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In applied health care research, an essentialised notion of culture is often used when studying ethnic disparities in health and health care access between the majority populations of Western countries and migrants, with ethnic backgrounds that differ from majority population. This notion of culture, however, is considered highly problematic in anthropology and ethnic studies. Therefore, in our research on Dutch illness certification practices, we employed a dynamic conceptualisation of culture. Our research shows that, in practice, when clients fail to meet the implicit norms of this practice, doctors ascribe this nonconformity differently when the client is a migrant than when he or she is a Dutch client. More specifically, when migrants fail to meet the norms, doctors are inclined to automatically ascribe this nonconformity to the assumed cultural background of the client. Consequently, these doctors feel less able to use the tools they normally use to coach their clients. This, in turn, results in more problematic and longer reintegration trajectories for migrants in comparison to Dutch clients in similar circumstances. In other words, framing the problems of migrants in terms of culture results in greater sick leave rates for migrants than for Dutch people. Clearly, culturalistic perspectives on ethnic differences have negative consequences. We therefore implore the application of a dynamic notion of culture in applied research. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether there are gender and ethnic disparities in the patient education provided by primary healthcare providers about heart disease (HD) risk and prevention. Methods: A telephone survey, conducted in four languages, was completed by 976 people, 40+ years of age, in Metro Vancouver, Canada. Questions assessing communication with healthcare providers’ provision of HD risk and management education were the focus. Results: Statistically significant gender and ethnic differences were found. Women were less likely to report discussing HD risk and management with their healthcare providers. Chinese-Canadian participants had less likelihood of receiving HD education compared with participants of other ethnic origins. These differences persisted after multivariate adjustment with income, highest level of education attained, age, and other factors. Conclusion: Primary healthcare providers should make improved efforts towards education about HD and its risk factors for women in general, and for postmenopausal women especially. Practice implications: Healthcare providers should be aware that some ethnic populations may not be receiving patient education similar to that received by people of other communities, as found for Chinese-Canadian members of this study community. Further understanding of the barriers faced by ethnic groups must be gained to develop solutions. [Copyright &y& Elsevier]

Objective: Although racial and ethnic disparities in the use of child mental health services have been well documented, the causes of and solutions to these disparities are not clearly understood. This study examined the role of caregiver strain in the disproportionately low rates of services use among youths from racial or ethnic minority groups who had already had contact with public service systems. Methods: This cross-sectional study used secondary analysis of a stratified random sample of 1,370 youths from the Patterns of Youth Mental Health Care in Public Service Systems Study, who were involved with at least one of five public sectors of care. Caregiver strain and use of child mental health services in the past 12 months were assessed by the Caregiver Strain Questionnaire and the Service Assessment for Children and Adolescents, respectively. A structural equation model that examined the mediating role of caregiver strain for use of child services among three racial and ethnic groups was evaluated for goodness of fit. Results: African-American caregivers reported lower levels of caregiver strain than did non-Hispanic white caregivers; Hispanic caregivers did not differ significantly from non-Hispanic white caregivers on reporting caregiver strain. Among African Americans, the effects of race on use of services were indirect, mediated through caregiver strain. Conclusions: Findings emphasize the importance of culturally influenced perceptions of caregiving practices and burden among caregivers of a child with emotional or behavioral problems. Intervention efforts to reduce disparities in use of services across racial or ethnic groups need to be informed by a better understanding of the causes of group differences in reporting caregiver strain and the relationship between reported caregiver strain and use of child mental health services. [ABSTRACT FROM AUTHOR]

Background: We aimed to test the hypothesis that differences in disability pensioning among different ethnic groups were attributable to differences in occupation, income, health, and mental distress. Methods: In a health survey conducted between 2000 and 2001 in Oslo, nearly half (48.7%; 11,072) of all inhabitants aged 40, 45 and 59-60 years participated. Survey data related to work, general health and mental distress were linked to disability pension data from the National Insurance Administration, and to income and country of origin data from Statistics Norway. A total of 9195 persons were eligible for disability pension at the end of 2000. Results: Approximately 5% received a disability pension in the 4 years following the health survey. An age- and gender-adjusted odds ratio of 2.27 (95% confidence interval (CI) 1.55-3.23) among immigrants from developing countries and Eastern Europe as compared to ethnic Norwegians was reduced to 0.88 (95% CI 0.46-1.67) after adjusting for occupation, working conditions, and income. The odds ratiowas further reduced to 0.63 (95%CI 0.32-1.25) when self-reported health and mental distress were added to themodel. Conclusions: The higher risk of receiving a disability pension among immigrants from developing countries and Eastern Europe than among ethnic Norwegians was largely explained by work factors and level of income. The addition ofmental distress and self-reported health to the multivariate model further reduced the risk, although not significantly different from ethnic Norwegians. [ABSTRACT FROM AUTHOR]

