Racial/ethnic discrimination and common mental disorders among workers: findings from the EMPIRIC Study of Ethnic Minority Groups in the United Kingdom

OBJECTIVES: We measured perceived discrimination and its association with common mental disorders among workers in the United Kingdom. METHODS: We conducted a secondary analysis of a national sample of 6 ethnic groups (n=2054). Discrimination was measured as reports of insults; unfair treatment at work; or job denial stemming from race, religion, or language. The outcome assessed was presence of common mental disorders. RESULTS: The risk of mental disorders was highest among ethnic minority individuals reporting unfair treatment (odds ratio [OR]=2.0; 95% confidence interval [CI]=1.2, 3.2) and racial insults (OR=2.3; 95% CI=1.4, 3.6). The overall greatest risks were observed among Black Caribbeans exposed to unfair treatment at work (OR=2.9; 95% CI=1.2, 7.3) and Indian (OR=3.1; 95% CI=1.4, 7.2), Bangladeshi (OR=32.9; 95% CI=2.5, 436.0), and Irish (OR=2.9; 95% CI=1.1, 7.6) individuals reporting insults. CONCLUSIONS: Racial/ethnic discrimination shows strong associations with common mental disorders.     

Perceived racial discrimination and risk of uterine leiomyomata

BACKGROUND: The incidence of uterine leiomyomata (fibroids, myomas) is 2-3 times higher in black women than white women. Black women also report higher levels of racial discrimination. We evaluated the hypothesis that greater exposure to racism increases myoma risk in black women. METHODS: Data were derived from the Black Women's Health Study, a prospective cohort study of US black women age 21-69 years in 1995. In 1997, women reported on "everyday" and "lifetime" experiences of racism. From 1997 through 2003, we followed 22,002 premenopausal women to assess the association between self-reported racism and risk of myomas. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated from Cox regression models. RESULTS: During 107,127 person-years of follow-up, 3440 new cases of uterine myomas confirmed by ultrasound (n = 2774) or surgery (n = 666) were reported. All IRRs for "lifetime" and "everyday" experiences of racism were above 1.0. Using a summary variable that averaged the responses from 5 "everyday" racism items, multivariable IRRs comparing quartiles 2, 3, and 4 to quintile 1 (lowest) were 1.16 (95% CI = 1.04-1.29), 1.19 (1.06-1.32), and 1.27 (1.14-1.43), respectively. Multivariable IRRs comparing women who reported 1, 2, or 3 lifetime occurrences of major discrimination (ie, job, housing, or police) relative to those who reported none were 1.04 (0.96-1.13), 1.17 (1.07-1.28), and 1.24 (1.10-1.39), respectively. Results did not vary according to case definition (ultrasound vs. surgery) or health care utilization. Associations were weaker among foreign-born women and among women with higher coping skills. CONCLUSIONS: Perceived racism was associated with an increased risk of uterine myomas in US-born black women.     

Somatotyping of schizophrenic and affective disorder patients

INTRODUCTION: Constitutional traits have been found to show a distinct relevance to major psychiatric disorders. Syndromal modified expressivity is also closely related to somatotypic constitution. In this view somatotyping appears valuable in diagnosis and prognosis of mental disorders. AIM: The present study was conducted in an attempt to outline somatotypic characteristics of schizophrenia and affective disorders with the aim of providing a logical basis for diagnosis of these major psychiatric disorders. MATERIAL AND METHODS: The somatotype of 54 schizophrenic and 68 affective disorder inpatients who fulfil the DSM-IV criteria for schizophrenia (subjects with schizophreniform, schizoaffective, schizoid and schizotypal personality disorders were excluded from the sample) and affective disorder (bipolar and unipolar) was assessed using the Health-Carter anthropometric method. RESULTS: The overall assessment of the somatotypes determined both groups as endomorphs mesomorphs with somatotype components 4.50-4.44-1.90 for schizophrenic patients and 5.87-5.40-0.36 for affective disorder patients. The difference between the two groups was statistically significant for any of the somatotype components. CONCLUSION: It is suggested that the constitutional and somatotypic characterization appears reasonable element in the multifactorial analysis of diagnostic decisions in these major psychiatric disorders.     

