Stress urinary incontinence and counseling and practice of pelvic floor exercises postpartum in low-income Hispanic women

The purpose of the study was to provide estimates of stress urinary incontinence (SUI) and practice of pelvic floor muscle training (PFMT) postpartum as well as counseling during and after pregnancy among Hispanic women. Two hundred Hispanic women were surveyed 6 months postpartum. Twenty-three percent had SUI with onset primarily during pregnancy (70%). Only 20% had received information regarding SUI and PFMT during pregnancy or postpartum. Most women not counseled wished they were (81%). Less counseling occurred among Hispanic women with lower levels of education (odds ratio [OR] = .39; 95% confidence interval [CI] = 0.19–0.82; p = 0.02) and those whose primary language was Spanish (OR = .36; 95% CI = 0.15–0.87; p = 0.02), while higher rates occurred among women with a forceps delivery (OR = 2.94; 95% CI = 1.06–7.78; p = 0.03). Fifty-seven percent of women counseled practiced the exercises. Primary reasons for noncompliance were belief that PFMT would not help (47%), and not understanding the instructions (39%). SUI and PFMT counseling is low among Hispanic women. Most women desire such information, and improvement in performance of PFMT among this group is possible. An erratum to this article can be found at     

Profiles of depression in a treatment‐seeking Hispanic population: Psychometric properties of the Patient Health Questionnaire‐9

ObjectivesScreening instruments can be powerful tools in assisting primary care providers with detecting depression in their patients and monitoring treatment response. Health disparities among racial and ethnic minorities result from inaccurate assessment in primary care.MethodsThe current study used baseline data from two federally funded research studies of treatment for depression among Hispanics in primary care. The Patient Health Questionnaire‐9 (PHQ‐9) was administered at baseline prior to the study interventions, and 499 participants provided responses.ResultsConfirmatory factor analyses found excellent factor validity for the PHQ‐9, yet reliability remained poor. Possible heterogeneity in depressive item scores was examined, and latent profile analysis identified four distinct profiles of PHQ‐9 responses. Profiles included a lower depression, moderate/somatization, moderate/negative self‐view, and severe depression profiles. Results indicate modest support for the PHQ‐9 and its use among Hispanics for the purpose of depression screening.ConclusionCapturing four profiles of depression in a large primary care sample helps characterize the manifestation of depression in a Hispanic population. The single item related to fatigue had the greatest variation across groups indicating it might be useful as a screening item. Inadequate evaluation of symptoms could lead to significant under identification of the disorder among Hispanics.     

The relative contributions of race/ethnicity, socioeconomic status, health, and social relationships to life satisfaction in the United States

Purpose  To evaluate racial/ethnic disparities in life satisfaction and the relative contributions of socioeconomic status (SES; education, income, employment status, wealth), health, and social relationships (social ties, emotional support) to well-being within and across racial/ethnic groups. Methods  In two cross-sectional, representative samples of U.S. adults (the 2001 National Health Interview Survey and the 2007 Behavioral Risk Factor Surveillance System; combined n > 350,000), we compared life satisfaction across Whites, Hispanics, and Blacks. We also evaluated the extent to which SES, health, and social relationships ‘explained’ racial/ethnic group differences and compared the magnitude of variation explained by life satisfaction determinants across and within these groups. Results  Relative to Whites, both Blacks and Hispanics were less likely to be very satisfied. Blacks were somewhat more likely to report being dissatisfied. These differences were reduced or eliminated with adjustment for SES, health, and social relationships. Together, SES and health explained 12–15% of the variation in life satisfaction, whereas social relationships explained an additional 10–12% of the variance. Conclusions  Racial/ethnic life satisfaction disparities exist for Blacks and Hispanics, and these differences are largest when comparing those reporting being ‘satisfied’ to ‘very satisfied’ versus ‘dissatisfied’ to ‘satisfied.’ SES, health, and social relationships were consistently associated with life satisfaction, with emotional support having the strongest association with life satisfaction.     

A randomized trial of thymoglobulin vs. alemtuzumab (with lower dose maintenance immunosuppression) vs. daclizumab in renal transplantation at 24 months of follow-up

Abstract: Introduction:  A long-term prospective randomized trial evaluating alemtuzumab, a humanized anti-CD52 monoclonal antibody, in a predominantly non-Caucasian population has yet to be reported.
Methods:  Ninety deceased donor (DD) first renal transplant recipients were randomized into three different antibody induction groups: group A, thymoglobulin (Thymo); group B, alemtuzumab; group C, daclizumab (Dac). In groups A and C, the target trough levels of tacrolimus were 8–10 ng/mL, mycophenolate mofetil (MMF) 1 g administered twice daily, and maintenance methylprednisolone. In group B, target tacrolimus trough levels were 4–7 ng/mL, 500 mg MMF administered twice-daily, without methylprednisolone. African-Americans and Hispanics comprised more than 50% in each group.
Results:  A minimum follow-up of 27 months showed no overall group differences in patient or graft survival (p   = 0.89 and 0.66), but a trend towards worse death-censored graft survival in group B (p   = 0.05). Acute rejection rates were not significantly different: six (20%), seven (23%), and seven (23%) in groups A, B, and C, respectively. The incidence of chronic allograft nephropathy was higher in group B than in A and C (p   = 0.008). The mean calculated creatinine clearance at 24 months was 81.1 ± 5.5, 64.4 ± 4.5, and 80.7 ± 5.7 in groups A, B, and C, respectively (p   = 0.01 for B vs. average of A and C).
Conclusion:  In this randomized 27-month minimum follow-up trial of predominantly non-Caucasian DD renal transplant recipients with alemtuzumab induction, lower maintenance tacrolimus, MMF, and steroid avoidance appear less effective than either Thymo or Dac with higher maintenance immunosuppression.     

