The health status of minority populations in the United States

There is increasing national recognition that while our nation's health care system is the most expensive in the world, the health care status of Americans overall ranks poorly compared with other Western, industrialized nations. In the United States we tend to look at minority-majority variations of health status, as well as the variations of many other indicators by race or ethnicity, because race and ethnicity are particularly important components of our society. In general, health status indicators of minority Americans are worse than those of whites. In some locales, death rates of minority Americans are comparable to those of Third World nations. At the same time, minority Americans make up a rapidly increasing proportion of the nation's population and work force. Our baseline national data on some minority groups, however, currently are inadequate to detect shifts in health status. Finally, the rapidly expanding problem of the acquired immunodeficiency syndrome among some minority populations provides both an imperative and an opportunity to learn how model prevention programs should be designed and executed.

An overview of the problem of toxoplasmosis and pneumocystosis in AIDS in the USA: implication for future therapeutic trials

By the end of 1989, 18,518 cases of Pneumocystis carinii infection and 5,614 cases of Toxoplasma gondii infection were reported to the Centers for Disease Control as the AIDS indicator disease. Pneumocystosis did not vary according to gender, race or risk factors; whereas toxoplasmosis was more common in black males with no known risk factors. Immigrants to the USA from Africa, Latin America and Haiti are three to four times more likely to develop toxoplasmic encephalitis than American-born patients with AIDS. The implications of this epidemiologic data for the predictive value of serology and clinical trials are discussed.

Perception of alcohol use and misuse in three ethnic communities: implications for prevention programming

This article compares data about perceptions of alcohol use and misuse, including perceived patterns of use, extent of the problem, reasons for use, and causes and effects of alcohol misuse in the Chinese, Indo-Pakistani, and Latin American communities in British Columbia. The methodology employed is an adaptation of Neuber's Community Needs Assessment model, using data from three sources: (1) relevant literature, (2) interviews with designated key informants, and (3) interviews with selected potential program consumers within the community. This article focuses on data gathered from potential program consumers. Results indicate that alcohol-related problems are considered least serious and widespread in the Chinese community and considerably more serious in the Latin American and Indo-Pakistani communities. Family difficulties present themselves in all communities as both possible causes and major consequences of alcohol misuse. Finally, implications for developing culturally responsive prevention programs are drawn.

Depressive symptoms and cigarette smoking among Latinos in San Francisco

We administered the Center for Epidemiological Studies Depression (CES-D) Scale to 547 San Francisco Latinos as part of a random digit dialing telephone survey to evaluate smoking behavior. Both men and women current smokers had the highest mean CES-D levels (9.7 and 14.3, respectively). Logistic regression analysis adjusting for gender, acculturation, education, age, and employment showed that current smokers had an odds ratio of 1.7 (95% CI = 1.3, 2.2) for significant depressive symptoms compared to former smokers (OR = 1.1;95% CI = .8, 1.6) and never smokers (OR = 1).

Depression, stress, mastery, and social resources in four ethnocultural women's groups

This descriptive study was designed to examine the interrelationships of depression, stress, mastery, and social resources in four ethnocultural women's groups. The random sample (N = 212) was comprised of Chinese (n = 60), Vietnamese (n = 46), Portuguese (n = 56), and Latin American (n = 50) immigrant women. Using the CES-D, high depressive symptoms were reported by all groups. Collectively, the major correlates and predictors of depression were perceived stress and mastery. Group-specific analyses revealed different models for predicting depression in each ethnic group. The findings underscore the need for observation of the indicators of depression in immigrant women--regardless of their phase of resettlement--and a flexible, individualized approach to ethnic women's psychological health care.

Access to medical care in a medically indigent population

OBJECTIVE

To study nature and extent of barriers to access to medical care in a single county and to define the nature of the illnesses in a population affected by those barriers.

DESIGN

Descriptive study of consecutive patients not able to obtain medical care because of financial or other barriers. Financial barriers and medical diagnoses were categorized and the severity of illness and impact of unavailability of medical services were judged by a panel of internists using consensus analysis. The likelihood of obtaining care after refusal of assistance was also evaluated.

SETTING

A social services eligibility office on the grounds of an urban, university teaching hospital that serves a largely medically indigent population.

PATIENTS

200 patients who presented to eligibility workers seeking financial assistance.

INTERVENTIONS

None.

MEASUREMENTS AND RESULTS

Sixty percent could not obtain care because they were illegal aliens, 40% could not obtain care because they did not meet the strict criteria of the assistance programs. Sixty percent of patients had a moderate to high likelihood of long-term disability from their illnesses; 38% of a subgroup were not able to find care four weeks after entering the study, and these patients appeared to have more severe disease than those who were able to find care.

CONCLUSIONS

Many medically indigent persons with significant illnesses face serious financial barriers to access to medical care.

