Immigrant perceptions of discrimination in health care: the California Health Interview Survey 2003

Journal ArticleThe 2002 Institute of Medicine (IOM) report Unequal Treatment summarized research on racial and ethnic disparities in health care defined as "racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention."1 The report documented extensive disparities in health care; however, the mechanisms underlying these disparities are less well understood and are likely multifactorial. One possible mechanism may be systematic bias or discrimination within the healthcare context, which would decrease quality of care, or patient perceptions of discrimination, which would influence care-seeking behavior and adherence. Studies have documented an association between perceptions of racial/ethnic discrimination and a delay in seeking treatment,2-4 lower adherence to treatment regimens, 4,5 and lower rates of follow up.4 The great majority of research on perceptions and experiences of discrimination in healthcare has focused on blacks,3,6-21 and there is a "relative paucity" of research on other groups

Pengaruh Kalsium-asam Lemak Sawit (Ca-als) dan Kalsium terhadap Bobot Telur, Tebal Kerabang dan Kekuatan Kerabang Ayam Petelur Lohman

Penelitian yang bertujuan untuk mengetahui pengaruh kalsium-asam lemak sawit (Ca-ALS) dan kalsium (Ca) dalam ransum terhadap bobot telur, tebal kerabang, dan kekuatan kerabang ayam petelur Lohman, telah dilaksanakan selama 20 minggu. Rancangan percobaan yang digunkanan adalah rancangan acakl lengkap (RAL) pola faktorial. Sebagai faktor pertama adalah tingkat penggunaan kalsium-asam lemak sawit (Ca-ALS) sebesar 5%, 10%, dan 15%. Faktor kedua adalah tingkat kalsium yang digunakan 2,75%, 3,00% dan 3,25% . Ayam yang digunakan sebanyak 280 ekor didistribusi kedalam 9 kombinasi perlakuan dan satu kontrol, setiap perlakuan terdiri atasb7 ulangan dan setiap ulangan terdiri atas 4 ekor ayam. Ransum yang digunakan mengandung energi metabolis 2620 kkal/kg dan protein kasar sebesar 16%. Ransum dan air minum diberikan secara adlibitum. Berdasarkan hasil penelitian ini dapat disimpulkan bahwa penggunaan kalsium-asam lemak sawit (Ca-ALS) sampai 15% dalam ransum ayam petelur Lohman dapat dimanfaatkan dengan baik sebagai sumber asam lemak dan kalsium untuk menghasilkan bobot telur, dan ketebalan kerabang telur. Penggunaan Ca-ALS 15% akan lebih baik dengan penambahan 3,25% kalsium (Ca) dibanding 2,75%, 3,0% untuk meningkatkan kekuatan kerabang telur di awal dan akhir bertelur, diukur pada posisi vertikal atau horizontal. THE EFFECT OF CALCIUM–PALM FATTY ACID (Ca-PFA) AND CALCIUM FOR EGG WEIGHT, EGG SHELL THICKNESS, AND SHELL STRENGTH OF LOHMAN LAYING HENS ABSTRACK The aims of this experiment were to study the effect of calcium-palm fatty acid (Ca-PFA) and calcium in the ration for egg weigh, egg shell thickness, and shell strength of Lohman laying hens was done fot 20 weeks. A completly randomized design (CRD) with factorial used in this experiment, the first factor was 5%, 10%, 15% Ca-PFA and second factor was 2.75%, 3.00% and 3.25% calcium . The treatment consisted 7 replicates with 4 laying hens each and control, totally used 280 laying hens. All feed is iso caloric (ME: 2620 Kcal/kg) and iso protein (CP:16%). Feed and water were offered adlibitum. Result of this experiment showed that used of palm fatty acid (Ca-PFA) until 15% in rations Lohman laying hens to utilized fatty acid and calcium resources for increased egg weigh , egg shell tickness. But can be better with addition 3.25% calcium equal 2.75%, 3.0% increased egg shell strength in vertical or horizontal position, in beginning or finished of layed

Between Me and The Computer: Increased Detection of Intimate Partner Violence Using a Computer Questionnaire

Study objective: The emergency department is a problem-focused environment in which routine screening for intimate partner violence (IPV) is difficult. We hypothesized that screening for IPV during computer-based health-risk assessment would be acceptable to patients and improve detection. Methods: We performed a descriptive study of IPV data collected during a controlled trial of computer-based health promotion in an urban hospital ED. Patients received computer-generated health advice, and physicians received patient risk summaries. Outcomes were patient disclosure and physician documentation of IPV and associated risks. Results: Two hundred forty-eight patients (69% female, 90% black, mean age 39 years) participated in a clinical trial of computer-based health promotion in the ED. Of 170 women, 53 (33%) disclosed emotional abuse, and 25 (15%) disclosed physical abuse. Of 78 men, 22 (29%) disclosed emotional abuse, and 5 (6%) disclosed physical abuse. Patients were also willing to self-report a history or concern of hurting someone close to them. This was true for 21 (14%) women and 15 (22%) men. Controlling for demographic factors, disclosures of victimization and perpetration were associated with multiple psychosocial risks. Computer screening resulted in chart documentation in 19 of 83 potential cases of IPV compared with 1 case documented in the group that received usual care. Conclusion: Providing an opportunity for patients to confidentially self-disclose IPV has the potential to supplement current screening efforts and to allow providers to focus on assessment, counseling, and referral for those at risk. However, further measures will be needed to ensure that information gathered through computer screening is adequately addressed during the acute care or follow-up visit

Better Health While You Wait: A Controlled Trial of a Computer-Based Intervention for Screening and Health Promotion in the Emergency Department

Study objective: We evaluate a computer-based intervention for screening and health promotion in the emergency department and determine its effect on patient recall of health advice. Methods: This controlled clinical trial, with alternating assignment of patients to a computer intervention (prevention group) or usual care, was conducted in a university hospital ED. The study group consisted of 542 adult patients with nonurgent conditions. The study intervention was a self-administered computer survey generating individualized health information. Outcome measures were (1) patient willingness to take a computerized health risk assessment, (2) disclosure of behavioral risk factors, (3) requests for health information, and (4) remembered health advice. Results: Eighty-nine percent (470/542) of eligible patients participated. Ninety percent were black. Eighty-five percent (210/248) of patients in the prevention group disclosed 1 or more major behavioral risk factors including current smoking (79/248; 32%), untreated hypertension (28/248; 13%), problem drinking (46/248; 19%), use of street drugs (33/248; 13%), major depression (87/248; 35%), unsafe sexual behavior (84/248; 33%), and several other injury-prone behaviors. Ninety-five percent of patients in the prevention group requested health information. On follow-up at 1 week, 62% (133/216) of the prevention group patients compared with 27% (48/180) of the control subjects remembered receiving advice on what they could do to improve their health (relative risk 2.3, 95% confidence interval 1.77 to 3.01). Conclusion: Using a self-administered computer-based health risk assessment, the majority of patients in our urban ED disclosed important health risks and requested information. They were more likely than a control group to remember receiving advice on what they could do to improve their health. Computer methodology may enable physicians to use patient waiting time for health promotion and to target at-risk patients for specific interventions

A National Survey of Skin Infections, Care Behaviors and MRSA Knowledge in the United States

A nationally representative sample of approximately 2000 individuals was surveyed to assess SSTI infections over their lifetime and then prospectively over six-months. Knowledge of MRSA, future likelihood to self-treat a SSTI and self-care behaviors was also queried. Chi square tests, linear and multinomial regression were used for analysis. About 50% of those with a reported history of a SSTI typical of MRSA had sought medical treatment. MRSA knowledge was low: 28% of respondents could describe MRSA. Use of protective self-care behaviors that may reduce transmission, such as covering a lesion, differed with knowledge of MRSA and socio-demographics. Those reporting a history of a MRSA-like SSTI were more likely to respond that they would self-treat than those without such a history (OR 2.05 95% CI 1.40, 3.01; p<0.001). Since half of respondents reported not seeking care for past lesions, incidence determined from clinical encounters would greatly underestimate true incidence. MRSA knowledge was not associated with seeking medical care, but was associated with self-care practices that may decrease transmission.</p

Internet Queries and Methicillin-Resistant Staphylococcus aureus Surveillance

The Internet is a common source of medical information and has created novel surveillance opportunities. We assessed the potential for Internet-based surveillance of methicillin-resistant Staphylococcus aureus and examined the extent to which it reflects trends in hospitalizations and news coverage. Google queries were a useful predictor of hospitalizations for methicillin-resistant S. aureus infections

Association of Genetic Loci with Sleep Apnea in European Americans and African-Americans: The Candidate Gene Association Resource (CARe)

Although obstructive sleep apnea (OSA) is known to have a strong familial basis, no genetic polymorphisms influencing apnea risk have been identified in cross-cohort analyses. We utilized the National Heart, Lung, and Blood Institute (NHLBI) Candidate Gene Association Resource (CARe) to identify sleep apnea susceptibility loci. Using a panel of 46,449 polymorphisms from roughly 2,100 candidate genes on a customized Illumina iSelect chip, we tested for association with the apnea hypopnea index (AHI) as well as moderate to severe OSA (AHI≥15) in 3,551 participants of the Cleveland Family Study and two cohorts participating in the Sleep Heart Health Study. Among 647 African-Americans, rs11126184 in the pleckstrin (PLEK) gene was associated with OSA while rs7030789 in the lysophosphatidic acid receptor 1 (LPAR1) gene was associated with AHI using a chip-wide significance threshold of p-value<2×$10^{−6}$. Among 2,904 individuals of European ancestry, rs1409986 in the prostaglandin E2 receptor (PTGER3) gene was significantly associated with OSA. Consistency of effects between rs7030789 and rs1409986 in LPAR1 and PTGER3 and apnea phenotypes were observed in independent clinic-based cohorts. Novel genetic loci for apnea phenotypes were identified through the use of customized gene chips and meta-analyses of cohort data with replication in clinic-based samples. The identified SNPs all lie in genes associated with inflammation suggesting inflammation may play a role in OSA pathogenesis

Impact of Common Diabetes Risk Variant in MTNR1B

The risk of type 2 diabetes (T2D) is increased by abnormalities in sleep quantity and quality, circadian alignment, and melatonin regulation. A common genetic variant in a receptor for the circadian-regulated hormone melatonin (MTNR1B) is associated with increased fasting blood glucose and risk of T2D, but whether sleep or circadian disruption mediates this risk is unknown. We aimed to test if MTNR1B diabetes risk variant rs10830963 associates with measures of sleep or circadian physiology in intensive in-laboratory protocols (n = 58–96) or cross-sectional studies with sleep quantity and quality and timing measures from self-report (n = 4,307–10,332), actigraphy (n = 1,513), or polysomnography (n = 3,021). In the in-laboratory studies, we found a significant association with a substantially longer duration of elevated melatonin levels (41 min) and delayed circadian phase of dim-light melatonin offset (1.37 h), partially mediated through delayed offset of melatonin synthesis. Furthermore, increased T2D risk in MTNR1B risk allele carriers was more pronounced in early risers versus late risers as determined by 7 days of actigraphy. Our results provide the surprising insight that the MTNR1B risk allele influences dynamics of melatonin secretion, generating a novel hypothesis that the MTNR1B risk allele may extend the duration of endogenous melatonin production later into the morning and that early waking may magnify the diabetes risk conferred by the risk allele