Cross-cultural invalidity of alcohol dependence measurement across Hispanics and Caucasians in 2001 and 2002

Aims

Do assessments of alcohol dependence demonstrate similarly validity across Hispanics and non-Hispanic Caucasians? This investigation examined this question.

Method

It employed confirmatory factor analyses for ordered-categorical measures to search for measurement bias on the AUDADIS, a standardized measure of alcohol dependence, across Hispanic (n = 4819) and non-Hispanic Caucasians (n = 16, 109) in a nationally representative survey of alcohol use in the United States conducted in 2001 and 2002.

Measurement

Analyses considered whether 27 items operationalizing the DSM-IV alcohol dependence construct provided equivalent measurement.

Findings and conclusions

Nine items revealed statistically significant bias, suggesting strong caution regarding the cross-ethnic validity of alcohol dependence. Sensitivity analyses established that item level differences erroneously impact alcohol dependence estimates among the 2001–2002 US Hispanic population. Biased measurement underestimates differences between Hispanics and non-Hispanic Caucasians, underestimates Hispanics' true use levels, and falsely minimizes current increases in drinking behavior evidenced among Hispanics. Findings urge improved public health efforts among the Hispanic community and underscore the necessity for cultural sensitivity when generalizing measures and constructs developed in the majority to Hispanic individuals.     

Clinical Significance of Incidental Colorectal Wall Thickening on Computed Tomography Scan in African-American and Hispanic Patients

We sought to assess the significance of an incidental finding of colorectal wall thickening (CRWT) on computed tomography (CT) scan in African-American and Hispanic patients. We retrospectively reviewed charts of African-American and Hispanic patients from January 1994 to December 2005. Those patients were included in whom the colonoscopy was performed due to incidental CRWT on CT scan. Patients with a history or a family history of colorectal malignancy, inflammatory bowel disease, or colorectal surgery, with an incomplete colonoscopic examination, or <18 years of age were excluded. Endoscopic and pathological findings were abstracted. Thirty-two patients met the criteria. Endoscopic examination was abnormal in 21 (65.6%). The positive predictive value of CRWT for abnormal endoscopic examination was 65.6%. Abnormal endoscopic examination revealed diverticulosis in 9 (43%), erythematous mucosa in 8 (38%), polyps in 6 (29%), mass in 2 (9%), thickened folds in 1 (5%), and diverticulitis in 1 (5%). Histopathological findings revealed colitis in 7 (33%), adenoma in 4 (19%), hyperplastic polyps in 4 (19%), adenocarcinoma in 2 (9%), lymphoid aggregates in 2 (9%), melanosis coli in 1 (5%), and normal in 1 (5%) in the abnormal examination group. Abnormal endoscopic examination was found in 65.6% of patients. The prevalence of colitis, adenomas, and malignancy was high, therefore abnormal CRWT warrants further endoscopic evaluation.     

Racial differences in presentation and management of follicular non-Hodgkin lymphoma in the United States: Report from the National LymphoCare Study

BACKGROUND:

Racial differences in follicular lymphoma (FL) in the United States have not been investigated.

METHODS:

The National LymphoCare Study is a multicenter, longitudinal, observational cohort study collecting data on treatment patterns and outcomes for patients with newly diagnosed FL in the United States between 2004 and 2007 without any predefined, study‐specific intervention. The authors investigated differences between white (W) patients, African American (AA) patients, and Hispanic (H) patients.

RESULTS:

Among 2744 enrolled patients, there were 95 (3%) AA patients, 125 (5%) H patients, and 2476 (90%) W patients. Compared with W patients, more AA and H patients were diagnosed at age <45 years (P < .0001). H patients more commonly were diagnosed with grade 3 FL compared with AA and W patients (29%, 13%, and 18%, respectively; P = .019) and more commonly received rituximab plus chemotherapy as initial therapy compared with W patients (66% vs 50%; P = .036), while AA patients less commonly received anthracyclines (49% vs 64% in W patients; P = .027). H and AA patients who received rituximab plus chemotherapy were less likely than W patients to receive maintenance rituximab (27% vs 31% vs 40%, respectively; P = .031). At a median follow‐up of 52 months, progression‐free survival was similar between AA and W patients but was longer in H patients, and there was no difference in overall survival.

CONCLUSIONS:

In the largest prospective cohort to date of AA and H patients with FL in the United States, AA and H patients were younger at presentation. Although racial differences in treatment patterns for FL were noted, additional follow‐up is needed to determine the impact of these differences on survival. Cancer 2012. © 2012 American Cancer Society.     

Identification of the prevalent BRCA1 and BRCA2 mutations in the female population of Puerto Rico

Mutations in the breast cancer 1, early onset (BRCA1) and breast cancer 2 (BRCA2) genes are responsible for the majority of hereditary breast cancers. Knowledge of the incidence and prevalence of BRCA mutations in a specific population or ethnic group is necessary to provide accurate genetic counseling for breast cancer patients and their families; however, these data have not been gathered in the population of Puerto Rico. We conducted a retrospective study of female breast cancer patients undergoing genetic testing for BRCA mutations in the highest-volume breast surgery practices in San Juan, Puerto Rico. Data collection includes three-generation family cancer history and results from complete BRCA sequencing. A total of six different deleterious mutations were observed, including one mutation in BRCA1 and five mutations in BRCA2. Three recurrent mutations (BRCA1 del exon1-2, BRCA2 4150G>T, and BRCA2 6027del4) account for over 70% of all the BRCA mutations observed in this study population. This study examines for the first time the characteristics of hereditary breast cancer in Puerto Rico and assesses the accuracy of existing genetic risk assessment tools in that population. This data is expected to contribute to providing accurate and efficient tools for the clinical management of hereditary breast cancer in Puerto Rico.