Patient–Physician Communication in the Primary Care Visits of African Americans and Whites with Depression

Background Little research investigates the role of patient–physician communication in understanding racial disparities in depression treatment. Objective The objective of this study was to compare patient–physician communication patterns for African-American and white patients who have high levels of depressive symptoms. Design, Setting, and Participants This is a cross-sectional study of primary care visits of 108 adult patients (46 white, 62 African American) who had depressive symptoms measured by the Medical Outcomes Study–Short Form (SF-12) Mental Component Summary Score and were receiving care from one of 54 physicians in urban community-based practices. Main Outcomes Communication behaviors, obtained from coding of audiotapes, and physician perceptions of patients’ physical and emotional health status and stress levels were measured by post-visit surveys. Results African-American patients had fewer years of education and reported poorer physical health than whites. There were no racial differences in the level of depressive symptoms. Depression communication occurred in only 34% of visits. The average number of depression-related statements was much lower in the visits of African-American than white patients (10.8 vs. 38.4 statements, p = .02). African-American patients also experienced visits with less rapport building (20.7 vs. 29.7 statements, p = .009). Physicians rated a higher percentage of African-American than white patients as being in poor or fair physical health (69% vs. 40%, p = .006), and even in visits where depression communication occurred, a lower percentage of African-American than white patients were considered by their physicians to have significant emotional distress (67% vs. 93%, p = .07). Conclusions This study reveals racial disparities in communication among primary care patients with high levels of depressive symptoms. Physician communication skills training programs that emphasize recognition and rapport building may help reduce racial disparities in depression care.     

Significant associations between lipoprotein(a) and corrected apolipoprotein B-100 levels in African–Americans

Objectives

Lipoprotein(a), Lp(a), represents an apolipoprotein (apo) B-carrying lipoprotein, yet the relationship between Lp(a) and apoB levels has not been fully explored.

Methods

We addressed the relationship between Lp(a) and apoB-containing lipoprotein levels in 336 Caucasians and 224 African–Americans. Our approach takes unique molecular properties of Lp(a) as well as contribution of Lp(a) to the levels of these lipoproteins into account.

Results

Levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apoB and apoB/apoA-1 did not differ across ethnicity. African–Americans had higher levels of Lp(a) and high-density lipoprotein cholesterol and lower triglyceride levels compared to Caucasians. Lp(a) levels were correlated with levels of TC (p < 0.005), LDL-C (p < 0.001), apoB (p < 0.05) or apoB/apoA-1 (p < 0.05) in both ethnic groups. These associations remained significant only in African–Americans after adjustments for the contribution of Lp(a)-cholesterol or Lp(a)-apoB. Furthermore, taking Lp(a)-apoB into account, allele-specific apo(a) levels were significantly associated with apoB levels and the apoB/apoA-1 ratio in African–Americans. The latter associations in African–Americans remained significant for allele-specific apo(a) levels for smaller apo(a) sizes (<26 K4 repeats), after controlling for the effects of age, sex, and BMI.

Conclusions

Although TC, LDL-C, and apoB levels were comparable between African–Americans and Caucasians, the associations of these parameters with Lp(a) and allele specific apo(a) levels differed between these two ethnic groups. In African–Americans, apoB and apoB/apoA-1 remained consistently and positively associated with both Lp(a) and allele-specific apo(a) levels after adjustments for the contribution of Lp(a)-apoB. The findings suggest an interethnic difference with a closer relationship between Lp(a) and apoB among African–Americans.     

What is the role of obesity in hypertension and target organ injury in African Americans?

Hypertension is the most common reversible risk factor for cardiovascular disease. It is especially common in African Americans. One of the factors that may contribute to the high rates of hypertension and target organ injury in African Americans is obesity. Hypertension and obesity are common among African Americans. Obesity is particularly common in African American women. About 75% of African American women are obese. Regulation of both body weight and blood pressure are complex, involving an interaction of genetic and environmental factors. Most research thus far has focused on blood pressure control systems studied in other forms of hypertension, including the sympathetic nervous system, the renin angiotensin system, and metabolic factors-primarily insulin resistance. Proposed mechanisms that are unique to obesity-associated hypertension include: 1) intrarenal physical forces associated with obesity-induced changes in the renal medulla; 2) genetic/metabolic factors; and 3) metabolic effects of abdominal visceral fat. The Jackson Heart Study provides a unique opportunity to address unresolved questions in the relationship of body weight, blood pressure, and cardiovascular disease.     