Racial discrimination, ethnicity and work stress

BACKGROUND: Previous research has suggested higher work stress among minority ethnic workers. AIMS: To determine levels of work stress in three ethnic groups, consider the contribution of racial discrimination to the groups' profiles of occupational and demographic associations with stress, and assess the association between work stress and well-being. METHODS: A household quota sample design was used, and 204 black African-Caribbean, 206 Bangladeshi and 216 white (UK born) working people took part in structured interviews. RESULTS: More black African-Caribbean respondents reported high work stress than either Bangladeshi or white respondents. Reported racial discrimination among black African-Caribbean female respondents was strongly associated with perceived work stress. Among the black African-Caribbean respondents, women who reported experiencing racial discrimination at work had higher levels of psychological distress. CONCLUSIONS: Perceived work stress may be underpinned by exposure to racial discrimination at work among black African-Caribbean women, and this may affect their psychological well-being.     

Influence of body size and body fat distribution on risk of uterine leiomyomata in U.S. black women

BACKGROUND: Uterine leiomyomata are a major source of morbidity in black women. We prospectively investigated the risk of self-reported uterine leiomyomata in relation to body mass index (BMI), weight change, height, waist and hip circumferences, and waist-to-hip ratio in a large cohort of U.S black women. METHODS: Data were derived from the Black Women's Health Study, a U.S. prospective cohort study of black women who complete biannual mailed health questionnaires. From 1997 through 2001, we followed 21,506 premenopausal women with intact uteri and no prior diagnosis of uterine leiomyomata. Cox regression models were used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). RESULTS: After 70,345 person-years of follow up, 2146 new cases of uterine leiomyomata confirmed by ultrasound (n = 1885) or hysterectomy (n = 261) were self-reported. Compared with the thinnest women (BMI <20.0 kg/m), the multivariate IRRs for women with BMIs of 20.0-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.9, 30.0-32.4, and 32.5+ kg/m were 1.34 (95% CI = 1.02-1.75), 1.39 (1.07-1.81), 1.45 (1.12-1.89), 1.47 (1.11-1.93), 1.36 (1.02-1.80), and 1.21 (0.93-1.58), respectively. IRRs were larger among parous women. Weight gain since age 18 was positively associated with risk, but only among parous women. No other anthropometric measures were associated with risk. CONCLUSIONS: BMI and weight gain exhibited a complex relation with risk of uterine leiomyomata in the Black Women's Health Study. The BMI association was inverse J-shaped and findings were stronger in parous women. Weight gain was positively associated with risk among parous women only.     

Are schizophrenia or antipsychotic drugs a risk factor for cataracts?

Lens changes and ocular disturbances have been reported in conjunction with the use of antipsychotic drugs. We estimated the incidence rate of a clinical diagnosis of cataract in patients with a psychotic disorder, schizophrenia, and compared it with the rate in the general population. Among the schizophrenic patients, we also examined the role of dose and duration of antipsychotic drugs on the risk of cataract development. We followed up two cohorts of patients 30-85 years of age who were included in the United Kingdom General Practice Research Database. Patients in one group had a diagnosis of schizophrenia (N = 4,209). The other group was an age- and sex-matched cohort of 10,000 patients sampled from the source population. The incidence of cataracts was 4.5 per 1,000 person-years among the general population and 3.5 in the schizophrenia population. Overall, antipsychotic drug use was not associated with the occurrence of cataracts. Nevertheless, among long-term users of chlorpromazine at daily doses of 300 mg or greater, and among users of prochlorperazine, the relative risks were 8.8 (95% confidence interval = 3.1-25.1) and 4.0 (95% confidence interval = 0.8-20.7), respectively. There is no indication that schizophrenia per se is associated with an increased risk of developing cataracts.     

A meta-analysis of the hepatitis C virus distribution in diverse racial/ethnic drug injector groups

Hepatitis C virus (HCV) is mostly transmitted through blood-to-blood contact during injection drug use via shared contaminated syringes/needles or injection paraphernalia. This paper used meta-analytic methods to assess whether HCV prevalence and incidence varied across different racial/ethnic groups of injection drug users (IDUs) sampled internationally. The 29 prevalence and 11 incidence studies identified as part of the HCV Synthesis Project were categorized into subgroups based on similar racial/ethnic comparisons. The effect estimate used was the odds or risk ratio comparing HCV prevalence or incidence rates in racial/ethnic minority groups versus those of majority status. For prevalence studies, the clearest disparity in HCV status was observed in the Canadian and Australian Aboriginal versus White comparison, followed by the US non-White versus White categories. Overall, Hispanic IDUs had greater HCV prevalence, and HCV prevalence in African-Americans was not significantly greater than that of Whites in the US. Aboriginal groups showed higher HCV seroconversion rates when compared to others, and African-Americans had lower seroconversion rates compared to other IDUs in the US. The findings suggest that certain minority groups have elevated HCV rates in comparison to other IDUs, which may be a consequence of stigma, discrimination, different risk behaviors or decreased access to health care, services and preventive education. Future research should seek to explicitly explore and explain racial/ethnic variations in HCV prevalence and incidence, and define the groups more precisely to allow for more accurate detection of possible racial/ethnic differences in HCV rates.     

