Factors Associated With Self-Reported Depression in Arab, Chaldean, and African Americans

Although depression is a chronic illness with high morbidity and personal and economic losses, little is known about depression in immigrants with an Arab or Chaldean ethnic background. Our primary objective was to determine the overall and ethnicity-specific prevalence of self-reported depression in Arab Americans, Chaldean Americans, and African Americans in the Midwest. The secondary objective was to evaluate the associations between potential risk and protective factors and the presence of self-reported depression. A total of 3543 adults were recruited from the Arab and Chaldean communities in Metropolitan Detroit. The sample in this study was restricted to those of Arab, Chaldean, and African ethnic backgrounds, resulting in 81.2% of the original sample (n52878). A health assessment survey questionnaire was administered The overall rate of self-reported depression was 18.2%. The highest rate of depression was found in Arab American participants (23.2%), followed by African Americans (15%) and Chaldeans (13.3%). Self-reported prevalence of depression by country of origin differed significantly. Our results show the need to provide culturally competent mental health services for Arab Americans and other minority American subgroups. Research is needed to identify risk factors, preferably modifiable factors, and to ascertain which factors are similar and non-similar to the general American population

Receipt of Cardiac Medications Upon Discharge Among Men and Women With Acute Coronary Syndrome and Nonobstructive Coronary Artery Disease

Background Management of acute coronary syndrome (ACS) patients with nonobstructive epicardial coronary artery disease (CAD) remains poorly understood. Hypothesis Acute coronary syndrome patients with nonobstructive CAD are less likely to receive effective cardiac medications upon discharge from the hospital. Methods We identified patients hospitalized with ACS that underwent coronary angiography and had a 6-month follow-up. Patients were grouped by CAD severity: nonobstructive CAD (<50% blockage in all vessels) or obstructive CAD (≥50% blockage in ≥ 1 vessels). Data were collected on demographics, medications at discharge, and adverse outcomes at 6 months, for all patients. Results Of the 2264 ACS patients included in the study: 123 patients had nonobstructive CAD and 2141 had obstructive CAD. Cardiac risk factors including hypertension and diabetes were common among patients with nonobstructive CAD. Men and women with nonobstructive CAD were less likely to receive cardiac medications compared to patients with obstructive CAD including aspirin (87.8% vs 95.0%, P = 0.001), Β-blockers (74.0% vs 89.2%, P < 0.001), or statins (69.1% vs 81.2%, P = 0.001). No gender-related differences in discharge medications were observed for patients with nonobstructive CAD. However, women with nonobstructive CAD had similar rates of cardiac-related rehospitalization as men with obstructive CAD (23.3% and 25.9%, respectively). Conclusions Patients with nonobstructive CAD are less likely to receive evidence-based medications compared to patients with obstructive CAD, despite the presence of CAD risk factors and occurrence of an ACS event. Further research is warranted to determine if receipt of effective cardiac medications among patients with nonobstructive CAD would reduce cardiac-related events. Copyright © 2010 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64902/1/20701_ftp.pd

Effects of a refugee elective on medical student perceptions

<p>Abstract</p> <p>Background</p> <p>There are growing numbers of refugees throughout the world. Refugee health is a relatively unstudied and rarely taught component of medical education. In response to this need, a Refugee Health Elective was begun. Medical student perceptions toward cultural aspects of medicine and refugee health before and after participation in the elective were measured.</p> <p>Methods</p> <p>Preliminary questionnaires were given to all preclinical students at the academic year commencement with follow-up questionnaires at the refugee elective's conclusion. Both questionnaires examined students' comfort in interacting with patients and familiarity with refugee medical issues, alternative medical practices, and social hindrances to medical care. The preliminary answers served as a control and follow-up questionnaire data were separated into participant/non-participant categories. All preclinical medical students at two Midwestern medical schools were provided the opportunity to participate in the Refugee Health Elective and surveys. The 3 data groups were compared using unadjusted and adjusted analysis techniques with the Kruskall-Wallis, Bonferroni and ANCOVA adjustment. P-values < 0.05 were considered significant.</p> <p>Results</p> <p>408 and 403 students filled out the preliminary and follow-up questionnaires, respectfully, 42 of whom participated in the elective. Students considering themselves minorities or multilingual were more likely to participate. Elective participants were more likely to be able to recognize the medical/mental health issues common to refugees, to feel comfortable interacting with foreign-born patients, and to identify cultural differences in understanding medical/mental health conditions, after adjusting for minority or multilingual status.</p> <p>Conclusion</p> <p>As medical schools integrate a more multicultural curriculum, a Refugee Health Elective for preclinical students can enhance awareness and promote change in attitude toward medical/mental health issues common to refugees. This elective format offers tangible and effective avenues for these topics to be addressed.</p