Reports
CLHIN eNewsletter For April, 2013
CLHIN eNewsletter For June, 2013
CLHIN eNewsletter For March, 2013
CLHIN eNewsletter For May, 2013
CLHIN eNewsletter for November, 2012
Communicating With LEP Patients
The American Medical Association has released the 2nd edition of its Official Guide to Communicating with Limited-English-Proficient Patients [608 KB PDF]. It’s a very brief guide — only 11 pages of text in a foldover 8 1/2″ by 5 1/2″ booklet — but it’s packed full of very practical information covering questions like:
- What does the term “LEP” mean?
- How do I know if I have LEP patients in my practice?
- How do language barriers affect quality of care and patient safety?
- What is the relationship between language assistance and cultural competency?
- What current and emerging strategies exist that can help physicians care for LEP patients?
- How should physician offices handle telephone calls to and from LEP patients?
- What can your office do to improve access to services for LEP patients?
- How can physician offices finance language assistance services?
Besides its own practical information, the booklet also includes useful references to further information, including:
- The Cross-Cultural Health Care Program
- National Center for Cultural Competence [note: the URL in the booklet is incorrect; this is a correct link]
- National Health Law Program – see their Library of Resources on Cultural and Linguistic Access to Health Care
- The Addressing Language Access Toolkit by the California Academy of Family Physicians
- The Health Care Language Services Implementation Guide by the HHS Office of Minority Health
Table 1 of that booklet (p. 4) emphasizes that bilingual health-care practitioners provide an option with high interpreting quality and a high patient comfort level, that is appropriate for all healthcare settings. This September 2007 article from NurseZone describes the success of one such program at the University of California-Davis Medical Center that includes nurses who are fluent not only in English, but also in Spanish, Russian, or Hmong.
Diabetes in US-Mexico Border Region
A new study coordinated by the Pan American Health Organization (PAHO) is the first to treat the US-Mexico border region as a single epidemiological unit. Examining the prevalence of diabetes, it found that rates of the disease as well as its risk factors are increasing. Diabetes is now Mexico’s leading cause of death. Among adults with type 2 diabetes living in the US-Mexico border region, approximately 22 percent were unaware that they had the disease.
Disparities in Adult Awareness of Heart Attack Warning Signs
The CDC’s Morbidity and Mortality Weekly Report for 2008-02-22 focused on a public health information issue potentially affecting hundreds of thousands of patients in the US each year. A new analysis of 2005 Behavioral Risk Factor Surveillance System (BRFSS) looked at data from 13 states and the District of Columbia, where the BRFSS included questions on the signs & symptoms of heart attack. The analysis found that overall, less than a third of all respondents were able to correctly identify the five warning signs of a heart attack, when given a list of closed-end (yes/no/don’t-know) questions. Those warning signs include:
- Pain and discomfort in the jaw, neck or back
- Feeling weak, lightheaded or faint
- Chest pain or discomfort
- Pain or discomfort in the arms or shoulder
- Shortness of breath
Even fewer respondents indicated that they would immediately call 9-1-1 if they suspected someone was having a heart attack. And although Texas was not one of the states studied, the analysis found notable disparities in awareness of heart-attack warning signs between Hispanic adults and non-Hispanic adults: only 14.3% of Hispanic adults knew the five warning signs and indicated they would call 9-1-1 in case of heart attack, compared with 16.2% among non-Hispanic blacks and 30.2% among non-Hispanic whites. Men also lagged significantly behind women overall (22.5% vs 30.8%) in awareness of the signs and correct steps to take.
Additional information on this study:
- CDC Press Release: English version and Spanish version
- Post by Consumers Union medical adviser Orly Avitzur, M.D., to the Consumer Reports Health Blog
- HealthDay coverage via US News Health
- Act Fast During Heart Attacks from the CDC
- Act In Time to Heart Attack Signs from the NHLBI
Effect of Acculturation on Drinking Along the Border
Acculturation to American society has often come with a price for immigrants, and that is the use of alcohol and the accompanying problems. This fact has been proven through research conducted primarily in metropolitan areas. But for the first time, research has focused on the use of alcohol on the Texas/Mexico border. Using information gathered during 2002-2003, among an almost even split of men and women, conclusions have been drawn on the effect of alcohol on the genders.
According to Raul Caetano, professor of epidemiology and regional dean (Dallas) at the University of Texas School of Public Health:
“There is a clear differential effect of acculturation by gender. While this was shown in previous research, the effects on the border seem to be more accentuated. Men drank less as they acculturated, and had a lower prevalence of alcohol-use disorders. Women drank more with acculturation, but this did not seem to lead to a higher rate of alcohol use disorders.”
The full report has been published in the February issue of Alcholism: Clinical & Experimental Research
EpiLink on Stress Among Latino Adolescents
The Texas Department of Health published the semimonthly Disease Prevention News for many years, but publication stopped abruptly back in 2003 in the middle of Volume 63. Under the auspices of the new Texas Department of State Health Services’ Infectious Disease Control Unit (ICDU), publication resumed with Volume 64 Issue 1 in January 2007 and continuing on a roughly monthly publication schedule with a new name: EpiLink Online Bulletin.
An article from the November issue of EpiLink has received some attention in the Spanish-language press after coverage by the Mexican news agency Notimex. The paper in question, “Current perspectives on stress among Latino adolescents” [PDF full text] was prepared by Richard C Cervantes and colleagues for the Annual Conference of the National Hispanic Network on Drug Abuse which took place in September. The paper is a review of research into the stressful living conditions that disproportionately affect Latino youth — including poverty, lack of health insurance, high school drop-out rates, increasing health problems (e.g., obesity), high teenage pregnancy rates, sexually transmitted diseases, increasing rates of HIV infections, substance abuse, and violence — and the present and future effects of that increasing stress on the health of an entire generation of Latinos.
According to the United States Department of Health and Human Services (DHHS) (Freid et al., 2003), … the highest rates of suicide consideration (26.5%) were for female Latinas. Latino and Latina youth from 9th to 12th grade overall had higher rates of attempted suicide than any other group; the male students were at 8.0% while, again, the female Latina rates (15.9%) were much higher. In an older survey, injurious suicide attempt rates were higher for Latina females 4.2%, followed by Latino males (2.5%), and then African Americans (DHHS, 1990). A study conducted by Rew et al. (2001) revealed that Latina adolescents had the highest rate of suicide attempts compared to other ethnic-gender groups. In addition, Latinas in the study also had relatively high reports of sexual abuse and suicide attempts by family members and friends. Latinas also have alarmingly higher rates of depression (27%). Latinas were the second highest ethnic group to report depressive symptoms. Acculturation stress due to conflictive gender roles in adolescent Latinas is believed to be the driving force of their higher rates of stress, depression and suicidality (National Coalition of Hispanic Health and Human Services Organization, 1999).
Although the reference list for the review article is impressive and very helpful, it also lays out a compelling case for a more comprehensive research agenda for studying issues such as intergenerational differences in acculturation and their effect on intrafamilial stress, differences between the mental and physical health of “acculturated” vs. “bicultural” Latino adolescents, and the relationship of gender differences in Latino adolescents to stressors, coping skills, resiliency, and mental and physical health.
Here’s an example of the Notimex coverage in Spanish: “Adolescentes hispanos afectados por el estrés” from MetroLatinoUSA, 2007-11-21; and here’s a blog post that reprints English-language coverage of the report from the 2007-11-09 issue of the Rio Grande Guardian (unfortunately, the original article does not appear on the Guardian‘s site now).
