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PubMed1998

A case report of Usher's syndrome and anorexia nervosa.

OBJECTIVE: This report describes the rare combination of anorexia nervosa, deafness, and visual impairment with a particular emphasis on management issues. To the author's knowledge, this is the first report of an eating disorder in a patient who is deaf with a visual impairment. DISCUSSION: It describes the history of such a patient and the difficulties encountered in her treatment.

Adult↗
PubMed1997

Endings, secrets, and silences: overreading in narrative inquiry.

Qualitative researchers seek to understand the words of the people they interview and may use narrative inquiry to find meaning in the stories told by research participants. Narrative inquiry entails "overreading," a sensitivity to unspoken or indirect statement, which is central to interpretation. Some of the tools of the literary overreader are applied to two research interviews, particularly as they direct readers to attend to inconsistencies, endings, repetitions, and silence. Because overreading is also intrusive, we conclude with some considerations about how far the overreader of the research may legitimately go.

Aged↗
PubMed1999

A feminist critique of research on menopausal experience of Korean women.

Despite the increasing number of studies on the menopausal experience of Asian women, the focus of the studies has been on simple comparisons of their symptoms with Western women's and other disease-oriented research topics. To propose directions for future research on menopause, we analyzed and critiqued 158 studies on the menopausal experience of a group of Asian women-Korean women. The studies were retrieved through a search of computerized databases in the United States and South Korea, and they were reviewed, analyzed, and critiqued with a feminist perspective. Many of the studies have problems with (a) conceptualization, including ethnocentric and androcentric views of menopause, biomedical perspectives, and language difficulties; (b) research methods, such as inadequate instruments, passive relationships between researchers and research participants, culturally inappropriate communication styles, inadequate study designs, and homogeneous research participants; and (c) interpretation and communication of study findings. These issues undermine the conclusions drawn about the nature of the menopausal experience of Korean women.

Communication Barriers↗
PubMed1998

Concurrent validity of the GMS-AGECAT (A3) package in a Danish nursing home population.

AIM: To validate the Danish version of the GMS-AGECAT (A3), the Standardized Mini Mental State Examination (SMMSE) and the Geriatric Depression Scale-15 (GDS-15) by comparing them to clinical ICD-10 criteria in a Danish nursing home population. METHODS: With a participation of 91%, the study included 100 residents. All residents were interviewed with the GMS-AGECAT (A3), SMMSE and GDS-15 by an MD and then blindly diagnosed by a consultant geriatric psychiatrist. All residents approached for an interview were included, also those who were not able to communicate (the non-accessibles). RESULTS: The prevalence of clinical psychiatric ICD-10 main diagnoses was 56%. The non-accessibles had significantly higher psychiatric morbidity and lower ADL scores (modified Barthel ADL index) compared to those who were able to communicate. With the non-accessibles (N = 100) included, the optimal screening and diagnostic cutpoint for the GMS-AGECAT organic diagnoses was 2/3, with 96% sensitivity, 73% specificity, 77% predictive value of a positive test and 95% predictive value of a negative test. The SMMSE and GDS-15 had better screening properties compared to the GMS-AGECAT but only 60% of the residents were able to complete the SMMSE and 78% were able to complete the GDS-15. CONCLUSION: The Danish version of the GMS-AGECAT has relevant diagnostic and screening properties for organic disorders in Danish nursing home populations.

Aged↗
PubMed2001

Promoting early detection of breast cancer among Vietnamese-American women. Results of a controlled trial.

BACKGROUND: Although breast cancer is the second most common cancer among Vietnamese-American women, previous research has shown that they are less likely to have ever had, and to be more often overdue for, clinical breast examinations (CBE) and mammograms than women in the general population. METHODS: Over a 2.5-year period, the following intervention activities were targeted at both Vietnamese women and physicians in Alameda County, California: neighborhood-based educational activities; dissemination of health education materials; a media campaign; and continuing medical education seminars for physicians. Women in Los Angeles and Orange Counties served as controls. Preintervention telephone interviews were conducted with 384 randomly selected Vietnamese women in the intervention community and 404 women in the control community in 1996, and post-test intervention interviews were conducted with 405 and 402 women, respectively, in 1998. RESULTS: Multiple logistic regression analyses of postintervention surveys showed the intervention community women at posttest were no more likely to recognize, receive, plan, or be up-to-date for CBE or mammograms than women in the control community. However, women who reported greater exposure to the various intervention elements were significantly more likely to have heard of, have had, and to plan CBE and mammograms than women with less exposure. CONCLUSIONS: Although the effect on the women in the intervention group was not significant, the intervention did have a modest positive impact on women who had more exposure to it.

Adult↗
PubMed2000

Utilization of Alzheimer's disease community resources by Asian-Americans in California.

