摘要:

Investigators in population-based studies confront unique ethical challenges due to the community context of their research, their methods of inquiry, and the implications of their findings for social groups. Issues surrounding requirements for informed consent, the protection of privacy and confidentiality, and relationships between investigators and participants take on greater complexity and have significance beyond the individual research subject. In this paper, ethical challenges associated with community-based epidemiological research are briefly examined. We argue that ethically responsible population-based studies must seriously consider community needs and priorities and that researchers should work collaboratively with local populations to implement study goals. Strategies that promote respect for populations in community-based studies are outlined. These include community participation in research development, implementation and interpretation; adequate provision of information about study objectives to community members; and systematic feedback of study results.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The legitimate and successful recruitment of minorities as research participants in clinical trials should be addressed from an ethical and historical perspective. To gain an appreciation of the challenges, to develop strategies and to overcome the disparities of minority involvement in clinic trials, it is essential to be cognizant of previous violations and abuses of ethics and human rights. Also significant are major legislation, regulations and federal initiatives that resulted from those abuses. From history, we have learned we cannot generalize data and assume that, if we have the majority group in clinical trials, then we can accurately apply that data to minorities. There are cultural and environmental differences; thus, it is absolutely crucial that researchers approach recruitment of minority groups with cultural competence and cultural sensitivity. Federal regulations and legislation set the framework for protection of human participants in research.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The science and technology enterprise of the United States has consistently produced seminal work and cutting-edge technologies. It has responded promptly to both new opportunities and urgent crises. The success of this enterprise derives largely from the diversity of the types of institutions doing the work and from the many sources of public and private funding available to accomplish it. To those who argue that public-sector funds should support only the best science at the premier research institutions on the nation’s East and West coasts, Dr. Rita Colwell, the director of the National Science Foundation (NSF) eloquently responds, “No one region, no one group of institutions, and no special communities have a corner on the market of good and great ideas, smart people, or outstanding researchers. Great ideas can come from just about anywhere.”

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The Robert Wood Johnson Foundation (RWJF) is the nation’s largest philanthropy devoted to health. The foundation long has been concerned about increasing diversity in the health professions. Between 1972 and 1981, grants totaling nearly $6.7 million were made to medical, medical/dental schools, or other educational organizations to support minority students. Funds enabled students who were interested in applying to medical or dental school to enroll in special preparatory courses. Most students were African American. One program, however, targeted US Puerto Rican students and other Hispanic students. Nearly 2500 students enrolled in these preapplication enrichment programs. Data reported to the foundation on medical or dental school acceptance for 1959 of these students indicated that 57% of students were successful. An additional $10.5 million in grants were awarded during this period: $2.5 million to provide scholarships for minority group medical students, $580,000 to support preceptorships with minority physicians/mentors, and $7.5 million to strengthen Meharry Medical College’s Comprehensive Primary Care Health Science Program. In the early 1980s, the RWJF Board of Trustees considered a series of staff analyses, which resulted in additional direct support to historically black medical schools, including Meharry and those at Drew University and Morehouse College. These analyses also set the stage for two RWJF programs, the Minority Medical Faculty Development Program and the Minority Medical Education Program, which exist today. This article describes these programs, along with the more recent Health Professions Partners Initiative, and offers reflection and analysis about their impact on diversity in the medical profession.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

