Fitting Health Care to People: Understanding and Adapting to the Epidemiology and Health Literacy of People Affected by Viral Hepatitis from Culturally and Linguistically Diverse Migrant Backgrounds

Journal of Immigrant and Minority Health - This study explored the epidemiology and health literacy of people affected by viral hepatitis (VH) from migrant culturally and linguistically diverse...     

Cross-Sectional and Longitudinal Effects of Racism on Mental Health Among Residents of Black Neighborhoods in New York City

Objectives. We investigated the impact of reported racism on the mental health of African Americans at cross-sectional time points and longitudinally, over the course of 1 year.Methods. The Black Linking Inequality, Feelings, and the Environment (LIFE) Study recruited Black residents (n = 144) from a probability sample of 2 predominantly Black New York City neighborhoods during December 2011 to June 2013. Respondents completed self-report surveys, including multiple measures of racism. We conducted assessments at baseline, 2-month follow-up, and 1-year follow-up. Weighted multivariate linear regression models assessed changes in racism and health over time.Results. Cross-sectional results varied by time point and by outcome, with only some measures associated with distress, and effects were stronger for poor mental health days than for depression. Individuals who denied thinking about their race fared worst. Longitudinally, increasing frequencies of racism predicted worse mental health across all 3 outcomes.Conclusions. These results support theories of racism as a health-defeating stressor and are among the few that show temporal associations with health.Racism doggedly structures American social life and institutions. In February 2014—Black History Month—The New York Times reported and editorialized on several racial inequalities and racist events, including overly harsh and racially patterned disciplinary policies in schools; the impact of mass incarceration on disenfranchisement; racial gaps in access to conventional mortgages; the defacement of and hanging of a noose on a campus statue of James Meredith, the University of Mississippi’s first Black student; and the death of Jordan Davis, a Black youth shot by a White man enraged by his playing loud hip-hop (“thug music”).1–5Most often, experiences with racism are not newsworthy, but quotidian; they are the product of a society for which racism is part and parcel of doing business.6 As a result, individuals who face racism must not only cope with the opportunity costs of racial exclusion but also manage emotional consequences and the awareness that it is likely to be an ongoing stressor.7 Whether as discrete instances of discriminatory exclusion from societal resources or as behaviors and social narratives that subjugate people of African ancestry, racism causes pain that many Black people would rather not acknowledge and to which many Whites remain inured.8 This pain is borne out in empirical research showing that racism negatively affects mental health.A 2006 review of the literature on racism and health analyzed 62 studies and found negative associations with mental health outcomes to be the most consistent finding.9 Similarly, a meta-analysis published 3 years later identified 110 studies on discrimination and mental health, with outcomes including symptoms of depression, anxiety, posttraumatic stress disorder, psychological distress, and several measures of general well-being.10 Discrimination was negatively (average zero-order correlation = −0.20) and equally associated across outcomes, with recent and chronic events having stronger effects than cumulative lifetime events. Although findings on mental health are often consistent, it is notable that they emanate from numerous and conceptually distinct measurements of exposure. The 2006 review found 152 different instruments employed.9 These measures assess interpersonal acts, daily hassles, more severe racist events, and nonspecific discrimination (unfair treatment), though the most common theoretical frame is often a stress-coping model.11Research conducted subsequent to these reviews continues to show the psychological sequelae of racism. One study investigated whether the experience of racism relates most strongly to psychiatric disorders with symptom profiles analogous to responses to racism. Results supported this premise: discriminatory experiences predicted generalized anxiety disorder, with its symptoms of chronic anxiety, worry, and muscle tension.12 Other work has linked racism with symptoms of depression among Black men, and risk increased for men who experienced difficulty in and fears about expressing their feelings.13 Finally, in a sample of US-born Black participants, reports of high levels of discrimination were associated with increased psychological distress, particularly for those who accepted unfair treatment as a fact of life.14Taken together, accumulated evidence is consistent on the negative mental health effects of racism, but because the majority of work is cross-sectional (76% in 1 review9), the ability to identify causes is reduced and researchers have called for longitudinal studies that better model directionality. One such study investigated everyday discrimination and symptoms of depression among a sample of Black women in Detroit. There, discrimination reported at baseline and change in discrimination over time predicted increases in depression over time.12We conducted cross-sectional and longitudinal assessments of the mental health impact of experiences with racism. We used self-report of nonspecific psychological distress, symptoms of depression, and the number of days in poor mental health over the past month to examine whether racism reported at baseline was associated with concurrently reported mental health indicators and with indicators 1 year later and whether changes in experiences with racism over time were associated with changes in mental health indicators.     

Improved microvessel repair: laser welding with an anti-thrombotic solder

BACKGROUND AND OBJECTIVES: Concentrated protein solutions can be used as thermally polymerized solders in laser welding. Solders supplemented with biologically active chemicals may provide in situ drug delivery for localized therapeutics. These studies characterize a serum albumin (SA) solder containing heparin, designed to reduce microvascular thrombosis rates. STUDY DESIGN/MATERIALS AND METHODS: Samples of heparin added to 30% SA to obtain heparin-to-albumin molar ratios (HAMR) of 4:1 and 2:1 were thermally polymerized, and heparin release into saline was measured. Using a rat thrombosis model, patency was determined for suture, and 0 U/ml (control), 2.5 U/ml, 50 U/ml heparin solder repairs. RESULTS: Heparin release was five times higher for 4:1 than 2:1 HAMR solder acutely, but was equivalent after 2 days. Animal patency rates were: 50% suture, 0% control, 50% low heparin, 66% high heparin (P < 0.05 vs. control). CONCLUSIONS: Solders incorporating heparin should provide in situ anti-thrombotic therapy reducing the risk of microvascular thromboses.     

Imaging and compartmental classification of solid pelvic tumours in children

Thirty-five children aged from 1 day to 16 years (median 5 years) with solid pelvic tumours were investigated with US, CT and MR. All three methods gave similar estimates of tumour size. For defining location of the tumours, the pelvis was divided into three midline compartments (anterior, middle and posterior) and a right and left lateral compartment. CT and MR were accurate and equally reliable in determining the tumour location, US was less accurate. Evaluation of confinement to organ of origin was uncertain, regardless of imaging modality. Tissue characteristics with CT and MR did not contribute to the differentiation of the various tumour types, and contrast medium enhancemen did not improve the discrimination. Compartmental localization was equally well assessed by CT and MR and, together with sex, was found to correlate with the tumour type.     

Interval between insulin injection and breakfast in diabetes

The relationship between the insulin-breakfast interval, postprandial increase in blood glucose, and glycaemic control was studied in 58 children with diabetes. Patients recorded insulin-breakfast intervals in a home diary over a seven day period, and during a 24 hour period at the weekend provided eight serial capillary dried blood spots for glucose analysis. The highest mean blood glucose value occurred two hours after breakfast and showed a significant correlation with fructosamine concentrations. Weekend insulin-breakfast intervals ranged from 2-30 minutes, with 70% reporting intervals of less than 15 minutes. There was a significant correlation between the weekend insulin-breakfast interval and the after breakfast increase in blood glucose with a mean increment of 0.4 mmol/l in the 30 minute group and 7.2 mmol/l in the 2 minute group. Over the whole study period, children with mean insulin-breakfast intervals of two to 12 minutes had a mean fructosamine concentration of 376 mumol/l compared with 341 mumol/l in those with intervals of 15-35 minutes. This study has shown that the interval between insulin injection and breakfast significantly influences the morning postprandial rise in blood glucose and consequently short term glycaemic control. It is therefore important that patients are encouraged to leave an interval of about 30 minutes between insulin injection and breakfast.