Colorectal cancer disparities and African Americans: is it time to narrow the gap?

Colorectal cancer is the second most common cause of cancer death in both men and women. Although the overall incidence and mortality rates of colorectal cancer are declining, African Americans have significantly higher rates of colorectal cancer than Caucasians, and they have worse 5-year survival rates. This article reviews some of the contributing factors that lead to this racial disparity in colorectal cancer between these groups. The increase in poor health outcomes among African Americans is due to low socioeconomic standing, poor compliance, psychosocial barriers, and patient mistrust of healthcare providers and the healthcare system. Research on interventions to improve health outcomes is important to reduce the causes of these disparities. Keywords: colorectal cancer; screening; African Americans; Blacks; health disparities; interventions; public health

Facilitators and Barriers of Breastfeeding in Post-emergency Settlements: Qualitative Findings From Uganda

Objectives Suboptimal breastfeeding practices have been reported among vulnerable populations including those living in post-emergency refugee settlements. This study investigated the barriers and facilitators of breastfeeding in post-emergency settlements in Adjumani district, in the West Nile region in Uganda. Methods Participants included mothers and fathers of children less than 23 months of age who lived in post-emergency refugee settlements of Agojo, Ayilo, and Nyumanzi. Participants formed a total of five focus group discussions (FGDs); four FGDs for mothers and two FGDs for fathers. The FGDs were conducted in native languages, Dinka and Madi, and were audio-recorded. Data were transcribed verbatim and back-translated into English. Thematic analysis was used and data were analyzed using NVivo v. 12. Results The mean age (years) for mothers was 27.1 and 39.7 for fathers. Over half (61.9%) of mothers and many fathers (74.9%) received some formal education. Over a quarter (28.5%) of mothers attended less than 4 antenatal visits during their last pregnancy. Facilitators of breastfeeding included knowledge of breastfeeding benefits, support from husband/father, support from the community, and support from non-governmental organizations. Mothers and fathers reported that breastfeeding protected children from diseases and breasted children grow well. Four themes were identified as barriers of breastfeeding: physical, socioeconomic, knowledge, and psychosocial barriers. Mothers and fathers reported physical barriers such as mothers stop breastfeeding when they are sick or they feel they are not producing enough breastmilk. Mothers described socioeconomic barriers including working outside the home and educated mothers chose to use other milk. Fathers reported psychosocial barriers such as mothers’ fear of pain during breastfeeding and maternal mental health issues. Conclusions Policies and interventions that aim to improve breastfeeding in post-emergency settlements should consider addressing the barriers to breastfeeding at each level: physical, socioeconomic, knowledge, and psychosocial. Involving and encouraging support from husbands/fathers, relatives, and the community may increase adherence to breastfeeding recommendations. Funding Sources Thoma Chair, Oklahoma State University.

Psychosocial barriers and facilitators for a successful return to work following injury within firefighters

Objective The aim was to explore firefighter’s experiences during their recovery from injury. Focused specifically on exploring perceived psychosocial barriers and facilitators firefighters faced during recovery and return to work. Methods Semi-structured interviews were used to provide an in-depth understanding of the firefighter’s experiences. The semi-structured interviews were informed by a topic guide. The topic guide focused on five main themes, (1) overall experience of returning to operational duties following an injury, (2) perceived barriers experienced during their return to work, (3) perceived facilitators experienced during their return to work, (4) confidence in participating in physical activity following injury and (5) where they felt areas of improvement could be made with the return to work process. Thematic analysis of the data collected was undertaken using The Framework Method. Results Two main themes were sought after transcription: barriers and facilitators. From these, nine subthemes were identified (1) communication, (2) confidence in physical activity participation, (3) modified duties, (4) physiotherapy, (5) return to operational duties, (6) support, (7) inconsistency, (8) use of station gyms, (9) detachment from the watch. Conclusions Consideration should be made for the consistency of procedures followed during an individual’s return to work following an injury. Further research is needed to understand if the themes identified in this study are the same for other fire services. Further research is also needed to understand how the findings may be best implemented within the fire service.

Physical Activity Behaviors and Barriers in Multifetal Pregnancy: What to Expect When You’re Expecting More

The health benefits of prenatal physical activity (PA) are established for singleton pregnancies. In contrast, individuals with multifetal pregnancies (twins, triplets or more) are recommended to restrict or cease PA. The objectives of the current study were to determine behaviors and barriers to PA in multifetal pregnancies. Between 29 May and 24 July 2020, individuals with multifetal pregnancies participated in an online survey. Of the 415 respondents, there were 366 (88%) twin, 45 (11%) triplet and 4 (1%) quadruplet pregnancies. Twenty-seven percent (n = 104/388) of respondents completed no PA at all during pregnancy, 57% (n = 220/388) completed PA below current recommendations, and 16% (n = 64/388) achieved current recommendations (150-min per week of moderate-intensity activity). Most respondents (n = 314/363 [87%]) perceived barriers to PA during multifetal pregnancy. The most prominent were physical symptoms (n = 204/363 [56%]) and concerns about risks to fetal wellbeing (n = 128/363 [35%]). Sixty percent (n = 92/153) felt that these barriers could be overcome but expressed the need for evidence-based information regarding PA in multifetal pregnancy. Individuals with multifetal pregnancies have low engagement with current PA recommendations but remain physically active in some capacity. There are physical and psychosocial barriers to PA in multifetal pregnancy and future research should focus on how these can be removed.