Disparities in health: perspectives of a multi-ethnic, multi-racial America

This 2006 survey of 4,157 randomly selected U.S. adults compared perceptions of health care disparities among fourteen racial and ethnic groups to those of whites. Findings suggest that many ethnic minority groups view their health care situations differently and, often, more negatively than whites. A substantial proportion perceived discrimination in receiving health care, and many felt that they would not receive the best care if they were sick. Most differences remained when socioeconomic characteristics were controlled for. The variety of responses across racial groups demonstrates the importance of examining ethnic subgroups separately rather than combined into a single category.     

Limited English proficiency and psychological distress among Latinos and Asian Americans

English proficiency is increasingly recognized as an important factor that is related to the mental health of immigrants and ethnic minorities. However, few studies have examined how the association between English proficiency and mental health operates and whether the pattern of association is similar or different among various ethnic minority groups. This paper investigates how limited English proficiency directly and indirectly affects psychological distress through pathways of discrimination for both Latinos and Asian Americans in the United States. Findings suggest that, for Asian Americans, limited English proficiency has an independent relationship with psychological distress over and above demographic variables, socioeconomic and immigration-related factors and discrimination. For Latinos, however, socio-demographic variables and discrimination show a stronger association than limited English proficiency in affecting psychological distress. Different forms of discrimination - everyday discrimination and racial/ethnic discrimination - are equally important for both ethnic groups. Findings underscore the differential role of limited English proficiency for the mental health of Asian Americans and Latinos and suggest the distinctive racial experiences and backgrounds of these two ethnic groups.     

Mental health care: perceptions of people with schizophrenia and their carers

The current study aims to discover the opinions of patients and their (informal and formal) carers concerning the mental health care of individuals with long term schizophrenic disorders within different contexts and cultures. It's a qualitative study with focus groups,in which 6 research centers (from Argentina, Brazil, Chile, Spain, England and Venezuela) participated. Eight focus groups were conducted in each center, totaling 303 individuals in 46 groups. The data were analyzed with the aid of the Qualitative Solutions and Research/Non-numerical Unstructured Data Indexing program (QSR NUD*IST 4.0). The perception regarding the quality of care is influenced by the professional-patient relationship and the availability of resources. Poor quality of care is also perceived as discrimination. People with schizophrenia in general consider themselves to be ostracized by professionals and services and lacking in more humanized care. In the contexts in which community care is less advanced, the complaints center on resources and services that do not meet demands. On the other hand, in more developed contexts criticism centers more on the attitude of the professionals and the professional patient relationship. Over and above the need for resources and services, people with schizophrenia require more humanized health care.     

Perceptions of race/ethnicity-based discrimination: a review of measures and evaluation of their usefulness for the health care setting

BACKGROUND: To assess discrimination in health care, reliable, valid, and comprehensive measures of racism/discrimination are needed. OBJECTIVE: To review literature on measures of perceived race/ethnicity-based discrimination and evaluate their characteristics and usefulness in assessing discrimination from health care providers. METHODS: Literature review of measures of perceived race/ethnicity-based discrimination (1966-2007), using MEDLINE, PsycINFO, and Social Science Citation Index. RESULTS: We identified 34 measures of racism/discrimination; 16 specifically assessed dynamics in the health care setting. Few measures were theoretically based; most assessed only general dimensions of racism and focused specifically on the experiences of African American patients. Acceptable psychometric properties were documented for about half of the instruments. CONCLUSIONS: Additional measures are needed for detailed assessments of perceived discrimination in the health care setting; they should be relevant for a wide variety of racial/ethnic groups, and they must assess how racism/discrimination affects health care decision making and treatments offered.     

Race and risk of schizophrenia in a US birth cohort: another example of health disparity?