Objectives: It is recognized that ethnic group is important in describing differences in infection and disease, but is often not routinely available to surveillance systems. Computerized programmes, such as NamPehchan, can assign ethnicity according to name; however, sensitivity and positive predictive value (PPV) can vary. The aim of this study was to assess whether the sensitivity and PPV of NamPehchan had changed, after an observation that surnames previously associated with South Asians were increasingly reported as Black. Study design: Cross-sectional. Methods: NamPehchan was used to classify women as South Asian using name, and compared with the gold standard (midwife-reported ethnicity). Sensitivity and PPV were calculated overall and by year. Frequency of infection by ethnic group was estimated. Results: A total of 627 women positive for hepatitis B surface antigen were identified. The majority were from minority ethnic groups, particularly Asian. The overall sensitivity of NamPehchan was 74.5% and PPV was 68.5%. Almost 50% of Black African women were classified as South Asian by NamPehchan. Conclusions: Immigration from African countries has reduced the sensitivity of NamPehchan in this group. Care is needed when using NamPehchan for groups which include Africans from Muslim areas, as misclassification is likely to occur. [ABSTRACT FROM AUTHOR]

Objectives The need to address cultural and ethnic diversity issues in medical education as a means to improve the quality of care for all has been widely emphasised. Cultural competence has been suggested as an instrument with which to deal with diversity issues. However, the implementation of culturally competent curricula appears to be difficult. We believe the development of curricula would profit from a framework that provides a practical translation of abstract educational objectives and that is related to competencies underlying the medical curriculum in general. This paper proposes such a framework. Methods The framework illustrates the following cultural competencies: knowledge of epidemiology and the differential effects of treatment in various ethnic groups; awareness of how culture shapes individual behaviour and thinking; awareness of the social context in which specific ethnic groups live; awareness of one’s own prejudices and tendency to stereotype; ability to transfer information in a way the patient can understand and to use external help (e.g. interpreters) when needed, and ability to adapt to new situations flexibly and creatively. Discussion The framework indicates important aspects in taking care of an ethnically diverse patient population. It shows that there are more dimensions to delivering high-quality care than merely the cultural. Most cultural competencies emphasise a specific aspect of a generic competency that is of extra importance when dealing with patients from different ethnic groups. We hope our framework contributes to the further development of cultural competency in medical curricula. [ABSTRACT FROM AUTHOR]

The article highlights the key issues that need to be emphasised in promoting positive mental health and well-being for older people from black and minority ethnic (BME) communities in Great Britain. It notes the five key areas that need to be addressed in promoting good mental health and well-being for older people. The five key areas are discrimination, participation in meaningful activity, relationships, physical health, and poverty. It is suggested that various methods and approaches may be emphasised to address the issues for BME older people than for the general population.

Nancy Krieger has been one of the leading voices in documenting how social ‘axes of difference’, including race, ethnicity and class make people vulnerable to poor health and limit their access to effective health care. We discuss the importance of ‘locating’ diversity in health inequalities research. This includes critically dissecting racial and ethnic axes into more nuanced social categories that incorporate differences based on immigration and other factors. It also involves considering how diverse population groups vary in their perception and use of space for health-related activities and exposures. Examples relating to immigrant populations’ health and access to health care are discussed. [ABSTRACT FROM AUTHOR]

Objective: Ethnolinguistic communities are underserved by mental health systems in immigrant-receiving, multicultural societies, but their perspectives are seldom elicited in mental health research or reform planning. This article helps fill this gap by presenting community perspectives on concepts of mental health, mental illness and mental health experiences with five ethnocultural communities (Latin American, Mandarin-speaking Chinese, Polish, Punjabi Sikh and Somali) in Ontario, Canada. Methods: Data were collected from 21 focus groups as part of a large-scale, participatory action research project called Taking Culture Seriously in Community Mental Health. Results: The analysis focuses on how mental health and mental illnesses are described, how mental health care is experienced and what recommendations community members provide to improve the mental health system. Conclusions: Study findings illustrate the importance of the social context of immigration and settlement in conceptualizing mental health and mental distress. We conclude that systemic changes are needed to formulate collaborative, community-based strategies for mental health promotion and interventions. [ABSTRACT FROM AUTHOR]

Objective. Lack of health insurance coverage for working-age adults is one of the most pressing issues facing the U.S. population, and it continues to be a concern for a large number of people. In the absence of a national solution, the states and municipalities are left to address this need. We examined the disparities in uninsurance prevalence by state and metropolitan areas in the U.S. and among racial/ethnic groups. Method. Data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed for working-age adults 18 to 64 years of age. Results. In 2006, according to the BRFSS data, overall 18.6% (standard error = 0.20) of working-age adults were without health insurance coverage; by state, this proportion ranged from 9.7% to 29.0%. Health insurance coverage varied by state and metropolitan area and racial/ethnic group, and a higher age-adjusted prevalence of uninsurance was observed for non-Hispanic black and Hispanic respondents. Conclusions. A substantial proportion of working-age Americans remain without health insurance coverage. Disparities in health insurance coverage were observed by population and geographic groups. Overall, black and Hispanic populations fared far worse in terms of lack of health-care coverage than working-age white Americans. [ABSTRACT FROM AUTHOR]

