A presentation about intercultural encounters within the healthcare relationship. This presentation was give, specifically, to allied health professional students.
Advancing the field of cultural competency by providing the first structural competency certificate program in the country. Online, on-demand and FREE, including free continuing education credits. Live trainings coming soon. Give me a call!
View the video here: https://www.youtube.com/watch?v=gCMCNReYnYs
Earn counseling CEUs here: https://www.allceus.com/member/cart/index/product/id/684/c/
Assumption 1: Counselors will not be able to sustain culturally responsive treatment without the organization's commitment to it.
Assumption 2: An understanding of race, ethnicity, and culture (including one's own) is necessary to appreciate the diversity of human dynamics and to treat all clients effectively
Assumption 3: Incorporating cultural competence into treatment improves therapeutic decision-making and offers alternate ways to define and plan a treatment program that is firmly directed toward progress and recovery
Assumption 4: Consideration of culture is important at all levels of operation—individual, programmatic, and organizational
Assumption 5: Culturally congruent interventions cannot be successfully applied when generated outside a community or without community participation.
Assumption 6: Public advocacy of culturally responsive practices can increase trust among the community, agency, and staff.
A presentation about intercultural encounters within the healthcare relationship. This presentation was give, specifically, to allied health professional students.
Advancing the field of cultural competency by providing the first structural competency certificate program in the country. Online, on-demand and FREE, including free continuing education credits. Live trainings coming soon. Give me a call!
View the video here: https://www.youtube.com/watch?v=gCMCNReYnYs
Earn counseling CEUs here: https://www.allceus.com/member/cart/index/product/id/684/c/
Assumption 1: Counselors will not be able to sustain culturally responsive treatment without the organization's commitment to it.
Assumption 2: An understanding of race, ethnicity, and culture (including one's own) is necessary to appreciate the diversity of human dynamics and to treat all clients effectively
Assumption 3: Incorporating cultural competence into treatment improves therapeutic decision-making and offers alternate ways to define and plan a treatment program that is firmly directed toward progress and recovery
Assumption 4: Consideration of culture is important at all levels of operation—individual, programmatic, and organizational
Assumption 5: Culturally congruent interventions cannot be successfully applied when generated outside a community or without community participation.
Assumption 6: Public advocacy of culturally responsive practices can increase trust among the community, agency, and staff.
Contextual factors in mental health.pptxpoojadesai100
This presentation is based on occupational therapy frameworks. It will provide detail insight into environment or context for the assessment and intervention in mental health disorders.
Read Theory and Practice of Counseling and Psychotherapy, pages.docxdanas19
Read:
Theory and Practice of Counseling and Psychotherapy
, pages 43-45; and
Addressing Diverse Populations in Intensive Outpatient Treatment
I have attached additional reading material, I need this by Thursday,
Serving Special Populations
After completing the reading for this unit, what do you think is the greatest obstacle facing special populations in addiction treatment? What will you do as a counselor to ensure that all of your clients receive the best treatment possible?
Your paper is to be in APA format, 1-2 pages, and include sources. Please see
paper guidelines
for explanation of requirements.
Addressing Diverse Populations in Intensive Outpatient Treatment
1. Introduction
1. Introduction
Culture is important in substance abuse treatment because clients' experiences of culture precede and influence their clinical experience. Treatment setting, coping styles, social supports, stigma attached to substance use disorders, even whether an individual seeks help--all are influenced by a client's culture. Culture needs to be understood as a broad concept that refers to a shared set of beliefs, norms, and values among any group of people, whether based on ethnicity or on a shared affiliation and identity.
Retrieved from,
Substance Abuse: Clinical Issues in Intensive Outpatient Treatment
, Center for Substance Abuse Treatment (2006).
2. What It Means To Be a Culturally Competent Clinician
It is agreed widely in the health care field that an individual's culture is a critical factor to be considered in treatment. The Surgeon General's report, Mental Health: Culture, Race, and Ethnicity, states, "Substantive data from consumer and family self-reports, ethnic match, and ethnic-specific services outcome studies suggest that tailoring services to the specific needs of these [ethnic] groups will improve utilization and outcomes” (U.S. Department of Health and Human Services 2001, p. 36). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994) calls on clinicians to understand how their relationship with the client is affected by cultural differences and sets up a framework for reviewing the effects of culture on each client.