In January 2000, the Healthy People 2010 initiative was introduced by the US Department of Health and Human Services (DHHS), which set the nation’s health goals for the coming decade. In 1990, a previous DHHS administration had released the Healthy People 2000 initiative, which set goals to be met by the year 2000. In 1979, the first set of health goals for the nation was released, titled Healthy People. Thus, Healthy People 2010 is the third iteration of such goals. This effort has achieved momentum and indeed is paying off handsomely. The framework of the Healthy People initiatives, however, is just one gauge of US public health care status; it and a myriad of other programs and studies in recent decades reflect the gains and shortcomings of our complex health care system. In several areas, minority health disparities continue to be the weakness in our capacity building to achieve the nation’s health goals.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The Bogalusa Heart Study, a long-term population study with a continued relationship with a community, addresses the problem of capacity building in minority health research. The study was originally funded as a Specialized Center of Research—Arteriosclerosis (SCOR-A) by the National Heart Lung and Blood Institute (NHLBI). These centers were to conduct research on atherosclerosis, coronary artery disease (CAD), hypertension, diabetes mellitus, and complications of cardiovascular-renal disease as the major causes of deaths in the United States. From earlier research on atherosclerosis, we became interested in the underlying characteristics in early life that would eventually lead to clinical morbidity and mortality from heart disease.1–3An observation at autopsy showed the degree of atherosclerotic involvement in human aortas, from young to older individuals (Figure 1). For example, at age 40 years, marked individual variability occurred in the severity and involvement with atherosclerotic disease. Some individuals showed very little disease, while almost 70% of the surface was diseased in others. Further studies on arterial wall matrix showed aortas from young individuals varied with the extent of disease and its chemical composition. This background stimulated an interest in studying children for early clinical evidence of major adult heart diseases. The Bogalusa Heart Study was begun in 1972 as an epidemiology study of cardiovascular risk factors in children and adolescents; it eventually evolved into observations of young adults. Bogalusa, LA, is a biracial (black/white) rural community 70 miles north of New Orleans, comparable to many other communities in southeastern United States.Figure 1. Atherosclerosis of aortas by age. Autopsy observations on individuals dying at Charity Hospital of New Orleans. The extensiveness of atherosclerosis is shown related to age. Note that at a given age, for example 40 years, a tremendous variability of the degrees of atherosclerosis. (Used with permission.)

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The increased prevalence of obesity among African-American women makes it likely that they bear a disproportionate burden of comorbidities attributable to obesity, such as diabetes, hypertension, and hyperlipemia. These observations suggest that intensive efforts to prevent obesity should be directed at this group. This presentation provides a summary of the findings of focus groups that convened prior to the Sisters Together, Move More, Eat Better campaign in Boston. This pilot campaign was designed to increase awareness of the importance of healthy eating and physical activity among young adult African-American women. In addition, data collected by the Division of Nutrition and Physical Activity of the US Centers for Disease Control and Prevention (CDC) provide additional information about attitudes toward diet and physical activity among African American youth. Such data are essential to understand the attitudinal changes necessary to prevent obesity in these vulnerable populations.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Cardiovascular mortality has continued to decline, but racial disparities in cardiovascular diseases (CVD) continue to grow. To build the capacity to address these racial disparities, two things will be required. First, a research and policy infrastructure must be in place to provide guidance on what to do and how to do it. Second, the will to implement and activate this infrastructure must be present at the community and policy-making levels. The Jackson Heart Study is an example of a research infrastructure with the economic resources, scientific expertise, and technical manpower required to monitor, organize, assess, and follow a cohort of individuals over time to study the burden, natural history, predictive factors, and level of care for CVD in an African American community. The creation of will within the community for CVD research may require additional strategies than in the majority community, such as community organization and local policy development. These additional efforts at the community level should create a fertile environment to develop research and, ultimately, test strategies for reducing national disparities in cardiovascular health.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The Strong Heart Study (SHS) is a large, multi-community study to investigate the high incidence of cardiovascular disease (CVD) among American Indians and to improve long-term health outcomes within the communities. CVD is the No. 1 cause of death for three geographically and culturally diverse American Indian populations. The SHS investigated the prevalence and incidence of CVD as well as the distribution of risk factors in members of 13 American Indian tribes in Oklahoma, Arizona, and (as one region) North and South Dakota. The SHS enrolled more than 4500 participants ranging in age from 45 to 74 years. During the three-phase study, which began with baseline examinations from 1989 through 1991 and concluded in 1999, participants received medical examinations in each phase. To build trust and cooperation, SHS investigators worked closely with tribal leaders and community members, including establishing empowered committees and hiring community members for jobs within the study. As a result of such cooperation, the SHS maintained retention rates of about 90% across all three phases. Benefits to tribal communities also included health care improvements and education for healthy lifestyles. The SHS could serve as a model for similar studies of American Indians or other minority groups.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID