Perceived barriers to accessing mental health services among ethnic minorities: a qualitative study in southeast england

Background: In most European countries, there are significant disparities in the understanding of mental health conditions and access to mental health services among ethnic minority groups. Studies in the UK suggest that individuals from ethnic minorities: have complex pathways to, accessing mental health services, have longer length of inpatient stays, are less likely to take antidepressants, are less likely to contact general practitioners about mental health. It is unclear whether these disparities represent variation in mental health needs, or result from personal/environmental factors and/or relationships between service users and healthcare providers. This qualitative study sought to identify perceived barriers to accessing mental health services among individuals from ethnic minorities in Southeast England to inform the development of effective and culturally acceptable services. Methods: Twenty six adults from ethnic minorities were recruited by community development workers to participate in two focus groups. Discussions were facilitated by researchers trained in cross-cultural communication and the qualitative methodology. Thematic analysis was conducted to identify key emerging themes. Results: Two broad themes were identified: Personal and environmental factors including: inability to recognise symptoms; males being reluctant to seek help; absence of social networks; social networks as an alternative to professional services; cultural identity and stigma; and financial factors. Relationship between service user and healthcare provider including: waiting times; language and communication difficulties; health professionals not listening to concerns or responding to individual needs; power and authority imbalance between healthcare providers and patient; culturally insensitive services; and lack of awareness about services. Conclusion: Members of ethnic minorities require greater mental health literacy and practical support to raise awareness of mental health issues, and provided with appropriate information about the different services and pathways to access these services. Healthcare providers need to be supported in developing effective communication strategies to deliver individually tailored and culturally sensitive care. The engagement of ethnic minorities in the development and delivery of culturally appropriate mental health services could also facilitate better understanding of mental health conditions and improved utilisation of mental health services

Association of heat shock protein70-2 (HSP70-2) gene polymorphism with obesity

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Surgical strategies for treatment of malignant pancreatic tumors: extended, standard or local surgery?

Tumor related pancreatic surgery has progressed significantly during recent years. Pancreatoduodenectomy (PD) with lymphadenectomy, including vascular resection, still presents the optimal surgical procedure for carcinomas in the head of pancreas. For patients with small or low-grade malignant neoplasms, as well as small pancreatic metastases located in the mid-portion of pancreas, central pancreatectomy (CP) is emerging as a safe and effective option with a low risk of developing de-novo exocrine and/or endocrine insufficiency. Total pancreatectomy (TP) is not as risky as it was years ago and can nowadays safely be performed, but its indication is limited to locally extended tumors that cannot be removed by PD or distal pancreatectomy (DP) with tumor free surgical margins. Consequently, TP has not been adopted as a routine procedure by most surgeons. On the other hand, an aggressive attitude is required in case of advanced distal pancreatic tumors, provided that safe and experienced surgery is available. Due to the development of modern instruments, laparoscopic operations became more and more successful, even in malignant pancreatic diseases. This review summarizes the recent literature on the abovementioned topics

Surgical Anatomy of the Parathyroid Glands

TheSurgerysuperiorSurgical anatomyandThoracic surgery inferior parathyroid glandsParathyroid glands are derived from the fourth and third pharyngeal pouches, respectively. This accounts for their differences in terms of variability in anatomic location. While most parathyroid glandsParathyroid glands can be found in their normal anatomic position, there remains a significant percentage of supernumerary glands and ectopic glands, which not uncommonly reside in the mediastinumMediastinum. Understanding the possible sites of ectopic parathyroidParathyroid glandsglandsEctopic/mediastinal parathyroid gland will help guide the surgeon during parathyroid exploration

Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: A qualitative study in Southeast England

Objective:In most developed countries, substantial disparities exist in access to mental health services for black and minority ethnic (BME) populations. We sought to determine perceived barriers to accessing mental health services among people from these backgrounds to inform the development of effective and culturally acceptable services to improve equity in healthcare.Design and setting:Qualitative study in Southeast EnglandParticipants:26 adults from BME backgrounds (13 men, 13 women; aged >18years) were recruited to 2 focus groups. Participants were identified through the registers of the Black and Minority Ethnic Community Partnership centre and by visits to local community gatherings and were invited to take part by community development workers. Thematic analysis was conducted to identify key themes about perceived barriers to accessing mental health services.Results:Participants identified 2 broad themes that influenced access to mental health services. First, personal and environmental factors included inability to recognise and accept mental health problems, positive impact of social networks, reluctance to discuss psychological distress and seek help among men, cultural identity, negative perception of and social stigma against mental health and financial factors. Second, factors affecting the relationship between service user and healthcare provider included the impact of long waiting times for initial assessment, language barriers, poor communication between service users and providers, inadequate recognition or response to mental health needs, imbalance of power and authority between service users and providers, cultural naivety, insensitivity and discrimination towards the needs of BME service users and lack of awareness of different services among service users and providers.Conclusions;People from BME backgrounds require considerable mental health literacy and practical support to raise awareness of mental health conditions and combat stigma. There is a need for improving information about services and access pathways. Healthcare providers need relevant training and support in developing effective communication strategies to deliver individually tailored and culturally sensitive care. Improved engagement with people from BME backgrounds in the development and delivery of culturally appropriate mental health services could facilitate better understanding of mental health conditions and improve access.</p

Women’s views on smoking cessation services and national tobacco control measures

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What factors are important in smoking cessation and relapse in women from deprived communities? – A qualitative study

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