Because verbal communication and the therapeutic alliance are distinguishing features of treatment for both substance use and mental disorders, the issue of culture is significant for treatment in both fields. The therapeutic alliance should be informed by the clinician's understanding of the client's cultural identity, social supports, self-esteem, and reluctance about treatment resulting from social stigma. A common theme in culturally competent care is that the treatment provider--not the person seeking treatment--is responsible for ensuring that treatment is effective for diverse clients.
Meeting the needs of diverse clients involves two components: (1) understanding how to work with persons from different cultures and (2) understandi.
This presentation deals with principles of basic communication skills, importance of it for Doctors and medical students. It also addresses the basic elements Doctor patient communication skills, kalmazoo Consensus working model for Clinical interview, 5 A model guidelines for the behaviour changes.
June 1, 2018
Historically and across societies people with disabilities have been stigmatized and excluded from social opportunities on a variety of culturally specific grounds. These justifications include assertions that people with disabilities are biologically defective, less than capable, costly, suffering, or fundamentally inappropriate for social inclusion. Rethinking the idea of disability so as to detach being disabled from inescapable disadvantage has been considered a key to twenty-first century reconstruction of how disablement is best understood.
Such ‘destigmatizing’ has prompted hot contestation about disability. Bioethicists in the ‘destigmatizing’ camp have lined up to present non-normative accounts, ranging from modest to audacious, that characterize disablement as “mere difference” or in other neutral terms. The arguments for their approach range from applications of standards for epistemic justice to insights provided by evolutionary biology. Conversely, other bioethicists vehemently reject such non-normative or “mere difference” accounts, arguing instead for a “bad difference” stance. “Bad difference” proponents contend that our strongest intuitions make us weigh disability negatively. Furthermore, they warn, destigmatizing disability could be dangerous because social support for medical programs that prevent or cure disability is predicated on disability’s being a condition that it is rational to avoid. Construing disability as normatively neutral thus could undermine the premises for resource support, access priorities, and cultural mores on which the practice of medicine depends.
The “mere difference” vs. “bad difference” debate can have serious implications for legal and policy treatment of disability, and shape strategies for allocating and accessing health care. For example, the framing of disability impacts the implementation of the Americans with Disabilities Act, Section 1557 of the Affordable Care Act, and other legal tools designed to address discrimination. The characterization of disability also has health care allocation and accessibility ramifications, such as the treatment of preexisting condition preclusions in health insurance. The aim of this conference was to construct a twenty-first century conception of disablement that resolves the tension about whether being disabled is merely neutral or must be bad, examines and articulates the clinical, philosophical, and practical implications of that determination, and attempts to integrate these conclusions into medical and legal practices.
Learn more: http://petrieflom.law.harvard.edu/events/details/2018-petrie-flom-center-annual-conference
Cultural Competence And Global Health Workersguest1a0563
By actively acknowledging the role that language and culture play in health care interactions, health care institutions can play an important role in easing the integration of global health workers into their organizations, and can harness their deep cultural knowledge to improve the quality of care for the increasing number of patients who come from other countries and cultural and linguistic backgrounds.
1 postsRe Topic 3 DQ 2Community health nurses must be c.docxaulasnilda
1 posts
Re: Topic 3 DQ 2
Community health nurses must be culturally compliant to provide the most adequate and highest level of quality care. Understanding certain feelings and recognizing these is the first step for the nurse to put aside stereotypes and bias. Most of the time, they are learned behaviors prior to nursing. Stereotyping in nursing is a preconceived assumption regarding a certain group of people; this, in turn, leads to various personal feelings built upon that stereotype resulting in being bias. In health care, these feelings can lead to implicit bias feelings we unconsciously display towards patients and can impact patient care (Falkner, 2018). It is challenging for nurses not to be biased against one group or the other due to the fact that medically and scientifically there are certain groups or populations that certain condition/diseases are more prevalent than others, but "jumping the gun" per say could result in false diagnosis or inadequate treatments (Puddifoot, 2019). Community nurses must take into account the scientific and medical data related to each and every individual.