Purpose. The association of race with not filling prescription medications because of cost for African-American and white patients 65 years or older was examined. Methods. African-American and white patients age 65 years or older were recruited from the practices of 48 Alabama primary care physicians participating in the Alabama Nonsteroidal Antiinflammatory Drug Patient Safety Study. All eligible patients were asked questions related to their ability to pay for prescription medications, comorbidities, insurance status, and socioeconomic status. Baseline and followup telephone surveys were completed between August 2005 and April 2006. Mediation analysis was conducted to determine whether patients' perceived income inadequacy mediated the association between race and not filling medications using staged logistic regression models and adjusting for age, comorbidities, and traditional markers of socioeconomic position (income, education, and insurance status). Results. Of 399 participants, 32% were African-American, 74% were women, and 53% had an annual household income of <$15,000. Patients not filling prescription medications were more likely to be African- American (50% versus 25%) and to report inadequate income to meet basic needs (61% versus 17%) (p < 0.001 for both comparisons). After adjusting for all covariates except the mediator, the odds ratio (OR) for African Americans not filling a prescription medication was 2.3 when compared with white patients. Adding the mediator perceived income inadequacy) to the model reduced the OR to 1.4. Conclusion. African Americans reported markedly greater difficulty in affording prescription medications than did white patients, even after accounting for income, education, health insurance status, and comorbidities. The inability of African Americans to afford prescription medications may be better predicted by perceived income inadequacy than more traditional measures of socioeconomic status. [ABSTRACT FROM AUTHOR]

Older overseas-born Australians of diverse cultural and language backgrounds experience significant disparities in their health and social care needs and support systems. Despite being identified as a ‘special needs’ group, the ethnic aged in Australia are generally underserved by local health and social care services, experience unequal burdens of disease and encounter cultural and language barriers to accessing appropriate health and social care compared to the average Australian-born population. While a range of causes have been suggested to explain these disparities, rarely has the possibility of cultural racism been considered. In this article, it is suggested that cultural racism be named as a possible cause of ethnic aged disparities and disadvantage in health and social care. It is further suggested that unless cultural racism is named as a structural mechanism by which ethnic aged disparities in health and social care have been created and maintained, redressing them will remain difficult. [ABSTRACT FROM AUTHOR]

Objective: Increased migration implies increased contacts for physicians with patients from diverse cultural backgrounds who have different expectations about healthcare. How satisfied are immigrant patients, and how do they perceive the quality of care? This study investigated which patient characteristics (such as cultural views and language proficiency) are related to patients’ satisfaction and perceived quality of care. Methods: Patients (n =663) from 38 general practices in Rotterdam (The Netherlands) were interviewed. General satisfaction with the general practitioner (GP) was measured by a report mark. Perceived quality of care was measured using the ‘Quote-mi’ scale (quality of care through the patient''s eyes—for migrants), which contains an ethnic-specific subscale and a communication process subscale. Using multilevel regression techniques, the relation between patient characteristics (ethnicity, age, education, Dutch language proficiency, cultural views) and satisfaction and perceived quality of care was analysed. Results: In general, patients seemed fairly satisfied. Non-Western patients perceived less quality of care and were less satisfied than Dutch-born patients. The older the patients and the more modern cultural views they had, the more satisfied they were about the GP in general, as well as about the communication process. However, non-Western patients holding more modern views were the most critical regarding the ethnic-specific quality items. The poorer patients’ Dutch language proficiency, the more negative they were about the communication process. Conclusion: It is concluded that next to communication aspects, especially when the patient''s proficiency in Dutch is poor, physician awareness about the patient''s cultural views is very important during the consultation. This holds especially true when the immigrant patient seems to be more or less acculturated. Practice implications: Medical students and physicians should be trained to become aware of the relevance of patients’ different cultural backgrounds. It is also recommended to offer facilities to bridge the language barrier, by making use of interpreters or cultural mediators. [Copyright &y& Elsevier]

The article presents a study on the screening disparities of colorectal cancer. It aims to examine the effects of demographic factors including ethnicity and economics on screening disparities. The study uses data from the 2001-2005 Medical Expenditure Panel Survey and the 2000-2004 National Health Interview Survey. Disparities were examined for screening of colorectal cancer and between races including Asians, Hispanics, and African-Americans. The study found that disparities for different races have varying determinants.

Nicky Thomas and colleagues report on a study into healthcare professionals' perceptions of the health needs of people from black and minority ethnic populations with hypertension and diabetes in an inner city borough. [ABSTRACT FROM AUTHOR]

Objective: This study compared suicide rates, clinical symptoms, and perceived preventability of suicide among persons in four ethnic groups who completed suicide within 12 months of contact with mental health services. Methods: The rates and standardized mortality ratios (SMRs) of suicide following contact with mental health services were calculated by using national suicide data from 1996 to 2001 for the four largest ethnic groups in England and Wales: black Caribbean, black African, South Asian (Indian, Pakistani, and Bangladeshi), and white. The study also investigated whether clinical indices of risk show ethnic variations. Results: A total of 8,029 suicides in the four ethnic groups were investigated. Overall, com- pared with the SMRs for their white counterparts, low SMRs were found for South-Asian men and women (SMR=.5, 95% confidence interval [CI]=.4-.6 for South-Asian men and SMR=.7, CI=.5-.9 for South-Asian women). High SMRs were found for black Caribbean and black African men aged 13-24 (SMR=2.9, CI=1.4-5.3 for black Caribbean men and SMR=2.5, CI=1.1-4.8 for black African men). High SMRs were found for young women aged 25-39 of South-Asian origin (SMR=2.8, CI=1.9-3.9), black Caribbean origin (SMR=2.7, CI=1.3-4.8), and black African origin (SMR=3.2, CI= 1.6-5.7). Some widely accepted suicide risk indicators were less common in the ethnic minority groups than in the white group. There were more symptoms of active psychosis for people from ethnic minority groups who later committed suicide, and perceived preventability was highest among black Caribbean people. Conclusions: Rates and SMRs varied across ethnic groups. Specific preventive actions must take account of the ethnic variations of clinical indices of risk and include more effective treatment of psychosis. (Psychiatric Services 59:414-420, 2008) [ABSTRACT FROM AUTHOR]