BACKGROUND: Immigrant groups in Western Europe have markedly increased rates of schizophrenia. The highest rates are found in ethnic groups that are predominantly black. Separating minority race/ethnicity from immigration in Western Europe is difficult; in the US, these issues can be examined separately. Here we compared rates of schizophrenia between whites and African Americans and evaluated whether the association was mediated by socioeconomic status (SES) of family of origin in a US birth cohort. METHODS: Study subjects were offspring of women enrolled during pregnancy at Alameda County Kaiser Permanente Medical Care Plan clinics (1959-66) in the Child Health and Development Study. For schizophrenia spectrum disorders, 12 094 of the 19 044 live births were followed over 1981-97. The analysis is restricted to cohort members whose mothers identified as African American or white at intake. Stratified proportional hazards regression was the method of analysis; the robustness of findings to missing data bias was assessed using multiple imputation. RESULTS: African Americans were about 3-fold more likely than whites to be diagnosed with schizophrenia [Rate Ratio (RR) = 3.27; 95% confidence interval (CI): 1.71-6.27]. After adjusting for indicators of family SES at birth, the RR was about 2-fold (RR = 1.92; 95% CI: 0.86-4.28). Using multiple imputation in the model including family SES indicators, the RR for race and schizophrenia was strengthened in comparison with the estimate obtained without imputation. CONCLUSION: The data indicate substantially elevated rates of schizophrenia among African Americans in comparison with whites in this birth cohort. The association may have been partly but not wholly mediated by an effect of race on family SES.     

云南省18个少数民族2009-2018年乙型病毒性肝炎流行趋势

  目的   分析云南省18个少数民族2009-2018年乙型病毒性肝炎(hepatitis B virus, HBV)流行趋势, 探索云南省乙肝发病率的民族差异。   方法   基于2009-2018年中国疾病预防控制信息系统中乙肝报告发病数据, 采用描述流行病学方法对不同少数民族的乙肝发病情况进行描述分析; 采用K-means聚类法方法对不同民族的乙肝年均发病率进行探索分析。   结果   2009-2018年云南省年平均发病率为44.26/10万, 低于全国总体水平; 少数民族乙肝年平均发病率为41.27/10万, 低于云南总体水平。不同民族乙肝流行趋势各有异同, 佤族的年均发病率明显高于其他(95.26/10万), 景颇族最低(22.51/10万)。按乙肝发病率高低将各民族分为3类:高发民族、中发民族和低发民族。   结论   云南省乙肝发病率存在民族差异, 部分民族发病率高于全国, 是乙肝防控工作的重点人群。     

The ecological relationship between deprivation, social isolation and rates of hospital admission for acute psychiatric care: a comparison of London and New York City

We report on comparative analyses of small area variation in rates of acute hospital admissions for psychiatric conditions in Greater London around the year 1998 and in New York City (NYC) in 2000. Based on a theoretical model of the factors likely to influence psychiatric admission rates, and using data from the most recent population censuses and other sources, we examine the association with area indicators designed to measure access to hospital beds, socio-economic deprivation, social fragmentation and ethnic/racial composition. We report results on admissions for men and women aged 15-64 for all psychiatric conditions (excluding self-harm), drug-related substance abuse/addiction, schizophrenia and affective disorders. The units of analysis in NYC were 165 five-digit Zip Code Areas and, in London, 760 electoral wards as defined in 1998. The analysis controls for age and sex composition and, as a proxy for access to care, spatial proximity to hospitals with psychiatric beds. Poisson regression modeling incorporating random effects was used to control for both overdispersion in the counts of admissions and for the effects of spatial autocorrelation. The results for NYC and London showed that local admission rates for all types of condition were positively and significantly associated with deprivation and the association is independent of demographic composition or 'access' to beds. In NYC, social fragmentation showed a significant association with admissions due to affective disorders and schizophrenia, and for drug dependency among females. Racial minority concentration was significantly and positively associated with admissions for schizophrenia. In London, social fragmentation was associated positively with admissions for men and women due to schizophrenia and affective disorders. The variable measuring racial/ethnic minority concentration for London wards showed a negative association with admission rates for drug dependency and for affective disorders. We discuss the interpretation of these results and the issues they raise in terms of the potential and limitations of international comparison.     