Campinha-Bacote and Munoz (2001) proposed a five-component model for developing cultural competence: Cultural awareness, Cultural knowledge, Cultural skill, Cultural encounters, and Cultural desire. One important way for nurses to achieve cultural competence and promote respect is to challenge our own beliefs and ask better questions regarding our patient populations. For example, nurses should avoid unintentionally stereotyping a patient into a specific cultural or ethnic group based on characteristics like outward appearance, race, country of origin or religious preference. Additionally, many subcultures and variations can exist within a cultural or ethnic group. For instance, the term Asian-American includes cultures such as Chinese, Japanese, Taiwanese, Filipino, Korean and Vietnamese, and within these cultures, there are variations in a geographic region, religion, language, family structure and more.
Using 200-300 APA format with references to support the discussion.
How should the nurse address these concepts to ensure health promotion activities are culturally competent? Propose strategies that you can employ to reduce cultural dissonance and bias to deliver culturally competent care. Include an evidence-based article that address the cultural issue
.
Contextual factors in mental health.pptxpoojadesai100
This presentation is based on occupational therapy frameworks. It will provide detail insight into environment or context for the assessment and intervention in mental health disorders.
Read Theory and Practice of Counseling and Psychotherapy, pages.docxdanas19
Read:
Theory and Practice of Counseling and Psychotherapy
, pages 43-45; and
Addressing Diverse Populations in Intensive Outpatient Treatment
I have attached additional reading material, I need this by Thursday,
Serving Special Populations
After completing the reading for this unit, what do you think is the greatest obstacle facing special populations in addiction treatment? What will you do as a counselor to ensure that all of your clients receive the best treatment possible?
Your paper is to be in APA format, 1-2 pages, and include sources. Please see
paper guidelines
for explanation of requirements.
Addressing Diverse Populations in Intensive Outpatient Treatment
1. Introduction
1. Introduction
Culture is important in substance abuse treatment because clients' experiences of culture precede and influence their clinical experience. Treatment setting, coping styles, social supports, stigma attached to substance use disorders, even whether an individual seeks help--all are influenced by a client's culture. Culture needs to be understood as a broad concept that refers to a shared set of beliefs, norms, and values among any group of people, whether based on ethnicity or on a shared affiliation and identity.
Retrieved from,
Substance Abuse: Clinical Issues in Intensive Outpatient Treatment
, Center for Substance Abuse Treatment (2006).
2. What It Means To Be a Culturally Competent Clinician
It is agreed widely in the health care field that an individual's culture is a critical factor to be considered in treatment. The Surgeon General's report, Mental Health: Culture, Race, and Ethnicity, states, "Substantive data from consumer and family self-reports, ethnic match, and ethnic-specific services outcome studies suggest that tailoring services to the specific needs of these [ethnic] groups will improve utilization and outcomes” (U.S. Department of Health and Human Services 2001, p. 36). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994) calls on clinicians to understand how their relationship with the client is affected by cultural differences and sets up a framework for reviewing the effects of culture on each client.
Because verbal communication and the therapeutic alliance are distinguishing features of treatment for both substance use and mental disorders, the issue of culture is significant for treatment in both fields. The therapeutic alliance should be informed by the clinician's understanding of the client's cultural identity, social supports, self-esteem, and reluctance about treatment resulting from social stigma. A common theme in culturally competent care is that the treatment provider--not the person seeking treatment--is responsible for ensuring that treatment is effective for diverse clients.
Meeting the needs of diverse clients involves two components: (1) understanding how to work with persons from different cultures and (2) understandi.
This presentation deals with principles of basic communication skills, importance of it for Doctors and medical students. It also addresses the basic elements Doctor patient communication skills, kalmazoo Consensus working model for Clinical interview, 5 A model guidelines for the behaviour changes.