The epidemiology and risk factors for venous thromboembolism are well described in European populations, but such data is scarce in other ethnic groups. Venous thrombosis has traditionally been perceived as affecting only Europeans; this erroneous belief is reinforced by the low incidence of the common hereditary thrombophilias outside Europe, together with the lack of general perception and poor availability of diagnostic services in developing countries. It is now evident that venous thrombosis is prevalent across a number of different racial groups. Furthermore, conventional thrombophilia testing has been shown to be uninformative in most non-Europeans and laboratory reference ranges for these tests may be inappropriate for some non-European populations. Further research is needed to characterize the nature of venous thromboembolism in non-Europeans. [ABSTRACT FROM AUTHOR]

Researchers have a responsibility to cause no harm, but research has been a source of distress for indigenous people because of inappropriate methods and practices. The way researchers acquire knowledge in indigenous communities may be as critical for eliminating health disparities as the actual knowledge that is gained about a particular health problem. Researchers working with indigenous communities must continue to resolve conflict between the values of the academic setting and those of the community. It is important to consider the ways of knowing that exist in indigenous communities when developing research methods. Challenges to research partnerships include how to distribute the benefits of the research findings when academic or external needs contrast with the need to protect indigenous knowledge. (Am J Public Health. 2008;98:22-27. doi:10.2105/ AJPH.2006.093641) [ABSTRACT FROM AUTHOR]

Objectives: To engage a community to critically examine local health disparities. Design: Concept mapping is a tool used to rapidly assess the variations in thinking of large stakeholder groups' about a particular topic. Setting: Jackson, Mississippi. Participants: Community members. Methods: Dialog groups and community meetings were held, and participants were asked to respond to the statement, "A specific thing that causes African Americans to get sicker and die sooner is…." Aggregate responses were rated for importance and feasibility and then sorted into related groups. Aggregate sorts and ratings were then processed by using multidimensional scaling and hierarchical cluster analysis. Results: There were 132 (unduplicated) reported contributors to health disparities. These responses fell into eight general clusters: economic issues, government, contextual factors, cultural factors, HIV, stress, environment, and motivation. Factors respondents felt were the most important contributors to disparities (economic factors, contextual factors, stress) did not correlate with those that they thought were most likely to be changed in society (contextual factors, government, motivation). Conclusions: Concept mapping provided a mechanism for rapidly documenting community thinking about health disparities. This mechanism stimulated community dialog and was used as a first step toward the long-term goal of creating equal community, academic, and medical partnerships for addressing disparities. The concept mapping process stimulated critical thinking about contributors to health inequities and uncovered contextual factors previously unknown to researchers and public health planners. The process allowed for active engagement and exchange of knowledge between the community and researchers and allowed a mechanism for identifying and rectifying disconnects in knowledge within and between stakeholder groups. [ABSTRACT FROM AUTHOR]

Recognition of the importance of 'cultural competence' is now central to health care policy and to nurse education and training across the international spectrum. Detailed engagement with models of cultural competence is comparatively recent in palliative care nursing. This article presents the findings from a development project on elders and carers from 'minority ethnic' groups, funded by the Department of Health, to increase awareness of palliative care and to improve understanding of the needs of these groups of service users. The article describes the experiences of nurses involved in the delivery of palliative care who were interviewed in focus groups as a part of the project. It draws attention to the complicated relationships between cultural knowledge and practice and to the non-rational and visceral dimensions of intercultural care. These aspects of nursing are marginalised in current approaches to cultural competence, which emphasise the rational acquisition and application of cultural knowledge and skills by practitioners. It is suggested that recognition of these marginalised experiences can contribute to the development of new approaches to intercultural nursing that are also more attuned to the ethos and values of palliative care. [ABSTRACT FROM AUTHOR]

Background: Physician cultural sensitivity is particularly important for end-of-life care. This study correlates physicians' own racial background, clinical experience, and cultural sensitivity training with their attitudes, perceptions, and knowledge of advance care planning issues for African American patients. Methods: A cross-sectional self-report questionnaire was distributed to 236 physicians at three major teaching hospitals. Results: Seventy-eight percent of all surveys were returned (183/236). The respondent racial characteristics were 53% white, 28% Asian, and 17% black. While 72% of physicians agreed that different ethnic groups have distinct attitudes towards advance directives, 58% acknowledged lack of familiarity with end-of-life preferences of African American patients. Black physicians (African American and non-U.S.–born) rated the cultural sensitivity training they received on a 0–10 Likert-type scale as 5.43 ( n = 28) versus a 3.74 rating by white physicians ( n = 91; p = 0.022). Black physicians (African American and non-U.S.–born, n = 27) rated their familiarity with advance care planning preferences of African Americans as 5.89 and white physicians ( n = 90) rated theirs as 4.14 on a 10-point Likert-type scale ( p = 0.002). Finally, 88% of U.S.-born black physicians (7/8) versus 35% of white physicians (32/91) perceived that the Tuskegee experiment has impacted African American medical decision-making ( p = 0.014). Similarly, a greater proportion of African American physicians perceived that the Tuskegee experiment has impacted African American medical decision making, compared to non-U.S.–born black physicians (88% (7/8) versus 26% (5/19), p = 0.008). Conclusion: The majority of the physicians surveyed routinely provide end-of-life care and believe they are aware of racial differences in advance care planning. Yet, most were unfamiliar with specific end-of-life preferences of African American patients. We advocate for further research and cultural sensitivity training to improve end-of-life care for African American patients. [ABSTRACT FROM AUTHOR]