中国26个少数民族7~18岁学生生长迟缓比较研究

目的 比较我国26个少数民族7~18岁学生生长迟缓现况，为促进少数民族学生生长潜力，提高少数民族学生健康水平提供参考依据。方法 选择2014年"全国学生体质与健康调研"中26个少数民族7~18岁学生，根据《学龄儿童青少年营养不良筛查标准》（WS/T 456-2014）判断生长迟缓，对各少数民族学生成年身高和生长迟缓现况进行比较。结果 2014年我国26个少数民族男生18岁身高为（168.3±6.8）cm，女生为（156.2±5.9）cm。26个少数民族男生合并生长迟缓率均为5.4%，女生合并生长迟缓率为5.1%。水族学生生长迟缓率最高（男生：24.5%，女生：23.0%），回族学生生长迟缓率最低（男生：0.1%，女生：0.3%）。男、女生生长迟缓率均超过平均水平的9个少数民族中，布依族男生、傈僳族女生和哈尼族女生在4个年龄组生长迟缓检出率差异无统计学意义，撒拉族学生生长迟缓集中在7~9岁年龄组，佤族等少数民族学生生长迟缓大多集中在较高年龄组。西南地区学生生长迟缓率最高（8.1%），明显高于华北地区（0.8%）学生（OR=10.6，95% CI：7.8~14.4）。7~17岁生长迟缓率与18岁身高呈显著负相关（男生：r=-0.811，P<0.001；女生：r=-0.715，P<0.001）。结论 2014年我国26个少数民族学生18岁平均身高民族间差异较大。总体而言，男生生长迟缓检出率前5位的民族分别为水族、佤族、布依族、瑶族和彝族，女生生长迟缓检出率前5位的民族分别为水族、瑶族、布依族、佤族和苗族。西南地区少数民族学生生长迟缓检出率明显高于其他地区。应当针对生长迟缓率较高的民族和地区进行营养干预和健康教育，以促进少数民族学生生长潜力。     

Perceived Discrimination,Psychological Distress,and Current Smoking Status: Results From the Behavioral Risk Factor Surveillance System Reactions to Race Module, 2004–2008

Objectives. We examined the association between perceived discrimination and smoking status and whether psychological distress mediated this relationship in a large, multiethnic sample.Methods. We used 2004 through 2008 data from the Behavioral Risk Factor Surveillance System Reactions to Race module to conduct multivariate logistic regression analyses and tests of mediation examining associations between perceived discrimination in health care and workplace settings, psychological distress, and current smoking status.Results. Regardless of race/ethnicity, perceived discrimination was associated with increased odds of current smoking. Psychological distress was also a significant mediator of the discrimination–smoking association.Conclusions. Our results indicate that individuals who report discriminatory treatment in multiple domains may be more likely to smoke, in part, because of the psychological distress associated with such treatment.The public health burden of cigarette smoking is well established. Smoking is the leading preventable cause of mortality in the United States, accounting for 1 of every 5 deaths,1 and is associated with cardiovascular and respiratory diseases as well as several cancers and adverse reproductive effects.2 Although rates of smoking have declined over the past several decades, a substantial proportion of the population still smokes.Data from the National Health Interview Survey show that 21% of adults aged 18 years or older are current smokers.3 Smoking prevalence is substantially higher among those of lower socioeconomic status (SES), and because of the disproportionate representation of minorities among the poor, low-SES members of racial/ethnic minority groups are particularly affected by smoking-related health disparities.4,5 When considered by race, the highest rate of adult smoking is found among American Indians and Alaska Natives (23%), followed by African Americans and Whites (both 21%); the lowest rate is that among Asian Americans (10%).3 The rate of smoking in the adult Hispanic population is 15%.3 In light of high levels of smoking-related morbidity and mortality and demonstrated health disparities, it is important to understand the factors that promote smoking among members of different racial/ethnic groups.Several investigators have proposed that perceived discrimination or unfair treatment may account in part for disparities in health behaviors and outcomes, particularly among members of racial and ethnic minority groups.6-8 Much of this work has been developed within the framework of stress and coping models, with perceived discrimination treated as a chronic stressor that has potentially negative effects on health.8,9Investigations linking discrimination to smoking are included in this growing body of research. For example, studies involving adolescent,10 young adult,11,12 and adult13,14 African Americans have shown that experiences of racial discrimination, and the stress caused by such experiences, are positively associated with cigarette smoking. Similar findings were reported in a study of Asian Americans experiencing high levels of unfair treatment and racial/ethnic discrimination, who were 2 to almost 3 times more likely to be current smokers than those who experienced no unfair treatment or discrimination.15Landrine et al. reported that racial/ethnic discrimination is associated with psychiatric symptoms as well as smoking behavior, and these relationships were stronger for racial and ethnic minority groups.14 Krieger et al. found a trend toward an association between discrimination and smoking among Blacks and Latinos but not among Whites.16 Guthrie et al. demonstrated that a daily hassles measure of stress mediated the relationship between reported discrimination and smoking among African American adolescent girls, offering support for stress and coping explanations of the relationship between discrimination and smoking.10According to Williams et al., in their review of the literature on discrimination and health, more research exploring mechanisms underlying the association between discrimination and health is needed.8 Much of the research on discrimination and smoking has been framed within stress and coping models, but relatively little work has been done to test whether psychological distress mediates this relationship.The theoretical framework that guided our investigation is the Clark et al. biopsychosocial model of the effects of perceived racism,9 which proposes that psychological distress may be one of the psychological responses to perceived discrimination. Consistent with this model, several studies have shown an association between perceived discrimination and psychological distress.17–19 However, whereas the Clark et al. model considers the relationship between discrimination and health outcomes, we were interested in the health behavior of smoking, which is commonly thought of as a means of coping with stress20 and is also associated with certain forms of psychological distress and psychopathology.21 Smoking may be used as a form of self-medication to alleviate stress and associated psychological distress.Reports on the association between discrimination and smoking have also tended to focus on single racial or ethnic groups (e.g., African Americans, Asian Americans) or have compared members of a single racial/ethnic minority group with Whites, limiting our ability to compare the relative effects of perceived discrimination on smoking behavior between groups. In addition, most previous research has involved convenience samples and, in some cases, relatively small sample sizes, limiting generalizability.We used 2004 through 2008 data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine the association between perceived discrimination and smoking status and whether psychological distress mediates this association in a large multistate, multiethnic random sample. Beginning in 2002, an optional module, Reactions to Race, was added to the BRFSS and adopted by several states in an attempt to capture data on perceived racial discrimination and its effects in a population-based sample.On the basis of findings from previous studies examining perceived discrimination and smoking, we hypothesized that the odds of smoking would be higher among those who perceived that they were treated differently because of their race (hypothesis 1). We also hypothesized that the association between discrimination and smoking would be stronger for racial and ethnic minority groups (hypothesis 2) and that psychological distress, as measured by reported mental health problems, would mediate the association between discrimination and smoking status (hypothesis 3).     