June 1, 2018
Historically and across societies people with disabilities have been stigmatized and excluded from social opportunities on a variety of culturally specific grounds. These justifications include assertions that people with disabilities are biologically defective, less than capable, costly, suffering, or fundamentally inappropriate for social inclusion. Rethinking the idea of disability so as to detach being disabled from inescapable disadvantage has been considered a key to twenty-first century reconstruction of how disablement is best understood.
Such ‘destigmatizing’ has prompted hot contestation about disability. Bioethicists in the ‘destigmatizing’ camp have lined up to present non-normative accounts, ranging from modest to audacious, that characterize disablement as “mere difference” or in other neutral terms. The arguments for their approach range from applications of standards for epistemic justice to insights provided by evolutionary biology. Conversely, other bioethicists vehemently reject such non-normative or “mere difference” accounts, arguing instead for a “bad difference” stance. “Bad difference” proponents contend that our strongest intuitions make us weigh disability negatively. Furthermore, they warn, destigmatizing disability could be dangerous because social support for medical programs that prevent or cure disability is predicated on disability’s being a condition that it is rational to avoid. Construing disability as normatively neutral thus could undermine the premises for resource support, access priorities, and cultural mores on which the practice of medicine depends.
The “mere difference” vs. “bad difference” debate can have serious implications for legal and policy treatment of disability, and shape strategies for allocating and accessing health care. For example, the framing of disability impacts the implementation of the Americans with Disabilities Act, Section 1557 of the Affordable Care Act, and other legal tools designed to address discrimination. The characterization of disability also has health care allocation and accessibility ramifications, such as the treatment of preexisting condition preclusions in health insurance. The aim of this conference was to construct a twenty-first century conception of disablement that resolves the tension about whether being disabled is merely neutral or must be bad, examines and articulates the clinical, philosophical, and practical implications of that determination, and attempts to integrate these conclusions into medical and legal practices.
Learn more: http://petrieflom.law.harvard.edu/events/details/2018-petrie-flom-center-annual-conference
Cultural Competence And Global Health Workersguest1a0563
By actively acknowledging the role that language and culture play in health care interactions, health care institutions can play an important role in easing the integration of global health workers into their organizations, and can harness their deep cultural knowledge to improve the quality of care for the increasing number of patients who come from other countries and cultural and linguistic backgrounds.
1 postsRe Topic 3 DQ 2Community health nurses must be c.docxaulasnilda
1 posts
Re: Topic 3 DQ 2
Community health nurses must be culturally compliant to provide the most adequate and highest level of quality care. Understanding certain feelings and recognizing these is the first step for the nurse to put aside stereotypes and bias. Most of the time, they are learned behaviors prior to nursing. Stereotyping in nursing is a preconceived assumption regarding a certain group of people; this, in turn, leads to various personal feelings built upon that stereotype resulting in being bias. In health care, these feelings can lead to implicit bias feelings we unconsciously display towards patients and can impact patient care (Falkner, 2018). It is challenging for nurses not to be biased against one group or the other due to the fact that medically and scientifically there are certain groups or populations that certain condition/diseases are more prevalent than others, but "jumping the gun" per say could result in false diagnosis or inadequate treatments (Puddifoot, 2019). Community nurses must take into account the scientific and medical data related to each and every individual.
Campinha-Bacote and Munoz (2001) proposed a five-component model for developing cultural competence: Cultural awareness, Cultural knowledge, Cultural skill, Cultural encounters, and Cultural desire. One important way for nurses to achieve cultural competence and promote respect is to challenge our own beliefs and ask better questions regarding our patient populations. For example, nurses should avoid unintentionally stereotyping a patient into a specific cultural or ethnic group based on characteristics like outward appearance, race, country of origin or religious preference. Additionally, many subcultures and variations can exist within a cultural or ethnic group. For instance, the term Asian-American includes cultures such as Chinese, Japanese, Taiwanese, Filipino, Korean and Vietnamese, and within these cultures, there are variations in a geographic region, religion, language, family structure and more.
Using 200-300 APA format with references to support the discussion.
How should the nurse address these concepts to ensure health promotion activities are culturally competent? Propose strategies that you can employ to reduce cultural dissonance and bias to deliver culturally competent care. Include an evidence-based article that address the cultural issue
.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. Cross Cultural Care and Education in
Geriatrics
Jerry Johnson, M.D.