Background: This study reports lifetime estimates of the extent of unmet need for alcohol services across the 3 largest ethnic groups in America, and examines factors that may contribute to ethnic differences in service use. Prior studies report mixed findings as to the existence of ethnic disparities in alcohol services, with some suggesting that minorities are over-represented in treatment settings. Methods: Drawing on the most recent National Alcohol Surveys, we compare rates and factors associated with the lifetime service use for alcohol problems among Whites, Blacks, and Hispanics who meet lifetime criteria for alcohol abuse or dependence. Results: While bivariate analyses revealed few ethnic differences in service use, there were significant differences by ethnicity in multivariate models that included alcohol problem severity and its interactions with ethnicity. At higher levels of problem severity, both Hispanics and Blacks were less likely to have utilized services than comparable Whites. Hispanics, on the whole, reported higher-severity alcohol problems than Whites. Yet, they were less likely to have received specialty treatment and multiple types of alcohol services, and were more likely to cite economic and logistical barriers as reasons for not obtaining care. Conclusions: Future efforts to study ethnic disparities in alcohol services should utilize analytic approaches that address potential confounding between ethnicity and other factors in service use, such as alcohol problem severity. Our findings suggest that Hispanics and Blacks with higher-severity alcohol problems may utilize services at lower rates than comparable Whites, and that, particularly for Hispanics, this may in part be attributable to financial and logistical barriers to care. [ABSTRACT FROM AUTHOR]

Abstract: The basic premise of the paper is that Western medicine''s co-opting of specific technologies and materials from other (indigenous) medical traditions, stripped of the original theories underlying their use, has problematic consequences for the practitioners and patients of both source and recipient traditions. The paper begins by illustrating the historical continuity of this process by way of an example from India''s colonial era. The fact that specific practices or materials are regarded as biomedically useful because they ‘work’ (are efficacious) does not mean that the ‘traditional’ theories underlying them are seen as correct. The knowledge contained in these traditions is not counted as legitimate, as the emphasis in biomedicine (the legitimate canon) on an identifiable concrete location in the body for the source of health problems creates difficulties—both for patients when their problems are not provided with a cause that matches their subjective awareness, and for the practitioners of other traditions whose patients have been exposed to biomedicine. The paper goes on to demonstrate, using case examples from extended ethnographic fieldwork in southern India, how this is played out in a setting in which an educated Indian patient population accepts this form of knowledge as legitimate but espouses ayurvedic therapy. Notions of ‘evidence’ are shown to be central to the interplay between biomedical and other medical traditions, since objective tests and measures in biomedicine are accepted as the only legitimate ‘evidence’ of cure, but these do not necessarily accord either with the premises of these other traditions or with patients’ subjective perceptions of well-being. Returning to an acceptance and practice of other traditions, consequently, requires nothing less than a fundamental cognitive shift in the grounds for what constitutes ‘evidence.’ [Copyright &y& Elsevier]

The article identifies separate and unequal systems of care for uninsured and insured patients in Bronx, New York as a cause of racial and ethnic health disparities. It provides a background on the establishment of the Bronx Health REACH, a coalition of community- and faith-based groups. An overview of health data showing the poor health status of residents in the region is presented.

The article provides a historical overview of the origins of racial and ethnic disparities in medical care. It outlines fundamental challenges to achieving a clear understanding of the problem and discusses current policy strategies espoused by conservative and liberal proponents. It also provides an in-depth discussion of one approach with significant bipartisan support.

The article presents evidence based studies related to therapeutic use of statins in developing countries. The article provides complete information on the initiation of statin therapy in patients with high risk of cardiovascular diseases, the target lipid levels, the response of different ethnic groups and its cost effectiveness. The article also gives meta-analysis involving 90,056 patients in 14 randomized trials showing the benefits of statin treatment.

