Decreased risk of prematurity after elective repeat cesarean delivery in Hispanics

Background: The current recommendation is to delay elective repeat cesarean deliveries (ERCD) until 39 weeks to decrease prematurity risks. Prior reports suggest accelerated maturity of fetuses according to race (African-Americans and Asians).

Objective: To analyze the effect of the Hispanic ethnicity on the prematurity risk after ERCD. Methods: The US Natality Database from 2004 to 2008 was reviewed. Inclusion criteria were singleton delivery, no trial of labor, repeat cesarean. Exclusion criteria were fetal anomalies, history of diabetes/hypertension related disorders. Outcomes analyzed were Apgar score, assisted ventilation, intensive care admission, surfactant/antibiotic use and seizures. Two groups were identified: non-Hispanic Whites (NHW) and Hispanic Whites (HW). Regression analysis was performed to calculate adjusted odds ratios. Deliveries at 36–40 weeks were studied with 40 weeks as the reference group.

Results: A total of 930?421 ERCDs were identified, 396?823 NHW and 236?733 HW. For NHW, the risk of prematurity was lower at 39 weeks. For HW, there was no difference in the risks of prematurity at/beyond 38 weeks.

Conclusion: There appears to be accelerated maturity with no increase in prematurity risk at 38 weeks in HW delivered by ERCD. Ethnicity can be considered for patient counseling and decision making regarding optimal timing of elective interventions.     

Patterns of Social Activity Engagement Among Older Hispanics and Their Relationship to Sociodemographic and Health Variables

The purpose of this study was to examine patterns of social activity engagement in a sample of older Hispanics (Puerto Rican, Dominican, and other Hispanic) and determine whether these patterns differed significantly from the comparison non-Hispanic White group. This article also analyzes how ethnicity, sociodemographic, and health variables (health problems and depression) relate to each of the activity engagement patterns. The factor analysis of social activities from the Norbeck Social Support Questionnaire yielded three factors, which describe engagement in social activities as: children and relatives active, friends and activities active, and senior services active. The results from the regression analyses show that Hispanic ethnicity and education are positively associated with being more engaged in activities with children and relatives, whereas being male and especially a male living alone is inversely associated with this pattern. In addition, being friends and activities active shows positive association with education, the participant living alone, and experiencing more language inclusion; however, it is inversely associated with depression, age, being male, and number of health problems. Finally, engaging in activities offered by senior services is only significantly associated with increased age and the number of health problems. The interpretations of these findings, directions for future research, and implications for activity professionals/recreation therapists are also discussed.     

Cultural Factors Influencing HIV Risk Behavior Among Dominicans in New York City

Abstract

Hispanics in the United States have disproportionately high rates of HIV. The existence of ethnically and culturally diverse Hispanic communities indicate that qualitative research on HIV-related attitudes and behaviors within subgroups is needed to develop successful interventions. Findings from interviews with 20 Dominicans involved with drug-related or sex work-related activities in New York City are presented in terms of predominant cultural influences and specific issues regarding sex work, drug use, and HIV/AIDS. Several directions for interventions in the Dominican community are indicated, e.g., outreach efforts sensitive to the stigmatization of behaviors such as needle use and homosexuality, and the encouragement of sex workers to use condoms with their partners as well as clients. Additional information regarding such areas as contraception, family planning, and drug treatment services is needed within this community. A knowledge of cultural norms can serve as a foundation for these intervention and education efforts.     

Workplace Exposures and Protective Practices of Hispanic Warehouse Workers

Background This study was undertaken to assess workplace hazards and protective practices among Hispanic men and women working post-harvest in asparagus, apple and pear packaging warehouses. Methods Three focus groups were conducted in July 2003 with 25 workers (20 women, 5 men) recruited from communities in the Yakima Valley, Washington. Focus group content informed the design of an in-person structured interview administered to 50 additional warehouse workers from August to November 2006. Results Focus group participants reported difficult working conditions, exposure to chemicals, adverse health effects and use of work and home protective practices to minimize exposures for themselves and their families. Structured interview participants reported few workplace exposures to chemicals although many reported engaging in workplace and home protective practices. Discussion Findings from this research can direct initial efforts to determine if and how interventions for warehouse workers may be designed to protect against hazardous workplace exposures.     

Early referral to supportive care specialists for symptom burden in lung cancer patients: a comparison of non-Hispanic whites, Hispanics, and non-Hispanic blacks

BACKGROUND:

Effective management of symptoms in cancer patients requires early intervention. This study assessed whether the timing of referral to the Supportive Care Center (SCC) and symptom burden outcome varied by race or ethnicity in lung cancer patients who had been seen at a tertiary cancer center.

