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BACKGROUND: Assessment and treatment of pain are based largely on patient's self reports. Patients with limited English proficiency (LEP) may have difficulties communicating their pain symptoms in the presence of language barriers. OBJECTIVE: To determine whether interpreter use was associated with quality of acute pain treatment among Latina patients with limited English proficiency. DESIGN: Secondary analysis of two cross-sectional surveys. PARTICIPANTS: One hundred and eighty-five Latino female patients hospitalized for obstetric and gynecological care who required interpreter services. Patients were classified into two groups according to interpreter availability ('Always' and 'Not Always' available). MAIN MEASURES: Quality of pain treatment was measured by patient report of 1) overall level of pain control during hospitalization; 2) timeliness of pain treatment; and 3) perceived provider helpfulness to treat pain. KEY RESULTS: Patients who always received interpreters were more likely to report higher levels of pain control ( P = 0.02), timely pain treatment ( P = 0.02), and greater perceived provider helpfulness to treat their pain ( P = 0.005), compared with patients who not always received interpreters. CONCLUSION: Use of interpreters by LEP patients was associated with better patient reports on quality of pain treatment, and may also improve clinical interactions related to pain. [ABSTRACT FROM AUTHOR]

Background: Considerable overlap in symptoms and disease comorbidity has been noted among medically unexplained and psychiatric conditions seen in the primary care setting, such as chronic fatigue syndrome, low back pain, irritable bowel syndrome, chronic tension headache, fibromyalgia, temporomandibular joint disorder, major depression, panic attacks, and posttraumatic stress disorder.Objective: To examine interrelationships among these 9 conditions.Design: Using data from a cross-sectional survey, we described associations and used latent class analysis to investigate complex interrelationships.Participants: 3,982 twins from the University of Washington Twin Registry.Measurements: Twins self-reported a doctor's diagnosis of the conditions.Results: Comorbidity among these 9 conditions far exceeded chance expectations; 31 of 36 associations were significant. Latent class analysis yielded a 4-class solution. Class I (2% prevalence) had high frequencies of each of the 9 conditions. Class II (8% prevalence) had high proportions of multiple psychiatric diagnoses. Class III (17% prevalence) participants reported high proportions of depression, low back pain, and headache. Participants in class IV (73% prevalence) were generally healthy. Class I participants had the poorest markers of health status.Conclusions: These results support theories suggesting that medically unexplained conditions share a common etiology. Understanding patterns of comorbidity can help clinicians care for challenging patients. [ABSTRACT FROM AUTHOR]

Objective: To determine what factors influence participation in health research among American Indians and Alaska Natives.Methods: Using vignettes that described 3 types of research studies (a behavioral intervention trial, a genetic association study, and a pharmacotherapy trial), we surveyed 319 patients and 101 staff from an urban Indian health care facility to ascertain how study design, institutional sponsorship, community involvement, human subjects' issues, and subject matter influence participation.Results: Overall response rates were 93% for patients and 75% for staff. Hypothetical participation was highest for the genetic study (patients=64%; staff=48%), followed by the behavioral intervention (patients=46%; staff=42%), and the pharmacotherapy trial (patients=32%; staff=23%). The odds of participation (odds ratio [OR]) were generally increased among patients and staff when the study was conducted by health care providers (OR=1.3 to 2.9) and addressed serious health problems (OR=1.2 to 7.2), but were decreased if the federal government led the study (OR=0.3 to 0.5), confidentiality might be broken (OR=0.1 to 0.3), and compensation was not provided (OR=0.5 to 0.7).Conclusion: Close attention to study type, institutional sponsorship, community involvement, potential risks and benefits, and topic are essential to conceptualizing, designing, and implementing successful health research with American Indian and Alaska Native populations. [ABSTRACT FROM AUTHOR]

Background: Differences in provider-patient health perceptions have been associated with poor patient outcomes, but little is known about how patients' cultural identities may be related to discordant perceptions.Objective: To examine whether health care providers and American-Indian patients disagreed on patient health status ratings, and how differences related to these patients' strength of affiliation with American-Indian and white-American cultural identities.Design: Survey of patients and providers following primary care office visits.Participants: One hundred and fifteen patients > or =50 years and 7 health care providers at a Cherokee Nation clinic. All patients were of American-Indian race, but varied in strength of affiliation with separate measures of American-Indian and white-American cultural identities.Measurements: Self-reported sociodemographic and cultural characteristics, and a 5-point rating of patient's health completed by both patients and providers. Fixed-effects regression modeling examined the relationships of patients' cultural identities with differences in provider-patient health rating.Results: In 40% of medical visits, providers and patients rated health differently, with providers typically judging patients healthier than patients' self-rating. Provider-patient differences were greater for patients affiliating weakly with white cultural identity than for those affiliating strongly (adjusted mean difference=0.70 vs 0.12, P=.01). Differences in ratings were not associated with the separate measure of affiliation with American-Indian identity.Conclusions: American-Indian patients, especially those who affiliate weakly with white-American cultural identity, often perceive health status differently from their providers. Future research should explore sources of discordant perceptions. [ABSTRACT FROM AUTHOR]