Abstract: Cross-cultural aspects of dementia are described, with the focus on demography, epidemiology of dementia in UK ethnic groups, diagnostic issues, instruments measuring cognition, pathways into care and principles of service provision. Suggestions for future directions for research and service delivery are also made. [Copyright &y& Elsevier]

Objective To determine whether access to cardiac procedures and drugs contributes to social and ethnic differences in coronary heart disease in a population setting. Design Prospective study with follow up over 15 years. Civil service employment grade was used as a measure of individual socioeconomic position. Need for cardiac care was determined by the presence of angina, myocardial infarction, and coronary risk factors. Setting 20 civil service departments originally located in London. Participants 10,308 civil servants (3,414 women; 560 South Asian) aged 35-55 years at baseline in 1985-8. Main outcome measures Use of exercise electrocardiography, coronary angiography, and coronary revascularization procedures and secondary prevention drugs. Results Inverse social gradients existed in incident coronary morbidity and mortality. South Asian participants also had higher rates than white participants. After adjustment for clinical need, social position showed no association with the use of cardiac procedures or secondary prevention drugs. For example, men in the low versus high employment grade had an age adjusted odds ratio for angiography of 1.87 (95% confidence interval 1.32 to 2.64), which decreased to 1.27 (0.83 to 1.94) on adjustment for clinical need. South Asians tended to be more likely to have cardiac procedures and to be taking more secondary prevention drugs than white participants, even after adjustment for clinical need. Conclusion This population based study, which shows the widely observed social and ethnic patterning of coronary heart disease, found no evidence that low social position or South Asian ethnicity was associated with lower use of cardiac procedures or drugs, independently of clinical need. Differences in medical care are unlikely to contribute to social or ethnic differences in coronary heart disease in this cohort.. [ABSTRACT FROM AUTHOR]

Background: The use of herbal supplements in the United States has become increasingly popular. The prevalence of herbal use among primary care patients varies in previous studies; the pattern of herbal use among urban racially/ethnically diverse primary care patients has not been widely studied. The primary objectives of this study were to describe the use of herbs by ethnically diverse primary care patients in a large metropolitan area and to examine factors associated with such use. The secondary objective was to investigate perceptions about and patterns of herbal use. Methods: Data for a cross-sectional survey were collected at primary care practices affiliated with the Southern Primary-care Urban Research Network (SPUR-Net) in Houston, Texas, from September 2002 to March 2003. To participate in the study, patients had to be at least 18 years of age and visiting one of the SPUR-Net clinics for routine, nonacute care. Survey questions were available in both English and Spanish. Results: A total of 322 patients who had complete information on race/ethnicity were included in the analysis. Overall, 36% of the surveyed patients (n = 322) indicated use of herbs, with wide variability among ethnic groups: 50% of Hispanics, 50% of Asians, 41% of Whites, and 22% of African-Americans. Significant factors associated with an individual's herbal use were ethnicity other than African-American, having an immigrant family history, and reporting herbal use by other family members. About 40% of survey respondents believed that taking prescription medications and herbal medicines together was more effective than taking either alone. One-third of herbal users reported using herbs on a daily basis. More Whites (67%) disclosed their herbal use to their health-care providers than did African-Americans (45%), Hispanics (31%), or Asians (31%). Conclusions: Racial/ethnic differences in herbal use were apparent among this sample of urban multiethnic adult primary care patients. Associated factors of herbal use were non-African- American ethnicity, immigrant family history, and herbal use among family members. Whereas Hispanics and Asians reported the highest rates of herbal use, they were the least likely to disclose their use to health-care professionals. These findings are important for ensuring medication safety in primary care practices. [ABSTRACT FROM AUTHOR]

Abstract Objectives: To examine whether self reported health status and use of health services varies in children of different social class and ethnic group. Design: Cross sectional study from the 1999 health survey for England. Subjects: 6648 children and young adults aged 2-20 years. Setting: Private households in England. Main outcome measures: Proportion of children (or their parents) reporting episodes of acute illness in the preceding fortnight and prevalence of self reported longstanding illness. Proportion reporting specific illnesses. Proportion reporting that they had consulted a general practitioner in the preceding fortnight, attended hospital outpatient departments in the three preceding months, or been admitted to hospital in the preceding year. Results: Large socioeconomic differences were observed between ethnic subgroups; a higher proportion of Afro-Caribbean, Indian, Pakistani, and Bangladeshi children belonged to lower social classes than the general population. The proportion of children and young adults reporting acute illnesses in the preceding two weeks was lower in Bangladeshi and Chinese subgroups (odds ratio 0.41, 95% confidence interval 0.27 to 0.61 and 0.46, 0.28 to 0.77, respectively) than in the general population. Longstanding illnesses was less common in Bangladeshi and Pakistani children (0.52, 0.40 to 0.67 and 0.57, 0.46 to 0.70) than in the general population. Irish and Afro-Caribbean children reported the highest prevalence of asthma (19.5% and 17.7%) and Bangladeshi children the lowest (8.2%). A higher proportion of Afro-Caribbean children reported major injuries than the general population (11.0% v 10.0%), and children from all Asian subgroups reported fewer major and minor injuries than the general population. Indian and Pakistani children were more likely to have consulted their general practitioner in the preceding fortnight than the general population (1.86, 1.35 to 2.57 and 1.51, 1.13 to 2.01, respectively). Indian,... [ABSTRACT FROM AUTHOR]

The article describes a project being supported by the Commonwealth Fund and the U.S. Health Resources and Services Administration to create a report card to assess quality at the health plan level for members of the various racial/ethnic minority groups. The project aims to determine if health plans can obtain data on members' race/ethnicity through one or more possible methods and whether those data can be used to produce reports on quality of care stratified by race/ethnicity.

