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The author reflects on the need for the U.S. government to partner with nongovernmental organizations, communities and advocacy groups to eliminate health disparities in the U.S. The author notes that despite medical advances many minorities in the U.S. continue to experience higher incidences of disease, morbidity and mortality.

In effectively treating the violent and psychotic patient, medical professionals are charged with the task of mitigating harm to all involved. While non-pharmacologic methods are often employed first, chemical restraint may also be necessary. The agents most often utilized in the management of such patients include antipsychotics – first and second generation agents – and benzodiazepines. When considering use of these agents, it is prudent that nurses appreciate the potential risks, including those of a cardiac nature given that they represent some of the most dangerous. This review article aims to highlight the potential cardiac complications and provide guidance in navigating this important task of harm mitigation for the violent and psychotic patient.

The relative lack of standards for collecting data on population subgroups has not only limited our understanding of health disparities, but also impaired our ability to develop policies to eliminate them. This article provides background about past challenges to collecting data by race/ethnicity, primary language, sex, and disability status. It then discusses how passage of the Affordable Care Act has provided new opportunities to improve data-collection standards for the demographic variables of interest and, as such, a better understanding of the characteristics of populations served by the U.S. Department of Health and Human Services (HHS). The new standards have been formally adopted by the Secretary of HHS for application in all HHS-sponsored population health surveys involving self-reporting. The new data-collection standards will not only promote the uniform collection and utilization of demographic data, but also help the country shape future programs and policies to advance public health and to reduce disparities.

Cardiovascular care in an increasingly diverse community represents a distinct challenge for cardiovascular medicine, the following cases illustrate these challenges. Case Presentation: A 66-year-old black woman arrives at her local emergency department in the southern United States. She works as a full-time secretary and has a history of poorly controlled hypertension despite several attempts at combination drug treatment therapies. She presents with chest pain and shortness of breath. Her antihypertensive regimen is adjusted, and she is given a follow-up appointment to see her usual physician. She returns in 2 weeks with new-onset heart failure (HF) status post old acute myocardial infarction. Case Presentation: A 72-year-old Hispanic woman visits her primary care physician. She has previously been diagnosed with diabetes mellitus, hypertension, and kidney disease. She speaks only Spanish, but the translator is not available owing to illness. The patient tells her physician that she has been experiencing shortness of breath and complains of no other symptoms. The patient is given a diuretic and a return appointment. She is admitted 3 days later with decompensated HF. Case Presentation: A 52-year-old stoic Southeast Asian man, a practicing physician, reports to a colleague the sudden onset of chest pain. He has had no previous diagnoses and exhibited no risk factors before the event. He is reassured and a routine exercise treadmill test is ordered. Within 24 hours, he experiences sudden cardiac death. A growing body of literature is forming a vision of a rapidly approaching different future for cardiology. The US Census Bureau predicts that by 2050, non-Hispanic whites will no longer be the majority as the numbers of Hispanics, Asians, and people of multiple races increase (Figure 1).1,2 With these predicted shifts in population demographics, well-known racial and ethnic health disparities will become increasingly prevalent. Because cardiovascular disease …

