Ethnicity, culture, and neuropsychiatry

The purpose of this paper is to review the research on the relationships among ethnicity, culture, neuropsychiatric diagnosis, and treatment. Psychiatric nurses provide care to an ethnically and culturally diverse group of clients. Knowledge of ethnic and cultural differences are essential to diagnosis and treatment. Ethnic diversity affects psychiatric diagnosis. Cross-ethnic differences in genetics, diet, environmental exposure, and fetal, childhood, and adolescent development may result in varied experiences of psychiatric illness among ethnic groups. Ethnic diversity also affects psychiatric treatment. There are dramatic ethnic differences in the metabolism of psychotropic medications and the effects of drugs on target organs. These differences are again due to genetic variation, exposure to different diets and environments, and other medications in use. Cultural diversity influences both diagnosis and treatment. Cultural forces shape symptom formation and the expression of distress, creating many sources for misdiagnosis based on DSM-IV criteria. The culture-bound syndromes represent unique illness forms with a natural history distinct from DSM classification. Culture also influences treatment expectations, therapeutic compliance, family involvement, and the interpretation of side effects, all of which help determine whether or not treatment will be effective. Neuropsychiatric nurses can contribute to research by studying cross-ethnic differences and similarities in biological markers of mental illness. A second significant area for research is that of ethnicity and psychotropic drug metabolism and pharmacodynamics.     

Ethnicity, academic skills and nursing student achievement

In 1982, Florida legislation mandated the use of the College Level Academic Skills Test (CLAST) to measure student achievement in college-level communication and computation skills. The exam is currently used in Florida's schools of higher education as a requirement for admittance to the junior year. This article addresses the CLAST as a predictor variable of academic success for students (N = 55) seeking a baccalaureate degree in nursing and for their ability to pass the examination for registered nurse licensure on their first attempt. The study also looks at other factors such as student grade point averages, ethnicity, foreign birth, and age to determine their importance, if any, in the success rate of nursing students and graduates. Results of the Pearson Product Moment Correlation Coefficient Index showed that CLAST scores do correlate positively with licensure exam scores, as does age. Ethnicity and sex did not reveal any correlations, which may have been due to the small sample size.     

Examining Acute Coronary Syndrome Across Ethnicity,Sex, and Age

Acute coronary syndrome (ACS) remains one of the leading causes of death in the United States. With its heightened prevalence, considerable variabilities in the disease process exist across ethnicities, sex, and age. This creates substantial disparities in the recognition and management of ACS, which consequently contributes to poor outcomes. It is of utmost importance that nurse practitioners remain vigilant, cognizant, and maintain a high index of suspicion to accurately identify ACS presentations and thus efficaciously intervene to successfully manage the disease process.     

Race,Ethnicity, and Income Factors Impacting Human Papillomavirus Vaccination rates

Background

Human papillomavirus (HPV) infection and cervical cancer disproportionately affect low-income and minority women. HPV vaccines have the potential to either reduce or exacerbate racial disparities in HPV-related diseases and cervical cancers, depending on the equitability of vaccine uptake.

Objectives

This review aims to identify barriers and facilitators of equitable uptake of HPV vaccination among low-income and minority girls. This review discusses factors related to race, ethnicity, and income that are associated with initiation and completion rates of the 3-dose HPV vaccine series and presents targets for intervention.

Methods

We reviewed relevant English-language literature to identify current vaccination rates and factors associated with vaccine uptake. Study findings related to race (black, Latino, Asian), and incomes were summarized.

Results

Current trends in the United States indicate low uptake among all adolescents, and that rates stagnated between 2011 and 2012. Low-income and minority adolescents are equally or more likely to start the HPV vaccination series than are white and higher-income adolescents, but are less likely to complete all 3 shots. Provider recommendation is a key factor in HPV vaccination, and minorities are less likely to report receiving recommendations for HPV vaccination.

Conclusions

As black, Hispanic, and Asian populations continue to grow in the United States over the next several decades, it is imperative that we not only improve HPV vaccination rates overall, but also focus on high-risk populations to prevent an increase in cervical cancer disparities.     

Ethnicity and peripheral vascular disease

There are well-documented differences in the prevalence of coronary artery disease and carotid disease between caucasians, Afro-Caribbeans and Indo-Asians. Very little data are available on ethnic differences in peripheral vascular disease (PVD). To investigate this further, we surveyed 200 consecutive patients attending the vascular surgery service at a city centre hospital serving a multiethnic patient catchment population. All patients had proven PVD, with an ankle brachial pressure index of less than 0.8. Within this cohort, Afro-Caribbeans presented more frequently with PVD compared with the proportion of this ethnic group in the local population (p = 0.013), with a greater proportion with diabetes mellitus than in the other two ethnic groups. There did not appear to be a significant difference between the ethnic groups in any of the other established risk factors or associations (i.e. treated hypertension, smoking, previous history of ischaemic heart disease, atrial fibrillation, previous history of cerebrovascular accident or transient ischaemic attack) with PVD. As with coronary artery disease and carotid disease, there are ethnic differences in the prevalence of PVD, and the underlying risk factors, between caucasians, Afro-Caribbeans and Indo-Asians. Furthermore, patients of Afro-Caribbean origin present more frequently with symptomatic PVD than do either caucasians or Indo-Asians.     

Ethnicity and peripheral artery disease

Peripheral arterial disease (PAD) is an important healthcareproblem and is an indicator of widespread atherosclerosis inother vascular territories, such as the cerebral and coronarycirculations. PAD is associated with considerable morbidityand mortality. Most population-based studies investigating PADprevalence and risk factors for its development and progressionhave been based on predominantly White ethnic groups. Much lessis known about the characteristics of this disease in otherethnic groups. Understanding the epidemiology of PAD amongstethnic minority groups is relevant, given that the populationof minority ethnic groups in countries such as the United Kingdomrose by 53% between 1991 and 2001 and is expected to rise furtherin the future. This article aims to provide an overview of possiblepathophysiological differences between ethnic groups for PAD,focussing predominantly on South Asians (people originatingfrom India, Bangladesh and Pakistan) and Blacks (people of BlackCaribbean and Black African descent) as these groups comprisethe majority of all ethnic minorities in the United Kingdom.