Alzheimer's disease is as prevalent among Asian ethnic minority groups as among Caucasians. We explored Asian groups' utilization of available Alzheimer's disease services in California, using a uniquely large sample of Asian-Americans. The Minimum Uniform Dataset includes data from nine California Alzheimer's Disease Diagnostic and Treatment Centers. Of the 9,451 cases included in the Minimum Utilizable Dataset, 4.2% were Asian (primarily Chinese), 0.8% Filipino, 0.3% Pacific Islander, and 75.9% Caucasian. In comparison to their numbers within the nine California countries served, Asian ethnic elders were underrepresented in enrollment by approximately 50%, except at one center where all staff were bilingual. The centers referred a significantly greater proportion of Asian than Caucasian patients for financial help (47.8 vs. 7.4%, P < 0.001), case management (47.8 vs. 22.3%, P < 0.001), and to Alzheimer's disease day care (41.3 vs. 28.4%, P < 0.05). A significantly greater proportion of Asian caregivers received referrals to caregiver resource centers (32.6 vs. 61.3%, P < 0.001) and financial help (29.6 vs. 4.7%, P < 0.001). A smaller proportion of Asian patients received referrals to home health services than Caucasians (4.3 vs. 14.9%, P < 0.05). Filipino patients were also referred more frequently to financial assistance than Caucasians (P < 0.05). Asians and Pacific Islanders under-enroll at centers specializing in AD care. Bilingual staff at centers specializing in dementia care, training for community physicians who treat these patients, and establishment of caregiver support groups within Asian and Pacific Islander communities may enhance the enrollment of these elders. AD care centers in areas supporting Asian and Filipino families may need to concentrate resources on providing financial assistance in case management.

Aged↗
PubMed1980

Important psychocultural factors in the delivery of mental health services to lower-class Puerto Rican clients: a review of recent studies.

Literature on the psychological orientation of lower class Puerto Rican clients, their cultural value system, and their expectations for mental health services was reviewed. First, lower-class Puerto Rican client's psychocultural orientation to therapy was seen as relatively dissimilar to that of the typical middle-class American client. Second, differences in expectations of therapy between the Anglo therapist and lower-class Puerto Rican client were described. Factors affecting the minimal use of mental health services by the lower-class Puerto Rican community were also discussed. Recommendations were offered to aid in the amelioration of these problems for Puerto Rican clientele.

Attitude to Health↗
PubMed1993

Is the medical community ready for worker notification?

Although the potential for early detection of disease has been of central importance in the evolution of worker notification policy and practice, it is not the only positive outcome of medical intervention. The provider-patient encounter also creates an important opportunity for patient-centered risk communication that may result in workplace modifications as well as lifestyle changes to reduce the likelihood of subsequent illness and injury--both work and nonwork related. At the same time, it may signal the beginning of a series of social, legal, and political actions that may have positive or negative consequences for notified workers. This article identifies several important roles for members of the medical community relating to worker and community notification programs and explores the readiness of health care professionals in assuming these roles. It is suggested that health care providers lack both the training and sociopolitical sensitivity needed for meaningful participation in the notification process. This article addresses possible short-term and long-term approaches to enhancing the readiness of health care providers and suggests that effective intervention with notified workers requires a willingness to step beyond the confines of the medical model.

Communication↗
PubMed1993

Cultural and linguistic factors in worker notification to blue collar and no-collar African-Americans.

This presentation offers historical and sociolinguistic perspectives regarding the origins of the language used by African-Americans. U.S. descendants of slaves of West and Niger Congo African origin should not be thought of as native speakers of English. To the extent that they have lived in de jure or de facto social isolation from Euro-American English-speaking persons, they have retained a West and Niger Congo African thought process or substratum in the phonology and morphosyntax of their speech. Their mother tongue has been described by several African-American linguists, psychologists, and ethnologists as Ebonics. In a sense, Ebonics refers to the paralinguistic verbal and non-verbal sounds, cues, and gestures that are systematically used in the process of communication by many African-Americans. As one consequence of historical social isolation, African-Americans invariably score poorly on nationally standardized scales of "Standard American" English competence. Therefore, worker notification intended for African-Americans, especially among the blue- and no-collar levels, that does not contain an Afro-centric perspective will likely not prove successful. The linguistic factors, which can severely impede or tremendously enhance the effectiveness of worker notification to these groups, are therefore vital and should not be ignored. Worker notification targeted for limited English-speaking or unlettered populations should include the development of materials and presentations in the language or primary medium best understood by the audience. Based upon research findings on the psycholinguistics of learning modal preference, the development of notification materials that target a learning channel that is audio oral or aural-oral is promoted.

Black or African American↗
PubMed1994

Informed consent and Huntington disease: a model for communication.

American and Canadian professional accreditation standards for medical genetics, and genetic counseling require certain abilities with regard to "communication." What remains unclear is how such standards are to be interpreted in terms of appropriate clinical protocols, objectives, and values. These issues have significant medical and legal implications, particularly with regard to medical malpractice. From the perspective of genetic testing for Huntington disease, this paper identifies those clinical objectives and practices which may be described as constituting the appropriate standard of care for "communication," and informed consent.

Age of Onset↗