MANY RACIAL AND ETHNIC MINORITIES, PEOPLE with limited English-language proficiency, people with disabilities, and other commonly underserved populations face unique health challenges, have reduced access to health care and insurance, and often experience poorer health throughout their lives. In the past, identifying disparities and effectively monitoring efforts to reduce them have been limited by a lack of specificity, uniformity, and quality in data collection and reporting procedures. The importance in the documentation of disparities and the critical importance of rich data systems to understand and track interventions to reduce health disparities among population subgroups have been called for, dating back to the 1985 Report of the Secretary’s Task Force on Black and Minority Health and the recent Institute of Medicine report Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement. As noted in those reports, consistent methods for collecting and reporting health data will help better characterize the nature of health problems in underserved populations. The Department of Health and Human Services (HHS) has adopted new data standards for the collection of race, ethnicity, sex, primary language, and disability status for selfreported data collected from population-based health surveys. Data standards were developed in accordance with section 4302 of the Affordable Care Act. That section of the act focuses on the standardization as well as collection, analysis, and reporting of health disparities data. It requires the HHS secretary to establish data collection standards for race, ethnicity, sex, primary language, and disability status. The law requires that, once established, these data collection standards be used in national population health surveys. The law also gives the secretary the authority to require collection of additional demographic data on departmental population health surveys and to develop appropriate additional data collection standards. Even though data collection will not reduce disparities, having such data is fundamental to the department’s efforts to understand the causes of health disparities, design effective responses, and evaluate progress in reducing disparities. The new data standards for race, ethnicity, sex, primary language, and disability status represent a critical step in uniformly collecting data needed to track disparities and to ensure continued progress in efforts to reduce disparities.

The authors reflect on the elimination of health disparities in the U.S. They suggest that in 2012 the opportunity to more effectively address health disparities and work toward health equity in the U.S. has never been greater. They argue that collective action to end health disparities in the U.S. is possible if individuals and organizations partner together to achieve health equality objectives.

Canada’s experience tells a story of e-development that started with great promise and a national vision of “Connected Canada,” then got stuck in the snow. Canada became a highly connected nation early in the twenty-first century, thanks to citizens’ enthusiastic experimentation with the Internet use, coupled with federally led initiatives to secure universal access and government online services. Since, Canada’s ranking as information society has declined. This chapter explores the reasons for this decline. E-leadership capacity was not institutionalized. E-development was undermined by changes in the political leadership and an ideological commitment to reduce the role of government. Vested interests from primary telecom carriers, among others, took full advantage of the leadership vacuum to obstruct the structural reforms necessary for Canada’s further transition to an information economy. Canada neglected to build on its earlier achievements and to learn from its earlier experiments.

Scientific and policy debates following new genetic discoveries have been intense and emotional when they have involved questions about the causes of, and solutions for, racial and ethnic health disparities in the United States. The difference in prevalence of diseases, allele frequency and genotype frequency among racial/ethnic groups are well known. The genomic profile for a given disease could have different genetic variants for different racial/ethnic groups. Do these results indicate that we have to consider different genetic tests and different genomic medicine for different racial/ethnic groups? If we do this, what is the impact on ethnic and class disparities in health care services in the United States? Current advances in genetic medicine are very promising; however, we must consider the possible impacts of these findings on health disparities, and how genetic medicine can be extended to everyone, not just those who can pay the often high price. If genomic medicine is to be a valid and reliable technology for all citizens regardless of wealth, race, ethnicity, or other determinants of social disadvantage, public health policymakers have to consider a number of policy issues and implications.

Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction (MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to understand the extent of disparities in treatment in these subpopulations.

Angina relief is a major goal of PCI; however, ~1/5 of patients continue to have angina after PCI. Understanding patient factors associated with residual angina would enable providers to more accurately calibrate patients’ expectations of angina relief after PCI. Patients who had PCI at 10 US

The article introduces the issue, which focuses on the ways in which technology and innovation can transform medically underserved communities in the U.S., prevent or manage chronic disease and improve public health. In the article the authors offer opinions on the use of technology to improve public health and discuss research which has investigated the impact technology can have on public health and chronic disease prevention and management.