Professor of Medicine
University of Pennsylvania
2. Objectives
Overall Goal: Preparation to Teach Cross Cultural
Aspects of Geriatrics
Anticipate predictable challenges
Relate your teaching content to the domains of cross
cultural interactions
Apply mnemonics for interactions with patients and
caregivers
Use diverse approaches to teaching
Identify resources for education and learning
3. Crossing the Quality Chasm
“The system by which health care is delivered
and financed must be designed to ensure that care
is safe, effective, efficient, equitable, timely, and
tailored to each individual’s specific needs and
circumstances.”
- Institute of Medicine Report, 2001
4. Cultural diversity
training
programs for
providers
Increase provider
sensitivity to attitudes
and beliefs which
marginalize ethnic
groups
Analytic Framework: Cultural Diversity
Training for Providers
Increase provider
knowledge of
culturally-based
beliefs and behaviors
Decrease differential
treatment due to
unconscious
discrimination
Increase use of
culturally appropriate
health care interventions
Improved
health status
outcomes
Greater
satisfaction
with care
Decrease ethic
differentials
in utilization
and treatment
Increase provider
abilities and strategies
for cross-cultural
interactions
Greater client
adherence to
care and treatment
recommendations
5. Challenges of Cross-cultural Care
Defining the concept of culture
Concern about stereotyping, relevance and legitimacy
Cross cultural care overlaps with other aspects of clinical
care: professionalism, humanism
Multiple levels of cultural competence
the health professional- patient relationship
the health system
the community
6. What is Culture?
Acquired attitudes, values and beliefs or “unwritten rules
of behavior.”
Caveats
Culture is not synonymous with race or ethnicity,
but...
“Culture is not a fixed, knowable entity that guides
individuals’ behaviors in linear ways” (see Gregg J.
Losing Culture on the Way to Competence: the use and misuse
of culture in medical education. Acad Med 2006: 81: 542-547).
Culture is mutable and multiple.
8. Relevant Cultural Constructs
• The culture of the patient
• The culture of the practitioner
• The culture of the practitioner’s profession:
e.g. medicine, nursing, and social work.
• The culture of the workplace: health
system, institution, or other entity
9. Relevance of Group Identities
Each individual’s identity is partly determined by
group affiliation: gender, ethnicity, religion....
Preservation of these group identities for many is
a matter of self esteem
Group identity partly determines how others view
us and interact with us
Cox, Taylor . Cultural Diversity in Organizations. 1993
11. Content Areas Relevant to Interactions
Self awareness
World view
Causation or explanatory models
Spirituality
Complementary alternative medicine
Help-seeking behavior (community and family)
Language and health literacy
Historical, social and economic factors
CREATE SOME REPRESENTATIVE CASES
12. Case Example: Explanatory Model
and Alternative Healing
Depression in a 75 yo man, self explained by the
patient, and treated outside the formal health care
system.
13. Case Example: Spirituality
Woman with multiple admissions for CHF
accompanied by markedly elevated BP, who
believes her faith, not medications, will treat
HTN.
Woman dying of metastatic breast cancer who
wants chemotherapy as an example of “being
strong” and maintaining faith.
14. Case Example: Language issues
Russian speaking man admitted with pain and gait
dysfunction
15. Case Example: social and economic
factors
Woman with large family, inadequate funds,
under significant stress
17. Conceptual Framework
Emphasis on the illness and its context:
Kleinman’s questions: Eisenberg et al. Culture, illness, and
care: clinical lessons from anthropologic and cross cultural
research. 1978
Carillo et al. Cross cultural primary care: a patient based approach. Annal Int
Med 130:829, 1999
Explore the meaning of illness
Conduct a social context “review of systems”
Negotiate management
18. Kleinman’s Questions
1 What caused it?
2 Why now?
3 How affects you?
4 How severe is it?
5 What treatment?
6 What results expected?
7 What chief problem?
8 What do you fear most?
9 What duration?
20. Mnemonics for Cultural Interactions
LEARN
BELIEF
RESPECT
ETHNIC and ETHNICS
BATHE
ADHERE
Others
21. LEARN
Listen with sympathy and understanding to the
patient’s perception of the problem
Explain your perceptions of the problem
Acknowledge and discuss the differences and
similarities
Recommend treatment
Negotiate treatment
Berlin E. Western Journal of Med 1983; 139: 934-938
22. BELIEF
Health Beliefs (What caused your illness ?)
