Cardiac risk underestimation in urban,black women

BACKGROUND: Black women have a disproportionately higher incidence of cardiovascular disease mortality than other groups and the reason for this health disparity is incompletely understood. Underestimation of personal cardiac risk may play a role. OBJECTIVE: We investigated the personal characteristics associated with underestimating cardiovascular disease in black women. DESIGN, SETTING, PARTICIPANTS: Trained surveyors interviewed 128 black women during the baseline evaluation for a randomized controlled trial in an urban, academic continuity clinic affiliated with a public hospital system. They provided information on the presence of cardiac risk factors and demographic and psychosocial characteristics. These self-report data were supplemented with medical record abstraction for weight. MEASUREMENTS AND MAIN RESULTS: The main outcome measure was the accurate perception of cardiac risk. Objective risk was determined by a simple count of major cardiac risk factors and perceived risk by respondent's answer to a survey question about personal cardiac risk. The burden of cardiac risk factors was high in this population: 77% were obese; 72% had hypertension; 48% had high cholesterol; 49% had a family history of heart disease; 31% had diabetes, and 22% currently used tobacco. Seventy-nine percent had 3 or more cardiac risk factors. Among those with 3 or more risk factors ("high risk"), 63% did not perceive themselves to be at risk for heart disease. Among all patients, objective and perceived cardiac risk was poorly correlated (kappa=0.026). In a multivariable model, increased perceived personal stress and lower income were significant correlates of underestimating cardiac risk. CONCLUSIONS: Urban, disadvantaged black women in this study had many cardiac risk factors, yet routinely underestimated their risk of heart disease. We found that the strongest correlates of underestimation were perceived stress and lower personal income.     

PTSD in Latino Patients: Illness Beliefs, Treatment Preferences, and Implications for Care

Background  Little is known about how Latinos with post-traumatic stress disorder (PTSD) understand their illness and their preferences for mental health treatment. Objective  To understand the illness beliefs and treatment preferences of Latino immigrants with PTSD. Design  Semi-structured, face-to-face interviews. Participants  Sixty foreign-born, Latino adults recruited from five primary care centers in New York and New Jersey and screened for PTSD. Approach  Content analytic methods identified common themes, their range, and most frequent or typical responses. Results  Participants identified their primary feelings as sadness, anxiety, nervousness, and fear. The most common feeling was “sad” (triste). Other words frequently volunteered were “angry” (enojada), “nervous” (nerviosa), and “scared” (miedo). Participants viewed their PTSD as impairing health and functioning. They ascribed their somatic symptoms and their general medical problems to the “stress” from the trauma and its consequences on their lives. The most common reason participants volunteered for their work and school functioning being impaired was their poor concentration, often due to intrusive thoughts. Most expressed their desire to receive mental health treatment, to receive it within their primary care center, and preferred psychotherapy over psychotropic medications. Among participants who did not report wanting treatment, most said it was because the trauma was “in the past.” Conclusions  Clinicians may consider enquiring about PTSD in Latino patients who report feeling sad, anxious, nervous, or fearful. Our study suggests topics clinicians may include in the psychoeducation of patients with PTSD.