Garth Graham Department of Medicine, University of Florida, Gainesville, FL, USA Abstract: This is a comprehensive narrative review of the literature on the current science and evidence of population-level differences in risk factors for heart disease among different racial and ethnic population in the US. It begins by discussing the importance of population-level risk assessment of heart disease in light of the growth rate of specific minority populations in the US. It describes the population-level dynamics for racial and ethnic minorities: a higher overall prevalence of risk factors for coronary artery disease that are unrecognized and therefore not treated, which increases their likelihood of experiencing adverse outcomes and, therefore, potentially higher morbidity and mortality. It discusses the rate of acute coronary syndrome (ACS) in minority communities. Minority patients with ACS are at greater risk of myocardial infarction, rehospitalization, and death from ACS. They also are less likely than nonminority patients to receive potentially beneficial treatments such as angiography or percutaneous coronary intervention. This paper looks at the data surrounding the increased rate of congestive heart failure in racial and ethnic minorities, where the risk is related to the prevalence of comorbidities with hypertension or diabetes mellitus, which, in combination with environmental factors, may largely explain congestive heart failure disparity. The conclusion is it is essential that health care providers understand these various communities, including nuances in disease presentation, risk factors, and treatment among different racial and ethnic groups. Awareness of these communities' attributes as well as differences in incidence, risk factor burdens, prognosis, and treatment are necessary to mitigate racial and ethnic disparities in heart disease. Keywords: heart disease, health disparities, hypertension, acute coronary syndrome

We quantified HIV-1 RNA load in rinses from needles/syringes (N/S) obtained at shooting galleries in Miami and also analyzed the rinses for antibodies for viral proteins. In rinses from 36 N/S that contained visible blood, 14 (39%) had detectable amounts of HIV-1 RNA. Numbers of copies of HIV-1 RNA ranged from the detection limit (400 copies/ml) to 268,000 copies/ml. We also detected antibodies to HIV-1 polypeptides in 34/36 (94%) of rinses from visibly contaminated N/S using Western blots specific for the HIV-1 proteins. No antibodies were detected in laboratory rinses from six visibly clean needles. The presence of HIV-1 RNA in N/S is an important indication of the risk created by N/S sharing as well as by shared paraphernalia and wash waters by injecting drug users.

Background: A significant proportion of individuals seen in US hospitals speak a language other than English. A number of reports have shown that individuals who speak a language other than English have diminished access to care, but few have examined specifically language barriers and its relationship to health insurance coverage. Objectives: To estimate the impact of language use on prevalence of reported health insurance coverage across multiple racial and ethnic groups and among persons living in the U.S. for varying periods of time. Design and participants: Cross sectional study using data from the 2010 National Health Interview Survey. Main measures: The main outcome measure is health insurance status. Key results: Persons who spoke Spanish or a language other than English were less likely to have insurance. Among Hispanics who speak Spanish or a language other than English, only 50.6% report having health insurance coverage compared to 76.7% of Hispanics who speak only or mostly English. For non-Hispanic whites who speak Spanish or a language other than English, 71.7% report having health insurance coverage compared to 83.4% of non-Hispanic whites who speak only or mostly English, this same pattern was observed across all racial/ethnic groups. Among those speaking only or mostly English living in the U.S.

The article presents an overview of challenges that African American men and boys face in disease incidence and in accessing suitable health care. A discussion of statistics which focus on the rates of several diseases which are found among African American men and boys, and of increased incidences of violence which African American boys and men are subject to, is presented. The positive role that the health care reform legislation may play in helping African American boys and men gain access to health care services is discussed. The U.S. Office of Minority Health's Commission on the Impact of Trauma and Violence on the Health of African American Men is mentioned.

Health care disparities and high chronic disease rates burden many communities and disproportionally impact racial/ethnic populations in the United States. These disparities vary geographically, increase health care expenses, and result in shortened lifespans. Digital technologies may be one tool for addressing health disparities and improving population health by increasing individuals' access to health information-especially as most low-income U.S. residents gain access to smartphones. The Aetna Foundation partners with organizations to use digital technologies, including mobile applications, data collection, and related platforms, for learning and sharing. Projects range from the broad-childhood education, lifestyle modification, health IT training, and nutrition education, to the specific-local healthy foods, stroke rehabilitation, and collection of city-level data. We describe our approaches to grantmaking and discuss lessons learned and their implications. When combined with sound policy strategies, emerging, scalable, digital technologies will likely become powerful allies for improving health and reducing health disparities.