Prevalence of and risk factors for the development of atopic dermatitis in schoolchildren aged 12–14 in northwest Croatia

BackgroundAtopic dermatitis is a common allergic disorder. A multifactorial background for atopic dermatitis has been suggested, with genetic as well as environmental factors influencing disease development. Our aim was to estimate the prevalence rate and associated factors for atopic dermatitis in northern Croatia using the methods of the internationally standardised ISAAC protocol.MethodsThe study was undertaken among 12–14-year-old schoolchildren. Data were collected using standardised ISAAC written questionnaire Phase One and some selected questions from the ISAAC supplementary questionnaire completed by parents.ResultsA total of 2887 children participated in the study. Estimated lifetime (ever) prevalence rate of atopic dermatitis symptoms was 7.55% and estimated 12-month prevalence rate was 5.75%. The factors found to be associated to the symptoms of atopic dermatitis ever were: positive family atopy, female gender, sleeping on feather pillow and contact with pets after age of seven, and to the symptoms in the past 12 months were: positive family atopy, female gender, sleeping on feather pillow, parasite infestation, and contact with pets in the first year of life.ConclusionsThe results of our study show that northern Croatia is a region with moderate prevalence rates of atopic dermatitis. Following risk factors were family atopy, female gender and sleeping on feather pillow. Because of controversial results of previous studies conducted on the same topic further investigations should be made.     

African Americans’ Perceptions of Physician Attempts to Address Obesity in the Primary Care Setting

BACKGROUND  Obesity disproportionately affects African Americans and leads to several major co-morbidities. While guidelines recommend physicians identify obese patients and counsel them on weight management, little is known about how these efforts are received by patients. OBJECTIVE  To elucidate how obese, urban African American patients perceive the physician role in the treatment of obesity and to identify specific provider behaviors that may motivate or hinder attempts at weight loss. DESIGN  Qualitative study involving eight focus groups. PARTICIPANTS  Forty-three obese African-American patients recruited from academic internal medicine practices participated in focus groups between September 2007 and February 2008. MEASUREMENTS AND MAIN RESULTS  Four broad themes emerged: (1) dislike of the word obese, (2) importance of the physician manner and timing when discussing weight, (3) necessity of a personalized approach in discussing weight management issues, and (4) variable response to scare tactics. Within each theme participants identified specific physician behaviors that were perceived as either motivating or hindering attempts at weight loss. CONCLUSIONS  Physicians must be cognizant of the potential unintended consequences of the techniques they use to educate and counsel African-American men and women on obesity, particulary those that may be perceived as negative and act to further alienate obese patients from seeking the care they need.     

Overestimate of Fibrosis by FIBROSpect? II in African Americans Complicates the Management of their Chronic Hepatitis C

Background: Evaluation of advanced fibrosis in patients with hepatitis C virus (HCV) infection is used to facilitate decisions on treatment strategy and to initiate additional screening measures. Unfortunately, most studies have predominately Caucasian (Cau) patients and may not be as relevant for African Americans (AA). Aims: This study specifically addresses the issue of defining minimal vs. significant fibrosis in African Americans (AA) with chronic hepatitis C (CHC) using noninvasive assays. Methods: All patients (n = 319) seen between 1 January 2008 and 30 June 2013 for whom a FibroSpect II® (FSII) assay was performed and had data for calculation of aspartate aminotransferase (AST) platelet ratio index (APRI) and Fibrosis-4 (FIB-4) were identified using the medical records. Results: When liver biopsy score and FSII assay results for the AA patients with CHC were compared, 31% of AA had advanced FSII fibrosis scores (F2-F4) despite a biopsy score of F0-F1. In contrast, 10% of Cau over-scored. The AA false positive rate was 14% for APRI and 34% for FIB-4. Combining FSII with either APRI (7% false positive) or FIB-4 (10% false positive) improved the false positive rate in AA to 7% (FSII + APRI) and 10% (FSII + FIB-4) but reduced the sensitivity for significant fibrosis. Conclusions: The FSII assay overestimates fibrosis in AA and should be used with caution since these patients may not have significant fibrosis. If the APRI or FIB-4 assay is combined with the FSII assay, minimal fibrosis in AA can be defined without subjecting the patients to a subsequent biopsy.     

Prevalence of musculoskeletal symptoms in the five urban regions of Brazil—the Brazilian COPCORD study (BRAZCO)

The objective of this study is to describe the prevalence of musculoskeletal symptoms (MSK-S) in the five urban geographical regions of Brazil using the Portuguese version of the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) core questionnaire (CQ)—BRAZCO study. From April to May 2013, a population-based survey was conducted by applying the CQ for 5000 individuals aged over 15 years in 16 capitals of the Brazilian regions. Trained teams assessed the MSK-S and socioeconomic status. The sample consisted of representative quotas of the Brazilian population, proportional to the capitals’ population density. It respected the groups’ quotas of gender and age and included all socioeconomic classes, educational levels, and occupations. There were 1342 (26.9 %) participants who presented MSK-S unrelated to trauma in 7 days preceding the interview. A higher prevalence of these complaints were in females (65.2 %), elderly people, in the north region of the country (30.7 %), and a lower prevalence was found in single individuals (41.7 %) and in the south (23.3 %). The most frequent pain sites were the spine (76.7 %) and knees (49.6 %), and the mean pain intensity was 6.8 (VAS). The BRAZCO study shows that Brazilian population presents a higher rate of MSK-S unrelated to trauma than many Asian countries. These results can be applied to guide the assessment of prevalence of rheumatic diseases. Additionally, it can help in the design of policies for health care workforce organization and its accessibility, as well as to reduce the risk of rheumatic diseases at the community level.     

