Disparities in transplant rates across social categories provide limited information about gatekeeping processes in access to kidney transplantation. We hypothesized that…
Disparities in transplant rates across social categories provide limited information about gatekeeping processes in access to kidney transplantation. We hypothesized that early opportunities for discussion of kidney transplantation potentially generate social capital that serves as a resource for patients as they navigate the transplantation pathway.
A national sample of first-year dialysis patients was surveyed and asked if kidney transplantation had been discussed with them before and after starting dialysis treatment. Associations between reported discussion and patient-specific clinical and nonclinical (sociodemographic) indicators of attributed utility for transplantation were investigated, and the association of reported transplant discussion with subsequent transplant waitlisting was analyzed.
Time to placement on the kidney transplant waiting list was significantly shorter for patients who reported that transplantation had been discussed with them before, as well as after, starting dialysis. Likelihood of reported discussion varied by patient age, employment and insurance status, cardiovascular comorbidity burden, and perceived health status; in addition, women were less likely to report early discussion.
It would be valuable to know more about the nature of the transplant discussions recalled by patients to better understand how social capital may be fostered through these discussions.
Indicators of attributed utility for successful transplantation were associated with transplant discussion both before and after starting dialysis, potentially contributing to observed disparities in access to kidney transplantation.
Predialysis nephrology care and patient participation in discussion of kidney transplantation may foster social capital that facilitates navigating the transplantation pathway.
Health promotion and rehabilitation models of care are valuable for persons with chronic health conditions, but when these individuals are dependent on a life-maintaining technology, such as kidney dialysis, a cure-oriented model may dominate the system within which they receive care. Providers can preserve their monopoly over expert treatment knowledge by defining the key care issues, by limiting patients’ access to expert knowledge, and by discrediting the patient as a responsible actor. Multiple care paradigms can benefit patients with chronic conditions, however, empowering the patient-actor to collaborate with the clinician to maximize functioning and well-being as well as patient survival.
Socioeconomic status (SES) is a fundamental social cause of disease. The association of SES with chronic renal failure has received limited study. Older persons and blacks…
Socioeconomic status (SES) is a fundamental social cause of disease. The association of SES with chronic renal failure has received limited study. Older persons and blacks are at significantly increased risk for this health condition, which is also known as end-stage renal disease (ESRD). Among ESRD cases and controls aged 56-88, we investigated whether SES was predictive of ESRD, independent of subjects' race, sex, age, and history of diabetes. Our SES measure combined information about individuals' education and occupation. In race-specific logistic regression models, there was a trend for higher SES to be protective against ESRD. In a combined model, controlling for the effects of race, sex, age, and diabetes, the SES effect was statistically significant. Diabetes and hypertension, important ESRD risk factors, are also related to SES. The adverse “effect” of black race on a health outcome like ESRD may be expressed preferentially among economically disadvantaged persons. Improved understanding of race, SES, and age vis-à-vis a chronic condition such as ESRD requires studies in which cohort changes in health, resources, access to care, and service utilization are monitored longitudinally and analyzed using a life course perspective.
Late nephrology referral, a problem currently identified across many high income countries, has been associated with reduced opportunities for delaying or halting the…
Late nephrology referral, a problem currently identified across many high income countries, has been associated with reduced opportunities for delaying or halting the progression of chronic kidney disease (CKD), delayed dialysis initiation, reduced choice in treatment modality, increased morbidity and hospitalization, and premature death. Despite a recent finding that the progression of CKD nearly always presents warning signs, and despite the fact that all Canadians are entitled to receive medically necessary health care free at the point of patient entry, each year in the province of British Columbia (BC) a substantial number of people with CKD experience late or no referral to nephrology care prior to requiring renal replacement therapy. A subset of these CKD patients experience no referral and “crash” onto dialysis (experience an acute or emergent start). Existing research has not fully explored the range of potential health determinants that may affect the timing of nephrology referral. This paper adopts a “determinants of health” framework and assesses the impact of a variety of indicators on patients’ physical health, demographics, socioeconomic status, social support, geographic and health system characteristics. Using a late referral definition of <3 months and data on BC patients who began dialysis between April 2000 and March 2003, multiple regression analysis indicates that the following determinants have an independent effect on the timing of referral: cause of end-stage renal disease (p=<0.0001); age (p=<0.0001); race/ethnicity (p=0.0019); English ability (p=0.0158); marital status (p=0.0202); proximity to care (p=0.0118); and, “age by first language” (p=0.0244).
The purpose of this paper is to understand the impact of American culture-oriented values, Chinese culture-oriented values and self-improvement values on luxury value…
The purpose of this paper is to understand the impact of American culture-oriented values, Chinese culture-oriented values and self-improvement values on luxury value perception through acculturation by examining an acculturated sample (Chinese living in the USA), a host cultural sample (Caucasian-American) and a home cultural sample (Mainland Chinese).
In order to examine the acculturative changes of Chinese living in the USA in terms of the influence of American and Chinese culture-oriented values and self-improvement values on their luxury value perception, data were collected via three online samples: host (American), home cultural (Chinese) and acculturated (Chinese living in the USA). Effects of acculturation were tested via comparisons between acculturated to host and home cultural samples.
Compared to that of Mainland Chinese and Caucasian-Americans, luxury value perception of Chinese living in the USA is jointly influenced by both American and Chinese culture-oriented values. The influence of cultural values on luxury value perception of Chinese living in the USA is not strengthened by their wish to integrate into the American culture or to maintain their Chinese culture. Nevertheless, Chinese living in the USA show more significant self-improvement (standing out) and conformity (fitting in) motives in luxury value perception when they wish to integrate into the mainstream culture.
The authors surveyed acculturated sample, host and home cultural samples to test the bidimensional acculturation model (Berry, 1997) in the context of luxury consumption. Although the conceptual model is not fully supported, this research broadens current understanding of the effect of acculturation on luxury value perception.
The purpose of this paper is to provide a selected bibliography of recent resources on library instruction and information literacy.
Introduces and annotates periodical articles, monographs, and audiovisual material examining library instruction and information literacy.
Provides information about each source, discusses the characteristics of current scholarship, and describes sources that contain unique scholarly contributions and quality reproductions.
The information may be used by librarians and interested parties as a quick reference to literature on library instruction and information literacy.