categories: demographic and health and social issues. A brief account of needed research areas is included. A demographic and health profile of older women in Puerto Rico and their informal support systems is presented. The article concludes with thoughts pertinent to the relevance of conducting research from the perspective of elderly women themselves and not merely that of researchers.
Subject(s)
Humans , Female , Aged , Women , Aged, 80 and over , Health Status , Poverty , Puerto Rico , Research , Social Support , Socioeconomic FactorsABSTRACT
OBJETIVOS: Este es un estudio descriptivo y dirigido a identificar las barreras personales y externas, percibidas por las mujeres de 65 años o más en Puerto Rico, para el cumplimiento con las prácticas de detección tempranma del cáncer de mama. En este artículo se presentan los resultados de la primera fase de la investigación cuyo propósito fue el explorar ideas, opiniones y vocabulario utilizado por mujeres de 65 años y mayores en Puerto Rico sobre el cáncer de mama y las prácticas de detección temprana para la construcción de un cuestionario culturalmente apropriado. TRASFONDO: Las mujeres de edad avanzada tienen un riesgo mayor de enfermar y morir de cáncer de mama de las mujeres más jovens. Sin embargo, llevan a cabo con menor frecuencia las prácticas recomendadas para la detección temprana de la enfermedad. Hay muy poca evidencia empírica sobre las barreras que puedan tener estas mujeres para cumplir con dichas prácticas. METODOLOGIA: Se llevaron a cabo siete grupos focales con una población total de 62 mujeres de edad avanzada, estratificada por zona de residencia y nivel educativo. Mediante un análisis de contenido se identificaron las áreas de preocuopación, temas y asuntos relevantes, y el vocabulario utilizado por las mujeres participantes. RESULTADOS: Se evidenciaron barreras personales y relacionadas con el sistema de servicios de salud. La relación médico-paciente y el nivel educativo aparentan ser variables claves para que las mujeres de edad avanzada cumplan con las prácticas recomendadas para la detección temprana del cáncer de la mama.
Subject(s)
Humans , Female , Aged , Breast Neoplasms , Health Knowledge, Attitudes, Practice , Age Factors , Aged, 80 and over , Breast Neoplasms , Breast Neoplasms/diagnosis , Puerto RicoABSTRACT
The rising number and proportion of elderly adults have implications for health promotion. The concept of wellness and not just health should be incorporated in these programs due to its holistic connotations. Life-style is another essential component in this conceptual framework. Wellness promotion programs for the aged must consider physical, biological, psychological and sociocultural characteristics of individuals from a longitudinal/historical perspective as well as specific health problems. Programs geared to the adoption of new life-styles by the aged must recognize their capability and right to assume responsibility for their well-being
Subject(s)
Aged , Humans , Health Promotion , Health Services for the Aged , Program Development , Life StyleABSTRACT
El libro presenta, con un enfoque integrado y actualizado, diversos temas relacionados con la salud y bienestar del anciano. Va dirigido a todos los responsables de la atención directa de este grupo y de tomar decisiones que sirvan de base para la adopción de políticas pertinentes. Como dice el prólogo: "El rápido envejecimiento de la población en los países en desarrollo, la identificación de necesidades específicas en la población anciana, ciertas circunstancias desestabilizadoras de la vida actual y futura (migración a las ciudades, desempleo y subdesempleo, fallas en los sistemas de seguridad social, reducción del tamaño de las familias, entre otras) y las limitaciones en el crecimiento económico constituyen poderosas razones para que los gobiernos y las organizaciones nacionales e internacionales, gubernamentales y no gubernamentales, relacionadas con el bienestar y la salud de las sociedades, se interesen y trabajen entusiasta y coordinadamente en favor de las personas de edad avanzada". La obra consta de 52 artículos, divididos en seis secciones, que cubren las siguientes áreas: el envejecimiento, la visión integral de los ancianos, principales aspectos de salud de los ancianos, bases para la atención de los ancianos, promoción del bienestar de los ancianos y perspectivas
Subject(s)
Health of the Elderly , Old Age Assistance , Aging , Health Services for the Aged , Quality of Health Care , Population Dynamics , Latin AmericaABSTRACT
El libro presenta, con un enfoque integrado y actualizado, diversos temas relacionados con la salud y bienestar del anciano. Va dirigido a todos los responsables de la atención directa de este grupo y de tomar decisiones que sirvan de base para la adopcion de políticas pertinentes. Como dice el prologo: "El rapido envejecimiento de la poblacion en los países en desarrollo, la identificacion de necesidades especificas en la poblacion anciana, ciertas circunstancias desestabilizadoras de la vida actual y futura (migracion a las ciudades, desempleo y subdesempleo, fallas en los sistemas de seguridad social, reduccion del tamano de las familias, entre otras) y las limitaciones en el crecimiento económico constituyen poderosas razones para que los gobiernos y las organizaciónes nacionales e internacionales, gubernamentales y no gubernamentales, relacionadas con el bienestar y la salud de las sociedades, se interesen y trabajen entusiasta y coordinadamente en favor de las personas de edad avanzada". La obra consta de 52 articulos, divididos en seis secciones, que cubren las siguientes áreas: el envejecimiento, la vision integral de los ancianos, principales aspectos de salud de los ancianos, bases para la atención de los ancianos, promocion del bienestar de los ancianos y perspectivas
Subject(s)
Old Age Assistance , Aging , Health of the Elderly , Latin America , Quality of Health Care , Population Dynamics , Health Services for the AgedABSTRACT
Este artículo trata el caso en Puerto Rico, país con una fuerte tradición cultural latinoamericana al que, sin embargo, le unen estrechos lazos económicos y políticos con los Estados Unidos de América. Se analizan los sistemas de apoyo del anciano y la asistencia desde la perspectiva de las hijas. Se concluye que la mujer puertorriqueña de edad mediana que desempeña el papel de proveedora principal de la atención de sus padres ancianos se enfrenta con mayores situaciones de conflicto que las que enfrentaron sus madres y sus abuelas al atender a sus parientes de edad avanzada. Las presiones impuestas son mayores en el caso de las mujeres que a su vez son cabezas de familia. La planificación de servicios geronto-geriátricos debe partir de la premisa de una diversidad de opciones que faciliten una responsabilidad compartida entre el Estado y la familia, y que redunden en la satisfacción adecuada de las necesidades particulares de los ancianos y de las personas que asumen el papel de cuidador principal en la familia, que por lo común son las mujeres
Subject(s)
Humans , Female , Aged , Caregivers/trends , Old Age Assistance/trends , Women/psychology , Puerto RicoABSTRACT
Este artículo presenta una visión de las principales características sociodemográficas y de salud de los ancianos de Puerto Rico al igual que de suis patrones en la utilización de servicios de salud. Se establecen comparaciones entre varones y hembras. Los ancianos rrepresentan un grupo con escasos recursos económicos, tienen un nivel educativo más bajo y sufren de un mayor número de enfermedades crónicas que el resto de la población. Las mujeres están en desventaja al compararse con los hombres en términos de estas características. Las implicaciones del reto que representan los ancianos para el sistema de prestación de servicios de salud en Puerto Rico son discutidas partienfdo de la realidad de que la mayoría vive en la comunidad y la familia representa su principal fuente de sostén
Subject(s)
Humans , Aged , Male , Female , Health Services for the Aged , Cause of Death , Chronic Disease , Demography , Health Status Indicators , Puerto Rico , Sex Factors , Social Support , Socioeconomic FactorsABSTRACT
This article presents a qualitative analysis of the informal networks of support of older. Puerto Rican women. It focuses on the support offered by adult children to their aged mothers. Cultural definitions about female and male roles affect the types of exchange that occur within the family. The elderly mothers expect and receive more help from their daughters than their sons. The daughters feel pleased by the fact that they are able to assist their mothers yet, many indicated that in certain occasions they feed stress
