Identification of Limited English Proficient Patients in Clinical Care

BackgroundStandardized means to identify patients likely to benefit from language assistance are needed.ObjectiveTo evaluate the accuracy of the U.S. Census English proficiency question (Census-LEP) in predicting patients' ability to communicate effectively in English.DesignWe investigated the sensitivity and specificity of the Census-LEP alone or in combination with a question on preferred language for medical care for predicting patient-reported ability to discuss symptoms and understand physician recommendations in English.ParticipantsThree hundred and two patients > 18 who spoke Spanish and/or English recruited from a cardiology clinic and an inpatient general medical-surgical ward in 2004-2005.ResultsOne hundred ninety-eight (66%) participants reported speaking English less than "very well" and 166 (55%) less than "well"; 157 (52%) preferred receiving their medical care in Spanish. Overall, 135 (45%) were able to discuss symptoms and 143 (48%) to understand physician recommendations in English. The Census-LEP with a high-threshold (less than "very well") had the highest sensitivity for predicting effective communication (100% Discuss; 98.7% Understand), but the lowest specificity (72.6% Discuss; 67.1% Understand). The composite measure of Census-LEP and preferred language for medical care provided a significant increase in specificity (91.9% Discuss; 83.9% Understand), with only a marginal decrease in sensitivity (99.4% Discuss; 96.7% Understand).ConclusionsUsing the Census-LEP item with a high-threshold of less than "very well" as a screening question, followed by a language preference for medical care question, is recommended for inclusive and accurate identification of patients likely to benefit from language assistance

Pharmacotherapy of Hypertension

Pharmacological treatment of hypertension continues to be the most effective and perhaps only practical management of hypertension. There is a rising tide of sentiment in this country for managing hypertension and other chronic diseases with diet, exercise, and a variety of behavioral modification techniques, including relaxation response, biofeedback, and transcendental meditation to the exclusion of drugs. There is no convincing evidence from well-controlled studies that any of these various techniques have a permanent or prolonged antihypertensive effect (1)

Workup of the Newly Discovered Hypertensive Patient

Newly discovered hypertensives should be evaluated to determine type of hypertension, to identify coexisting conditions that may alter therapy, and to search for correctable underlying causes. Workup should be minimal, rapid, and inexpensive. Intravenous pyelography should not be done routinely

Tobacco epidemic in Argentina: The cutting edge

Argentina has an annual production of 150,000 tons of tobacco and 70% of this is exported. Since 1972, the state subsidy of the national tobacco industry is through a special fund supported by a 7% tax on each pack of cigarettes. Phillip Morris and British American Tobacco control over 90% of the tobacco market in Argentina through subsidiaries. Overall, 37% of adults over the age 16 years currently smoke cigarettes and second hand smoke exposure affects 70% of homes. Tobacco use accounts for 15% of all deaths in persons under age 65 years and this represents an economic cost equivalent to 0.17% of the gross national product. Health care for diseases caused by tobacco use accounts for some 16% of the total health care expenditures in the country. The transnational tobacco industry views Argentina as an expansion market and has developed an intense advertising campaign including targeting all persons 16 years of age and older. Psychographic profiles similar to those used in the US market have been developed in Argentina to target adolescents and young adults. There is no comprehensive tobacco control law in Argentina. Even though the President has signed the WHO Framework Convention on Tobacco Control, ratification is being delayed by the active lobbying of regional legislators from the tobacco growing provinces who in turn are influenced by industry positions

Elder Mistreatment among Chinese and Korean Immigrants: The Roles of Sociocultural Contexts on Perceptions and Help-Seeking Behaviors

The purpose of this study was to identify dimensions of elder mistreatment in Chinese and Korean immigrant communities and to increase sociocultural understanding of such mistreatment by elucidating the complexities of abuse embedded in unique social and cultural contexts. In-depth interviews were conducted with 20 local professionals working primarily in Asian elderly advocacy, and six focus group discussions were conducted involving 60 community members in the San Francisco Bay area. Five dimensions of elder mistreatment were identified: psychological abuse, neglect by a trusted person, financial exploitation, physical abuse, and sexual abuse. In general, fewer Korean community member participants reported having observed physical or financial abuse than Chinese groups, but they reported greater knowledge of situations involving psychological abuse, neglect by a trusted person, and sexual abuse. The contexts of cultural influences and immigration and acculturation were salient themes that shaped participants' subjective perceptions and beliefs about elder abuse and hence help-seeking behaviors

Inulin Labeled With Chromium 51 for Determination of Glomerular Filtration Rate

Glomerular filtration rate (GFR) was determined in 12 patients by simultaneous clearance of inulin and inulin labeled with chromium 51 (inulin51Cr). Paired GFRs calculated by the classic C=UV/P formula showed excellent correlation (r±0.995; P<0.001; y =1.01x - 2.03, where y indicates clearance of inulin5Cr, and x indicates clearance of inulin). The clearance ratio was 0.975. Determination of GFR with inulin51Cr proved to be faster, cheaper, and more practical than with inulin. This compound makes GFR determinations readily available for clinical use

Antihypertensive effectiveness of oxprenolol administered twice daily

Oxprenolol, a beta‐blocker, is an effective antihypertensive when administered 3 or 4 times daily. We evaluated the antihypertensive effect of oxprenolol given twice daily (bid). The subjects were 15 ambulatory men whose standing diastolic blood pressure (BP) was at least 100 mm Hg after 3 wk of treatment with hydrochlorothiazide and oxprenolol placebo. Oxprenolol 40 mg twice daily was then substituted for the placebo. On subsequent weekly visits oxprenolol was titrated to 80 and 160 mg bid if the standing diastolic BP was greater than 90 mm Hg. Blood pressures on the last visit on placebo were compared to those on the last visit on oxprenolol. Standing BP declinedfram 145 ± 4/108 ± 1 to 130 ± 4/98 ± 4 on a mean dose of 256 mg of oxprenolol (p < 0.001 syst.; p < 0.01 diast.). Recumbent BP fell from 146 ± 4/107 ± I to 138 ± 5/93 ± 2 (p < 0.06 syst.; p < 0.01 diast.). During the final week, 13 of the 15 patients were admitted to the hospital for 24‐hr monitoring of BP. The 24‐hr BP readings showed a mean coefficient of variation of 6.6% recumbent and 7.2% standing. We conclude that bid oxprenolol will maintain 24 hr BP control in most patients