To assess physicians' use of and attitudes toward electronic mail (e-mail) for patient communication, we conducted a mail-in survey of physicians who see patients in outpatient clinics affiliated with a large academic medical center (N = 283). Seventy-two percent of physicians reported using e-mail to communicate with patients, averaging 7.7 e-mails from patients per month. The lowest level of use was by community-based primary care physicians (odds ratio, 0.22; 95% confidence interval, 0.08 to 0.59). Those physicians who reported using e-mail with patients reported high satisfaction with its use. Although physicians were concerned about the confidentiality of e-mail, few discussed this issue with patients. [ABSTRACT FROM AUTHOR]

Little is known about prevention among elderly or urban American Indian/Alaska Native (AI/AN) populations. We reviewed the medical records of 550 older urban AI/AN primary care patients to evaluate how frequently preventive measures were received. Adherence to guidelines was examined by a culturally appropriate (> or =50 years) and standard age threshold (> or =65 years), and by performance of preventive measures at any time ("ever") and in the past year. Lifetime performance was inadequate for the many measures, including mammograms (56%), fecal occult blood testing (37%), audiometry (33%), visual acuity testing (50%), smoking cessation counseling (50%), and pneumococcal (22%) and influenza (49%) vaccinations. Performance of the measures was less frequent in the prior year, but did not differ by age threshold. Predictors of adherence included female gender, having insurance, and having more health problems and medications. Nonadherence infrequently resulted from patients' failure to comply with recommendations. We conclude that use of most preventive services among elderly urban AI/ANs is suboptimal and should be improved. [ABSTRACT FROM AUTHOR]

Examines comorbid clinical conditions in chronic fatigue. Link of fatigue with physical health conditions; Case definition for fatigue and degree of psychiatric morbidity; Influences of genetic and noninherited factors underlying the link between fatigue and related illness.

In order to make meaningful scholarly contributions, clinician-educators need protected time. Forty-one clinician-educators at the University of Washington recorded their work activities in 30-minute intervals for 2 weeks. The average work week was 58.7 hours (SD = 13.8). The time devoted to scholarship, 7.6 hours (13%), was significantly less than the 20% designated for scholarship in the clinician-educator job description (p < .001); 42% of scholarly work occurred outside the regular work week. At a time when many schools rely on clinician-educators to sustain their clinical and teaching missions, schools should ensure that faculty have adequate time and resources to meet scholarly expectations for promotion. [ABSTRACT FROM AUTHOR]

Objective: To assess the comprehensibility of hepatitis B translations for Cambodian refugees, to identify Cambodian illnesses that include the symptoms of hepatitis, and to combine these observations with critical theoretical perspectives of language to reflect on the challenges of medical translations generally.Design: Open-ended, semistructured interviews, and participant-observation of a refugee community in Seattle, Washington.Setting: Homes of Cambodian residents of inner-city neighborhoods.Participants: Thirty-four adult Cambodian refugees who had each been educated about hepatitis B through public health outreach.Results: Medical interpreters translated hepatitis B as rauk tlaam, literally "liver disease." Unfortunately, while everyone knew of the liver (tlaam), rauk tlaam was a meaningless term to 28 (82%) of 34 respondents and conveyed none of the chronicity and communicability intended by refugee health workers for 34 (100%) of the respondents. In contrast, all respondents knew illnesses named after symptom complexes that include the symptoms of acute and chronic hepatitis, but do not refer to diseased organs. The Cambodian words chosen to translate hepatitis B reflect the medical thinking and medical authority that can unintentionally overwhelm attempts at meaningful communication with non-English-speaking patients.Conclusions: To improve comprehension of hepatitis B translations for the Khmer, translators must choose between medical terminology focused on the liver and Khmer terminology which identifies recognizable experiences, but represents important Khmer health concepts. A critical linguistic view of this situation suggests that for these translations to be meaningful clinicians and health educators must first analyze and then monitor the contextual significance of medical language. In cross-cultural settings, this means a partnership with medical interpreters to pay close attention to the experience of illness and social context of the translation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify important determinants of noncompliance among Cambodian refugees. DESIGN: Open-ended interviews. SETTING: University-affiliated ambulatory care clinic in an inner-city hospital. PARTICIPANTS: Thirty adult Cambodian refugees (15 men and 15 women) who were regular utilizers of a refugee clinic. MEASUREMENTS AND MAIN RESULTS: Sixty-seven percent of the participants described being noncompliant with at least one of their medications. Four common causes of noncompliance were identified: 1) misunderstanding the intent of the medication; 2) side effects; 3) concern about the effect of medication on 'internal strength'; and 4) Cambodian ideas about pharmacokinetics. CONCLUSIONS: Noncompliance was commonly reported by the Cambodian respondents. Noncompliance was both intentional and unintentional; the unintended noncompliance derived from patients' attempting to comply with therapy according to Cambodian ideas about the body and Western medication. This article suggests clinical approaches to enhance compliance with prescribed regimens among recent Cambodian immigrants and refugees [ABSTRACT FROM AUTHOR]