Prevalence of Hb S (HHB: c.20A > T) in a Honduran Population of African Descent

Abstract

Sickle cell disease is the most common hemoglobinopathy worldwide, particularly in Africa and among people of African descent. Serious clinical consequences characterize the homozygous condition. To determine the prevalence of Hb S (HBB: c.20A?>?T) and anemia in a community of people of African descent from Honduras, 202 individuals were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The high prevalence found indicates that it is necessary to implement a program to prevent the consequences of this disease in vulnerable populations of Honduras.     

Time Trends of the Prevalence of Asthma,Rhinitis and Eczema in Thai Children–ISAAC (International Study of Asthma and Allergies in Childhood) Phase Three

Using the same questionnaire as in ISAAC Phase One study conducted in 1995, the ISAAC Phase Three was carried out in Bangkok and Chiang Mai, Thailand, in 2001, among children aged 6–7 and 13–14 years. There was an increase in the prevalence of the three diseases in the younger age group, i.e., current asthma, rhinitis, rhinoconjunctivitis, and flexural eczema. In the older age group, the prevalence of rhinitis and rhinoconjunctivitis increased. There was no change of prevalence of asthma in Bangkok, but prevalence decreased in Chiang Mai. Prevalence of eczema in older children increased in Bangkok, but remained the same in Chiang Mai.     

Prevalence of Factor V 1691 G–A (Leiden) and prothrombin G20210A polymorphisms and the risk of venous thrombosis among cancer patients

Aims Cancer patients have an increased risk for thromboembolism (TE). Factor V 1691 G–A(Leiden) (FVL) and prothrombin (PT) G20210A mutation are common inherited risk factor for TE. The aim of the study is to evaluate the prevalence of FVL and PT G20210A polymorphism in cancer patients with and without TE as compared to patients with TE without malignancy and healthy control. Materials and methods We have studied 43 cancer patients who developed TE during cancer treatment (group 1); 81 cancer patients without TE (group 2); 100 patients with TE without malignancy (group 3); 100 healthy control (group 4). FVL and PT G20210A polymorphisms were determined by the method of polymerase chain reaction-based DNA analysis. Results The prevalence of FVL was significantly greater in cancer patients with TE (13 of 43, 30.2%) compared with other groups: 3.7% in group 2; 18% in group 3; 8% in group 4 (P < 0.0001). There was no significant difference in the prevalence of PT G20210A among the groups (P > 0.05). Conclusions The study suggested that cancer patients with TE should be evaluated for FVL but PT G20210A was not contributing factor to the development of TE during cancer therapy.     

Prevalence of asthma,rhinitis and eczema among 13–14-year-old schoolchildren in Tochigi,Japan

To analyze the prevalence and severity of asthma, rhinitis and eczema in children living in different countries, the International Study of Asthma and Allergies in Childhood (ISAAC) was developed. The ISAAC Phase One study evaluated approximately 720 000 children in 56 countries, including Japan. In late 1995 and early 1996, we administered the ISAAC questionnaire to 4466 schoolchildren aged 13–14 years of age in 24 schools in Utsunomiya City and Tochigi City (both in Tochigi Prefecture, Japan). With regard to asthma, the reported prevalence of wheezing in the preceding 12 months was 8.4%, of frequent wheezing attacks 0.6% and of wheezing with sleep disturbance 0.5%. The prevalence in the preceding 12 months of rhinitis was 42.1% and of rhinoconjunctivitis was 21.5%. Nasal symptoms were most frequent in April (19.9%) and least frequent in July (5.6%). The prevalence of atopic eczema in the prior 12 months was 9.6% and atopic eczema with sleep disturbance was 0.6%. All prevalence values were slightly increased in Utsunomiya City, the largest city in Tochigi Prefecture, in comparison with Tochigi City. In conclusion, in Japanese cities, 33.3% of children had some allergic symptoms and 2.4% of children reported severe allergic symptoms.     

Prevalence of type 2 diabetes mellitus (T2DM) in India: A systematic review (1994–2018)

AimTo conduct a systematic and critical review of published studies on prevalence of Type 2 diabetes mellitus (T2DM) in urban and rural areas of India.MethodsWe conducted a literature search in PubMed, EMBASE and Web of Science using the terms ‘prevalence’, ‘Type 2 diabetes, ‘India’, ‘urban’ and ‘rural’ for English language articles published during January 1994–December 2018. We selected articles that reported the results of original studies that randomly sampled adults aged 15–80 years, and which reported T2DM prevalence based on the actual examination of blood samples.ResultsOf 1751 articles screened by titles and abstracts, 37 fulfilled our inclusion criteria. Majority (28 of 37; 76%) of studies were from South India, especially from the states of Tamil Nadu, Andhra Pradesh, Kerala and Karnataka. The prevalence of T2DM showed a wide range from 1.9% to 25.2%. Only 11 studies covering 24 regions separately reported the data by urban or rural location. Albeit inconsistent, 17 studies reported prevalence of T2DM by age group.ConclusionIn this systematic review, we show that there remains an ambiguity about the actual prevalence of T2DM from India due to several factors. The findings underscore a strong need for having periodic regional surveillance involving appropriate epidemiological methods.