ABSTRACT. Objective. Racial/ethnic disparities in hospitalization rates among children with asthma have been documented but are not well-understood. Medicaid programs, which serve many minority children, have markedly increased their use of managed care in recent years. It is unknown whether racial/ethnic disparities in health care use or other processes of care exist in managed Medicaid populations. This study of Medicaid-insured children with asthma in 5 managed care organizations aimed to 1) compare parent-reported health status and asthma care processes among black, Latino, and white children and 2) test the hypothesis that racial/ethnic variations in processes of asthma care exist after adjusting for socioeconomic status and asthma status. Methods. This cross-sectional study collected data via telephone interviews with parents and computerized records for Medicaid-insured children with asthma in 5 managed care organizations in California, Washington, and Massachusetts. The American Academy of Pediatrics (AAP) Children's Health Survey for Asthma was used to measure parent-reported asthma status. We used multivariate models to evaluate associations between race/ethnicity and asthma status while controlling for other sociodemographic variables. We evaluated racial/ethnic variations in selected processes of asthma care while controlling for other demographic variables and asthma status. Results. The response rate was 63%. Of the 1658 children in the respondent group, 38% were black, 19% were Latino, and 31% were white. Black children had worse asthma status than white children on the basis of the AAP asthma physical and emotional health scores, symptom-days, and school days missed in the past 2 weeks. Latino children had equivalent AAP scores but missed more school days than white children. On the basis of the AAP asthma physical health score, the black-white disparity persisted after adjusting for other sociodemographic variables. After adjusting for... [ABSTRACT FROM AUTHOR]

The Department of Health has adopted mainstreaming as a fundamental principle of its race and equal opportunities work in service delivery, workforce policies and the tackling of institutional racism. A logical and necessary extension of this approach is to mainstream ethnic monitoring, a need supported by an increasing number of government departments, agencies and independent research bodies and implicitly recognized in the equalities framework for the NHS. However, the sparseness of proposals to improve the information base appears as the weak link in the Department's race equality agenda, reflecting a highly fragmented and piecemeal approach to ethnic monitoring in the past. Much of the information collected in the NHS and social care settings either does not record ethnic group or yields data of such poor quality and completeness that they are not used. Monitoring must be made relevant to the needs of those collecting the data as well as for central reporting, so that usage itself contributes to improvements in quality. Guidance and training covering the principles of monitoring, the process of collection and the use of the data generated should be a key component in implementing the process. Making ethnic monitoring a high political priority and locating it at the centre of race equality policies is needed to ensure that the huge potential it offers in the modernization of the NHS is fulfilled. [ABSTRACT FROM AUTHOR]

Objective: To determine whether professional interpreter services increase the delivery of health care to limited-English-proficient patients.Design: Two-year retrospective cohort study during which professional interpreter services for Portuguese and Spanish-speaking patients were instituted between years one and two. Preventive and clinical service information was extracted from computerized medical records.Setting: A large HMO in New England.Participants: A total of 4,380 adults continuously enrolled in a staff model health maintenance organization for the two years of the study, who either used the comprehensive interpreter services (interpreter service group [ISG]; N = 327) or were randomly selected into a 10% comparison group of all other eligible adults (comparison group [CG]; N = 4,053).Measurements and Main Results: The measures were change in receipt of clinical services and preventive service use. Clinical service use and receipt of preventive services increased in both groups from year one to year two. Clinical service use increased significantly in the ISG compared to the CG for office visits (1.80 vs. 0.70; P <.01), prescriptions written (1.76 vs 0.53; P <.01), and prescriptions filled (2.33 vs. 0.86; P<.01). Rectal examinations increased significantly more in the ISG compared to the CG (0.26 vs. 0.02; P =.05) and disparities in rates of fecal occult blood testing, rectal exams, and flu immunization between Portuguese and Spanish-speaking patients and a comparison group were significantly reduced after the implementation of professional interpreter services.Conclusion: Professional interpreter services can increase delivery of health care to limited-English-speaking patients. [ABSTRACT FROM AUTHOR]

Presents a study which examined the use of complementary and alternative medicine for the treatment of cancer among ethnic groups in Hawaii. Methodology; Results; Discussion.

Although Hispanics' use of breast cancer screening services has been investigated, to date there have been no published studies of distinct Hispanic populations in different areas of the country. Using the diverse populations and sites involved in the National Hispanic Leadership Initiative on Cancer ` En Acción', this study examines ethno-regional differences in breast cancer screening rates among these groups and explores the correlates of screening participation. Data collected through telephone surveys were analyzed for women 40 years of age and older ( n = 2082). After controlling for demographic variables traditionally related to breast cancer screening rates, it was found that ethno-regional differences in breast cancer screening practices clearly persisted. In addition to traditional demographic factors, other variables evidently underlie differences in Hispanics' utilization of breast cancer screening services. These variables may be cultural and should be investigated in future research. Meanwhile, researchers should not refer to the `Hispanic' population at large without identifying, addressing and clarifying the ethno-regional characteristics of their samples. [ABSTRACT FROM AUTHOR]

Describes the prevalence of dementia across ethnic minority groups in the United States. Role of cultural values and social conditions of the ethnic group in family caregiving; Implications of the ethnic group's cultural values for developing formal services and interventions for people with dementia.

Discusses the United Kingdom's initiatives taken to develop policies to improve access to health services by ethnic groups and understand the issues on their health and disease patterns. Main issues in policy development; Department of Health policies; Conclusions.