METHODS:

Non‐Hispanic white (n = 752), Hispanic (n = 111), and non‐Hispanic black (n = 117) patients with nonsmall cell lung cancer comprised this sample. Data on sociodemographic factors, stage of disease, comorbid conditions, and symptom severity (pain, depressed mood, fatigue) served as potential predictor variables.

RESULTS:

Whereas the mean time (15 months; median = 7 months) from initial presentation at the cancer center to referral to the SCC did not vary by race or ethnicity, we found that Hispanics and non‐Hispanic blacks had higher symptom burden when they first presented at the cancer center than non‐Hispanic whites. Severe pain, depressed mood, and fatigue were significant predictors for early referral (<7 months) of non‐Hispanic whites, but only severe fatigue (P <.05) was predictive of early referral for Hispanics and non‐Hispanic blacks. Furthermore, while the proportion of non‐Hispanic white patients reporting severe pain, depressed mood, and fatigue significantly decreased (P <.001) at first follow‐up visit after referral to the SCC; among Hispanics, improvement was only observed for depressed mood. No improvement in any of these symptoms was observed for non‐Hispanic blacks.

CONCLUSIONS:

Whereas the timing of referral to supportive services did not vary by race, disparities in symptom burden outcomes persisted. Additional studies are needed to validate our findings. Cancer 2012;. © 2011 American Cancer Society.     

Diabetes prevalence and treatment adherence in residents living in a colonia located on the West Texas, USA/Mexico border

Abstract   Little is known about how diabetes affects the health status of Hispanic people living in colonias located along the USA/Mexico border. The purpose of this report is to describe the demographic factors, prevalence of diabetes, and the health status of the residents living in a colonia on the border between El Paso, Texas, USA, and Juarez, Mexico, and to report the residents' adherence to the Behavioral Risk Factor Surveillance System (BRFSS) protocols for the management of type 2 diabetes. This study included 188 participants. The instruments used included a demographic questionnaire, the Short Acculturation Scale for Hispanics, "Cutting Down, Annoyance by Criticism, Guilty Feelings, and Eye-openers", BRFSS, and the Short Form-36 (v2). The prevalence of diabetes was 15.4% and 41.3% of the residents had a Body Mass Index score > 30. The rate of hypertension, elevated cholesterol, and depression for those reporting diabetes was significant. The SF-36 v2 physical score for the diabetic residents was 42.9 and it was 52.4 for the non-diabetic residents. The average resident of the colonia who reports diabetes has many health disadvantages when compared to those in other parts of Texas and the USA generally.     

Leading an academic health center in the 21st century: a pediatric surgeon's perspective

Purpose

At present, there is a gathering storm that is threatening the very practice of the art of medicine for future generations as never before. This article gives successful examples and calls for approaches that support improvements in education and health care for low-income and minority populations.

Methods

To address this problem, the University of Texas Health Science Center at San Antonio established the Regional Academic Health Center (RAHC) along the Texas/Mexico border, which provides educational opportunities, clinical partnerships, and facilities to attract faculty to research and examine the health problems that are common in the Hispanic population.

Results

In less than 4 years at the RAHC, nearly 100 medical students have been educated and 60% of residents are staying in the border area to practice. The creation of the RAHC has also has stimulated interest in students who are largely Hispanic to pursue health professional education. The University of Texas Health Science Center at San Antonio is now the number one public medical school graduating the most Hispanics in the nation.

Conclusions

The concept of the RAHC is an important means of addressing access to health care while serving as a catalyst to increase opportunities for students of all backgrounds to pursue health professional education.     

Hispanic acculturation and utilization of colorectal cancer screening in the United States

BACKGROUND: Despite the evidence on the effectiveness of colorectal cancer (CRC) screening procedures, its use remains low, especially among Hispanics. Social-cultural factors may play a role in the underutilization of cancer screening. This study aimed to examine whether low acculturation was a risk factor for the underutilization of colorectal cancer screening in the Hispanic population. METHODS: The subjects were adults aged 50-80 years who identified themselves as Hispanic and never were diagnosed with colorectal cancer. Colorectal cancer screening utilization was assessed based on the use of at-home Fecal Occult Blood Test (FOBT) and the use of endoscopies (sigmoidoscopy, colonoscopy, or proctoscopy). Respondents who underwent a test for diagnostic purposes were excluded from the study. RESULTS: Our data showed that colorectal screening was underused in Hispanics compared to non-Hispanic Whites. There was a trend that acculturation level was inversely correlated with having an endoscopy in the past 5 years. This trend was also seen with having a FOBT in the past year or an endoscopy in the past 5 years. However, the association disappeared after adjusting for factors pertaining to utilizing other health care services. Additionally, after stratifying by gender, the association between the two variables was diluted. CONCLUSIONS: The findings show that low acculturation was associated with the underutilization of endoscopic colorectal cancer screening. This association may be related to lower utilization of health care services and/or language barriers that may contribute to the lower utilization.