A programme of mental health for political refugees: dealing with the invisible pain of political exile

Political persecution, state terrorism, torture, political assassinations, kidnapping and forced exile have become common occurrences in many parts of the world. Several researchers have tried to determine the impact of these situations on the mental health of those affected. At the same time, different types of aid programmes have been developed to prevent and treat the effects of violence on mental health. In this article we present clinical materials collected for 10 years by the Latin American Collective of Psychosocial Work [Colectivo Latinamericano de Trabajo Psicosocial (Colat)], a medical-psychosocial assistance programme for political refugees. The programme was under the academic supervision of the Catholic Universities of Leuven (KUL, ULC), Belgium. The concept of identity is the central theme of a model which tries to understand and explain the suffering of exiles. We try to identify and expose the mechanisms of political violence that have traumatized an individual's self-esteem and disordered his familial and social bonds. In the second part of this article, the central ideas which support the medical-psychosocial practice of the programme are presented. This programme seeks to heal the damage caused by repression and exile through the active participation of those affected. Only in a context of communal action is it possible to develop a therapy to promote an individual recovery. It is in this sense that the strategic goal of the programme is to permit elaboration of the suffering at an individual, familial and group level, and to facilitate group dynamics which can trigger the potential of the exiles to transform the conditions of violence that originated and maintain their pain.

[Changes in the parameters of skin capillaries during the adaptation of students from the countries of Asia, Africa and Latin America]

Time-dependent changes in diameters of various parts of the capillaries, distances between loops of the skin papillary capillaries in the nail wall and number of functioning capillaries per 1 mm2 of the skin surface have been studied biomicroscopically in foreign students, arrived from hot countries, during the process of their adaptation. Reorganization of these skin capillary parameters, actively participating in processes of heat exchange, demonstrate a time-dependent character. Therefore, by means of regressive analysis it is possible to approximate dynamics of the initial data using suitable theoretical models. The dynamics of average meanings of the capillary diameters in the arterial part subordinates to the hyperbolic dependence, changes of other parameters approach the rectilinear regression.

[The low frequency of false positive results in the serological detection of infectivity with the human immunodeficiency virus in collectives of healthy young people]

Among 1002 foreign students examined in Odessa 11 subjects with antibody to HIV, i.e. infected with HIV, were detected. A complete agreement of the results of the enzyme immunoassay and immune blotting test was observed. The reasons of this are discussed. A specific regional distribution of seropositive subjects by their permanent residence places was revealed.

[Latin Americans in Europe. Experience in deracination and the psychocultural identity process]

The deracinating process Latin Americans undergo as a result of their migrating to Europe has been occurring approximately for two hundred years now. It came to be a cultural topic, subsequently integrated to culture as a self-developing phenomenon, especially in the field of both literature and oral communication. Out of the 'root tearing' experience, four basic types may be told apart: Small craftsmen, Transplanted, Exiled, and Transhumants (culture-syncretizing migrants). These experience-related prototypes represent specific socio-cultural forms established during this generic experience which, in turn, lead those involved to assume different forms of self-awareness as well as articulating their lives within the new environment. The study focuses on the deracinating experience effects on the migrants, and how it affects their psychosocial health. Furthermore, the terms -necessary to scrutinize the problem from the migrants' perspective- are defined.

Racial differences in vitamin B12 levels in the United States

Studies from Africa have demonstrated that black people have higher vitamin B12 (cobalamin) levels than do white people. The authors compared healthy white people, black people, and Latin-Americans in the United States. Their study is also the largest in which the effect of race and sex on the cobalamin levels has been examined. Analysis of 233 healthy subjects showed that black people had significantly higher (P less than 0.0001) vitamin B12 levels than did white people. Latin-Americans had levels intermediate between those of white and black people, although their levels were significantly different only in comparison with white people (P = 0.0029). Based on the study of 305 healthy subjects, no sex difference in vitamin B12 levels was noted. Conflicting claims have been made on sex difference in the past. The authors conclude that there is a racial but not a sex difference in vitamin B12 levels in the United States. Like African black people, black people and Latin-Americans in this country have significantly higher vitamin B12 levels than do white people. This finding supports the thesis that genetic factors contribute to the racial differences in vitamin B12 levels.

Platelet counts in three racial groups

Documented differences exist in red blood cell (RBC) and granulocyte counts between black and white people. However, little comparative information is available on differences in platelet counts in the two racial groups. Therefore, this study was performed to compare platelet counts in healthy white (94), black (92), and Latin-American (63) persons. Black women had significantly higher platelet counts than did white women (P less than 0.025). Latin-American women were between the other two groups. No differences were noted among men. Black women also had a significantly higher prevalence of iron deficiency and microcytosis of RBCs than did white women. After exclusion of women with either microcytosis or iron deficiency, racial differences in platelet counts were no longer evident. The authors conclude that the differences in the platelet counts between black and white women were secondary to common RBC differences (such as iron deficiency and other causes of microcytic anemia) and were not intrinsic to the platelets. These and other factors that can affect platelet counts should be excluded before determining the reference ranges for proper interpretation of the platelet counts.