Data from the 1991 Belize Family Health Survey show differentials in the use of maternal and child health services between ethnic groups (Creole, Mestizo, Maya/Ketchi and Garifuna). Multivariate analysis is used to explore whether such differentials can truly be attributed to ethnicity or to other characteristics that distinguish the ethnic groups. Health services considered are: family planning, place of delivery (hospital/other), postpartum and newborn check-ups after a birth, and immunisations for children. The language usually spoken in the household is found to be important for interpreting ethnic differentials. Mayan-speaking Maya/Ketchis are significantly less likely to use family planning services or to give birth in a hospital. Spanish-speakers (Mestizos and Maya/Ketchis) are less likely to use newborn and postpartum check-ups, after controlling for other characteristics. There are no ethnic differentials for immunisations. Programmatic implications of these results are discussed. [ABSTRACT FROM PUBLISHER]

Telephone interviews about organ donation were conducted with 4880 white respondents, 634 African–American respondents and 566 Hispanic respondents. Forty-three percent (42.9%) of whites, 31.2% of Hispanics and 22.6% of African–Americans reported that they were willing to donate their organs after their death (p<0.001). Logistic regression analysis revealed three significant correlates of willingness to donate across all ethnic groups: having had a family discussion about end-of-life issues; the belief that a doctor does all he or she can to save a life before pursuing donation; and concerns about surgical ‘disfigurement’ of a relative’s body after donation. Concerns in relation to body disfigurement were more prevalent among African–American and Hispanic respondents (p<0.001) than among white respondents. Public education should: a) stress the need for family communication about end-of-life issues including organ donation; b) underline the fact that donation is considered only after all efforts to save the life of the patient are exhausted; and c) reassure minorities that the body of the donor is treated respectfully and not disfigured. [ABSTRACT FROM AUTHOR]

This project was undertaken to expand student learning experiences with Hispanic and Southeast Asian clients. In addition to classroom experiences, the project included home visiting with individual families. The visits focused on health promotion/disease prevention and illness care as necessary. Students also taught group health promotion classes. At the completion of this experience students were able to relate more therapeutically to minority clients and to plan culturally acceptable nursing interventions, and they demonstrated increased cultural self-efficacy. [ABSTRACT FROM AUTHOR]

Examines measures of need for health care and their relationship to utilization of health services in different racial and ethnic groups in California. Community resident survey; Demographic measures; Estimated adjusted utilization within ethnic groups.

Addresses the equity treatment persons of different ethnic groups in the British National Health Service received, as analysed in surveys conducted between 1984 and 1991. Information on the data used; Methology of data; What were the results of the data.

Assesses fetal mortality among low income ethnic women in California seeking federally-funded prenatal care. Comparison of fetal death rates; Analysis of stillbirths by gestational age; Identification of social and behavioral predictors of fetal mortality; Economic status as a strong predictor; Importance of adequate access to maternity care.

Discusses the issues concerning the requirement for mandatory collection of data on ethnic group of inpatients by the Department of Health in Great Britain. Difficulties foreseen on the implementation of the policy; Implications of the policy on ethnic groups and minorities.

Assesses the cultivation of medical care among various ethnic groups in the United States. Identification to factors hampering the completion of health care guidelines; Includes knowledge of proxies and age; Call for increased educational campaigns on the subject.

Background: With few exceptions, evaluation of the capacity of general practitioners (GPs) to recognise psychiatric disorder in their patients has failed to consider the role of ethnic diversity in the consultation process and whether such knowledge can improve understanding of the degree to which psychiatric morbidity is recognised within GP settings.Methods: This research was completed in five general practices representative of all those within an inner-city health district. Psychiatric morbidity in patients consecutively attending the practices was then assessed using the General Health Questionnaire; in addition, GPs were asked to complete a checklist of current problems identified during each consultation.Results: Analysis suggested that Asian and Black patients were less likely than White patients to have psychological problems identified; that social problems and a psychiatric history facilitated recognition; and that current physical illness hindered recognition.Conclusions: GP recognition of psychological problems varies according to patient ethnicity but can be substantially masked by both the physical and social circumstances of patients at consultation. [ABSTRACT FROM AUTHOR]

Compares the effect of race and ethnicity on the use of selected health care procedures in South Central Los Angeles to the remainder of Los Angeles County. Decreased physician availability in South Central Los Angeles; Major predictors of procedure use; Prevalence of ethnic groups.

The article discusses the aspects of educating health professionals for the needs of patients in a multi-ethnic population including refugees in London, England. It states that health professionals must be prepared on working in multiracial communities for them to provide proper health care for their needs. It cites the significance of multicultural health training which should be the focus of general practitioners (GPs). It mentions a teaching course designed for GPs involving subjects of health and ethnicity. A survey regarding the competence of GPs in working with refugee and ethnic minority patients has distinguished problems including patient interaction, refugee health, and migration's psychosocial effects.

The article discusses a study which investigated the effectiveness of the British dermatology training programme in providing adequate training for specialist registrars in the diagnosis and management of diseases based on the ethnic population. Involved in the questionnaire-based study were 217 dermatology trainees and 77 junior consultants. The authors argue that the results reflect general trends concerning all aspects of dermatology training in the country.