Explanation (Why did it happen?)
Learn (Help me understand your belief/opinion)
Impact (How is this illness affecting your life?)
Empathy (This must be very difficult for you)
Feelings (How are you feeling?)
23. RESPECT
Respect: a demonstrable attitude
Explanatory model: patient explanation of cause
Social cultural context: gender, migration status,
sexual orientation, economic group, history
Power differential: acknowledge it
Empathy: put into words
Concerns and fears: eliciting them
Therapeutic alliance and trust
24. ETHNIC and ETHNIC(S)
Explanation : What do you think is the reason for your
sx?
Treatment: What kinds of treatment have you tried, what
kinds of treatment do you want?
Healers: Advice from alternative healers?
Negotiate: discuss options and expected results
Intervention. Determine an intervention
Collaboration
Spirituality or Seniors
Levin, S. Ethnic. Patient Care 2000; 34 (9): 188-189
25. BATHE
Background (what is going on in your life?)
Affect (How do you feel?)
Trouble (What troubles you most?)
Handling (coping)
Empathy (That must be very difficult)
26. ADHERE
Acknowledge (need for treatment and joint goals)
Discuss (potential treatments and alternatives)
Handle (questions)
Evaluate (health literacy and barriers to
adherence)
Recommend (treatment)
Empower (the patient by listening)
27. General Tips in Cross Cultural Care
Avoid idioms
Use titles such as Mr. and Miss
Yes does not always mean yes
Be cautious of touching
Use trained interpreters when available
29. Large Group Exercises
Aging Panel: Who are the elderly
Working with interpreters-film
Spirituality panel and case discussions
CAM presentation with practitioners
30. Small Group Activities
Discussion sessions following large groups, often
with guests (seniors, chaplains)
Self awareness exercises
Introduction to the Physical Community
part of a home visitation course
Narrated van tour of West Philadelphia
Resident and fellow presentations in community sites
31. Faculty and Preceptor Education
One or two orientation sessions per year
Materials prepared with key readings and
discussion questions for small groups
Debriefings after small group sessions
32. Evaluation
Students: one or two page description of an
experience with presentation to peers in a small
group
Focus groups of trainees
Critique of presentations and sessions: value,
lessons learned
33. References and Materials
Full Curricula
UCSF: Culture and communication in health care, a
curriculum
TACCT: Tool for assessing cultural competence
training : a project initially privately funded, now
adopted by the AAMC
34. References and Materials
Monographs and articles
Doorway Thoughts-American Geriatrics Society
Ham and Sloan: Cased Based Primary Care Geriatrics,
chapters on Ethnic and Cultural Aspects of Geriatrics
(4th and 5th editions). Jerry Johnson
35. Other Resources for Teaching
Stanford: stanford.edu/group/ethnoger
HRSA website: cultural and linguistic competence
education:
www.hrsa.gov/culturalcompetence/curriculumguide
The California Endowment website
Kaiser Foundation website
Manager’s electronic resource center (ERC) a cultural
competence quiz produced by Management Sciences for
Health
36. Summary
Cultural differences are common and germane.
The process of inquiry, rather than knowing a set of facts
about a group, is fundamental.
Knowledge of critical domains can direct the interaction.
Several mnemonics are available.
Discussions and interactive exercises work.
Extensive resources on cross cultural care are available.
Culture matters
Editor's Notes
Awareness of deficiencies in quality were brought to the public’s attention with a report that claimed that health care is often of a poor quality
That report made recommendations in five areas: safety, effectiveness, efficiency, equity, and patient centered care.
So, if the chief quality officer said, we have established measures in each of the areas and now we are thinking about equity. WHAT WOULD YOU SAY?