[Morphofunctional characteristics of the conjunctival microcirculation of students of different regions of the world]

By means of vital microscopy, the conjunctival microcirculation has been estimated in students from various regions of the world depending on duration of the time of their life in the USSR. Adaptive rearrangements of the conjunctival microcirculation of the eye ball have been revealed in various time of adaptation. Integral estimation of the conjunctival microcirculation has demonstrated that at initial phase of adaptation synchronization in the work of separate links of the microcirculatory bed is observed. These changes can be interpreted as strain of the compensatory mechanisms. In two years of study, certain stabilization of the microcirculation system activity is observed in the foreign students; this can be considered as the phase of stable adaptation. In the students arrived from hot regions of the world, pigmentation in the eye ball conjunctiva has been revealed. By means of the correlative analysis it has been demonstrated that the pigmentation influences the most labile parts of the microcirculatory bed-capillaries and venules. Pigmentation is usually regarded as a pathological sign peculiar for some diseases. Our investigations have demonstrated that pigmentation should be interpreted carefully and the place of residence of the students investigated should be taken into account, since pigmentation can be the result of elevated solar radiation, specific for hot regions of the Earth.

[Energy expenditure of students at the Patrice Lumumba People's Friendship University during classes]

Energy expenditures were studied in 68 first- and fourth-year male students of the Medical Department of the Patrice Lumumba University of Peoples' Friendship, who arrived to Moscow from different regions of the world: Asia, Africa, Latin America, the Middle East, the Near East, and from the USSR. The measurement of the energy expenditures was conducted at rest, when they sat reading special literature, or stood at the blackboard solving mathematical problems, and during walking at a rate of 4 km/h, applying indirect calorimetry according to the rate of the intake of oxygen and the output of carbon dioxide, with the use of Douglas-Haldane's apparatus and automatic gas analyzer. It was established that the mean values of energy expenditure per 1 kg bw during varying types of activity did not significantly differ in students of various nationalities from different regions: daily energy expenditures of students from the USSR comprised 2591 kcal, from Asia--2240 kcal, from Africa--2296 kcal, from Latin America--2470 kcal, from the Middle and the Near East--2399 kcal. Energy expenditures of the students from different regions during examinations did not significantly differ from those during the routine studying process.

Epiphyseal union of the anterior iliac crest and medial clavicle in a modern multiracial sample of American males and females

Epiphyseal union of the anterior iliac crest and the medial clavicle is examined in 605 males and 254 females in a sample of modern Americans aged 11-40 years. The sample includes American whites, American blacks, Latin-Americans, and Orientals. This is the first skeletal investigation using a large sample of individuals of known age since the McKern and Stewart study of 1957. Epiphyseal union is analyzed in terms of four stages: 1) nonunion with no epiphyses, 2) nonunion with separate epiphyses, 3) partial union, and 4) complete union. The results provide broader age ranges for the stages of union than previous studies. Age ranges for males and females are similar or vary by only 1-2 years. Racially, no major distinguishing patterns are found except for greater variability in age distributions appearing to exist among American black females. The study furnishes valuable data on epiphyseal timing in the teenage years.

Immunogenetic studies of juvenile dermatomyositis. HLA antigens in patients and their families

Typing for HLA-A and -B antigens was performed on 87 children with definite juvenile dermatomyositis (JDMS). A significantly increased frequency of HLA-B8 (estimated relative risk = 2.8, Pc less than 0.01) was observed among White patients, but not among Blacks or Latin Americans with JDMS. No abnormality of HLA haplotype segregation was observed among 38 healthy siblings of the JDMS probands.

Latin American Nursing Students in the United States

The Latino students confront a unique set of difficulties and patterns of adjustment in the majority culture and the educational experiences in the United States. Careful consideration must be given not only to the general characteristics of this group, but also to the individual's history of immigration, socioeconomic status, educational experiences and background. Multicultural education for the international nursing students can benefit all students, but it should not gloss over conflicts of values and beliefs. It must honestly deal with differences and similarities. It must be based on experience, not on stereotypes of root cultures or ethnic characteristics. In addition to addressing the cognitive affect and skill needs of all students, the multicultural education must address the special needs of minorities. Anglo students or majority-group students need realistic opportunities for experience and interaction with minority students and minority-faculty. Every group has something to teach the other. Faculty advisors and majority students should be encouraged to acquaint themselves with the need to establish rapport with the Latino student. There is also a need to develop in the classroom an atmosphere that enhances the learning experiences. The learning experiences should be so designed that all students and school personnel can intellectually, emotionally and socially participate on equal terms in a culturally diverse society.