Health and social care needs in minority communities: an over‐problematized issue?

As far as Britain’s black and South Asian minority communities are concerned, the development of health and social care in the community is often perceived to be problematic. For some minority groups (or for some sections of particular communities) this view is justified. Firstly, significant numbers of people in minority ethnic communities are socially and economically disadvantaged and might lack the resources (income, satisfactory housing, access to transport, family support) to provide care to the level that is needed. Secondly, the planning and delivery of care services for people in minority communities can leave much to be desired. Among other problems, racism and institutional discrimination can result in services which neglect the needs of minority communities. However, the argument remains that to a degree the issue of community care in minority ethnic communities is an over‐problematized one. Are the problems faced by particular groups in the minority population experienced widely in every minority community? This paper examines the argument by focusing on the care of older people. It accepts that problems of racism in the planning and delivery of health and social services are serious and lead to limited access to, and under‐use of, social services by some. However, it is evident that some minority communities are in a much better position than others to meet the care needs of older people.     

Agency and structure: the impact of ethnic identity and racism on the health of ethnic minority people

Abstract To understand ethnic inequalities in health, we must take account of the relationship between ethnic minority status, structural disadvantage and agency. So far, the direct effects of racial oppression on health, and the role of ethnicity as identity, which is in part a product of agency, have been ignored. We set out to redress this balance using data from the Fourth National Survey of Ethnic Minorities. Factor analysis suggested that dimensions of ethnic identity were consistent across the various ethnic minority groups. Initially some of these dimensions of ethnic identity appeared to be related to health, but in a multivariate model the factor relating to a racialised identity was the only one that exhibited any relationship with health. These findings suggest that ethnic identity is not related to health. Rather, the multivariate analyses presented here showed strong independent relationships between health and experiences of racism, perceived racial discrimination and class.     

5种非典型抗精神病药临床应用药物经济学分析

目的:评价常用非典型抗精神病药物治疗精神分裂症的经济学效果。方法:250例接受单一抗精神病药物治疗的患者入组;试验时间为1年;以阳性与阴性症状量表评分减少量评价疗效,并进行最小成本分析。结果:241例患者完成研究,5组药物疗效相近,不良反应发生率氯氮平最高,齐拉西酮最低,齐拉西酮组泌乳素水平低于其他4组;治疗总成本由低到高依次为:氯氮平、利培酮(维思通)、齐拉西酮(卓乐定)、喹硫平(思瑞康)、奥氮平(再普乐)。结论:在治疗精神分裂症方面,氯氮平最具经济性,利培酮适合中国国情。