Bariery nauki. Szkic o epistemologicznych granicach ludzkiego poznania

The article is devoted to the analysis of factors that prevent or limit the development of broadly understood science. The following types of limitations have been distinguished: psychosocial, biological, political, resource barriers and the final nature of science. Biological barriers lie in human sensory endowment. Psychosocial barriers are determined by the conditions of the functioning of human societies. Resource barriers are constraints on economic and energy reserves. The problem of the scope of science is understood as the finite scope of the mysteries of science itself – the fact of a limited number of possible discoveries.

Adolescent Organ Transplants: A Lifetime Commitment to Medication

Purpose: Medication non-adherence is the most prevalent issue within the adolescent population, where often times adolescent patients will face barriers to achieve adherence. This article sought out to present a narrative review of medication adherence barriers identified and reported in adolescent organ transplant patients, whilst providing potential adherence intervention methods. Method: A literature review was conducted using the databases PubMed, MasterFILE Premier*, Elsevier, and Google Scholar. The articles were chosen based on their relativity to the topic of medication adherence barriers and interventions in adolescent organ transplant patients. Also, a total of 11 different medical practitioners were contacted for an interview. Results: Twenty-six studies were chosen to be a part of this review, and based on the content of the studies, five barrier types were developed: “treatment-related barriers”, “psychosocial barriers”, “transition readiness barriers”, and “relationship barriers”. The literature review also identified various intervention methods for medication adherence in regards to education, behavior, relationships, and mental health interventions. One interview was conducted with a pediatric nephrologist. Conclusion: Based on these results it is important to acknowledge that there is not one common barrier among every patient, as each patient develops a unique set of barriers. The review recognized the importance of awareness on the vast possibilities of barriers rather than a generalized approach to adherence.

Environmental and Psychosocial Barriers Affect the Active Commuting to University in Chilean Students

Biking and walking are active commuting, which is considered an opportunity to create healthy habits. Objective: The purpose of this study was to determine the main environmental and psychosocial barriers perceived by students, leading to less Active Commuting (AC) to university and to not reaching the Physical Activity (PA) recommendations. Material and Methods: In this cross-sectional study, 1349 university students (637 men and 712 women) were selected. A self-reported questionnaire was applied to assess the mode of commuting, PA level and barriers to the use of the AC. Results: Women presented higher barriers associated with passive commuting than men. The main barriers for women were “involves too much planning” (OR: 5.25; 95% CI: 3.14–8.78), “It takes too much time” (OR: 4.62; 95% CI: 3.05–6.99) and “It takes too much physical effort “ (OR: 3.18; 95% CI: 2.05–4.94). In men, the main barriers were “It takes too much time” (OR: 4.22; 95% CI: 2.97–5.99), “involves too much planning” (OR: 2.49; 95% CI: 1.67–3.70) and “too much traffic along the route” (OR: 2.07; 95% CI: 1.47–2.93). Psychosocial barriers were found in both sexes. Conclusions: Psychosocial and personal barriers were more positively associated with passive commuting than environmental barriers. Interventions at the university are necessary to improve the perception of AC and encourage personal organization to travel more actively.

The psychosocial barriers to medication adherence of patients with type 2 diabetes: a qualitative study

Background The adherence of diabetic patients to their medication regimen is associated with many psychosocial factors that are still unknown. Therefore, the present study aims to identify the psychosocial barriers to medication adherence of patients with type2 diabetes (T2D). Methodology This descriptive qualitative study was done in Isfahan, Iran by conducting in-depth unstructured interviews with 23 purposively selected patients with T2D and 10 healthcare providers (HCPs). The participants were interviewed face-to-face between November 2017 and June 2018 at the patient’s home, a Health Care Center, or at the diabetes clinic. Data analysis was performed using MAXQDA-10 software and the conventional content analysis. Results The analysis of the data led to six categories of perceived psychosocial barriers: 1) fear, concern and distress, 2) exhaustion and burnout, 3) the children’s issues being the priority, 4) poor financial support, 5) communication challenges, and 6) poor work conditions. Conclusions This study identified some of the psychosocial barriers to medication adherence of patients with T2D, which will be of great help to researchers and HCPs in designing and implementing effective interventions to overcome these barriers and change patient self-care behaviors and increase their medication adherence.