Ethical and psychiatric aspects of torture: a Canadian study

In the last two decades widespread use of torture by totalitarian governments has been reported in over 60 countries. This situation concerns physicians who are sometimes called upon to see the victims. This paper reports the psychiatric findings in a group of 41 Latin American refugees who arrived in Canada from 1977 to 1979 and alleged to have been subjected to political persecution and torture under the military rulers of their own countries. Most of them, young educated men, were apprehended violently and imprisoned under conditions below the minimum international standards. Systematic physical and psychological torture was the rule, including blindfolding, beatings, electrical shocks, sexual abuse and threats of execution or sham executions. These experiences were followed by a cluster of psychiatric symptoms and physical evidence of trauma compatible with the history given. This pattern constitutes the torture syndrome included under category 308 and 309 of the DSM-III and ICD-9. The alleged professional conduct of 19 doctors who saw 21 of these patients is discussed. A list of codes of medical ethics, intended to guide and protect doctors confronted with this difficult problem, is included.

Congenital metacarpotalar syndrome

Three children were presented having similar facies, musculoskeletal anomalies and a common ethnic background. All had dislocated hips, scoliosis, congenital vertical tali and hand deformities. There was a very small web space between the first and second metacarpals, extension deformities at the wrist, flexion deformities at the metacarpophalangeal joints, and at one or more proximal interphalangeal joints. In addition, 2 of the 3 youngsters had marked crowding of the teeth and a small maxillary arch. All laboratory studies were normal. The most alarming finding was the poor wound healing which averaged 48%. The wound complication rate at Shriner's Hospital in San Francisco during the identical period of time these children were treated ranged from 1.2% to 1.8%. It is believed that this represents a new syndrome, as similar cases could not be found in the literature. The orthopedist may treat these anomalies in the standard fashion but should keep in mind the propensity for poor wound healing in these patients. The common ethnic background was that of Spanish-American or Chicago families.

Comparative tolerance of adolescents of differing ethic backgrounds to lactose-containing and lactose-free dairy drinks. I. Initial experience with a double-blind procedure

A lactose-free (LF) chocolate dairy drink and one containing 4.5% lactose (LC) were administered randomly in 240- and 480-ml volumes on 4 consecutive mornings under double-blind conditions to 110 healthy teenagers (14 to 19 years old) of differing ethnic backgrounds. Capillary blood glucose analysis after 50 g of oral lactose identified 67 of them as lactose malabsorbers. Neither absorbers nor malabsorbers reported significantly different gastrointestinal symptoms after 240 ml of LC compared with the same amount of LF. However, 17 absorbers and 21 malabsorbers reported symptoms inconsistent with intolerance due to lactose. These subjects had symptoms after LF only, after both LF and LC, or after 240 ml but not 480 ml of LC. After 480 ml of LC, 26 malabsorbers had symptoms, compared to 15 after 480 ml of LF. The prevalence of symptoms after 480 ml of LC, but not after 480 ml of LF, was 7% for absorbers, and 24% for malabsorbers. The results indicate that most of the individuals who reported gastrointestinal symptoms after ingestion of the two beverages did so for reasons other than their lactose content.

Academic achievement as a function of specific and global measures of self-concept

This study examined the correlations between academic achievement and factor specific, as well as global, measures of self-concept for 314 fourth and sixth grade boys and girls divided into grade level groups with and without Spanish surnames. The Primary Self-Concept Inventory was used to measure self-concept on six scales: physical size, emotional state, peer acceptance, helpfulness, success, and student-self. A global self-concept score was derived by totaling the scores on the six scales. Achievement was measured as total score on the Comprehensive Tests of Basic Skills. The two specific measures of self-concept that were most reflective of school performance, success and student-self, tended to show low positive correlations with achievement. The remaining specific measures, as well as the global measure, tended to show no relationship to achievement. These results suggest that an area specific model of self-concept is more useful than a global or undifferentiated model. Further, the low correlations between school related self-concept and achievement suggest that, as a group, students frequently have rather inaccurate academic self-concepts.

A study of illness referral in a Spanish-speaking community

In an anthropologic study of illness referral among Latin-American immigrants three phases were ascertained: First, there was extended use of self-treatment. Second, referrals were made to the social network, particularly to people from the same country of origin. Finally, referrals to the professional network were made to professionals with the same cultural heritage. Latin-American immigrant families living in a cooperative were studied over a 14-month period, utilizing the method of participant observation, a family health calendar, and interviews. This report focuses on the results of the family health calendar. Most illnesses reported by families did not go beyond self-treatment. Cultural influences including language, social network, priorities of daily living were related to the alternatives selected by families when illness incidents occurred.