Objective: To determine whether there are differences between men and women patients who have chronic fatigue syndrome (CFS) and, if so, to ascertain whether a gender-related pattern exists.Design: A descriptive study of demographic, clinical, and psychosocial measures, the results of which were prospectively collected for patients who had CFS.Setting: A university-based referral clinic devoted to the evaluation and management of chronic fatigue.Patients: 348 CFS patients who had undergone complete medical evaluations.Measures: Clinical variables included symptoms, physical examination findings, and laboratory results. Psychosocial assessment consisted of a structured psychiatric interview, the Medical Outcomes Study Short-form General Health Survey to assess functional status, the General Health Questionnaire to ascertain psychological distress, the Multidimensional Health Locus of Control, and measures of attribution, social support, and coping.Main Results: Overall, few gender-related differences were identified. Women had a higher frequency of tender or enlarged lymph nodes (60% versus 33%, p < or = 0.01) and fibromyalgia (36% versus 12%, p < or = 0.001) and lower scores on the physical functioning subscale of the Medical Outcomes Study Short-form General Health Survey (37.6 versus 52.2, p < 0.01); men more often had pharyngeal inflammation (42% versus 22%, p < or = 0.001) and reported a higher lifetime prevalence of alcoholism (20% versus 9%, p < or = 0.01).Conclusions: In general, demographic, clinical, and psychosocial factors do not distinguish men from women CFS patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of depressive symptoms among Vietnamese refugees who have lived in the United States for at least two months.Design: A prospective and descriptive study using the Vietnamese Depression Scale (VDS). Scores of > or = 13 on the VDS were considered indicative of depression.Setting: Ten public health clinics in four states.Patients/participants: Four hundred seventy-six consecutive adult Vietnamese refugees presenting for primary care.Interventions: The VDS, an 18-item culture-specific self-report measure, was used to screen for depressive symptoms.Measurements and Main Results: Twenty percent of these patients had scores of 13 or above. Although being female; being older; being divorced, separated, or widowed; and being poorly educated were significant univariate risk factors for screening positive, only the latter two were significant in a multivariate model. Physical complaints were common and induced considerable anxiety about health status, but psychological and emotional symptoms were even more prevalent. Patients scoring 13 or higher had a higher rate of endorsement for every item in the scale than did those scoring lower than 13.Conclusions: This study substantiates the feasibility and importance of screening for depressive symptoms among Vietnamese refugees, particularly in primary care settings where they are most likely to seek care for both medical and psychological problems. [ABSTRACT FROM AUTHOR]

Objectives: To identify psychiatric differences between patients with chronic fatigue and those with rheumatoid arthritis and to investigate whether patients meeting Centers for Disease Control (CDC) criteria for chronic fatigue syndrome (CFS) can be differentiated from patients with chronic fatigue on measures of disability and psychosocial distress.Design: Cross-sectional study comparing 98 patients with chronic fatigue with 31 patients with rheumatoid arthritis on structured psychiatric interviews and patient questionnaires. Nineteen patients meeting CDC criteria for CFS were compared with 79 patients with chronic fatigue not meeting CDC criteria on questionnaires measuring disability and psychosocial distress.Setting: Consecutive patients with chronic fatigue were selected from a chronic fatigue clinic at the University of Washington, and 31 consecutive patients with rheumatoid arthritis were sampled from a private rheumatology practice.Main Results: Patients with chronic fatigue had a significantly higher prevalence of lifetime major depression and somatization disorder than did patients with rheumatoid arthritis. Patients with chronic fatigue also had a significantly higher prevalence of current and lifetime psychiatric diagnoses. Only 19 of 98 patients with chronic fatigue met CDC criteria for CFS. Patients meeting CDC criteria for CFS could not be differentiated from the larger group of patients with chronic fatigue on any study variable.Conclusions: Patients with chronic fatigue have a significantly higher burden of psychiatric illness than do patients with rheumatoid arthritis. The psychiatric illness preceded the development of chronic fatigue in over half the patients. Centers for Disease Control criteria for CFS did not select a subset of chronic fatigue patients who could be differentiated on disability or psychosocial parameters from patients with chronic fatigue who did not meet CDC criteria. [ABSTRACT FROM AUTHOR]

To ascertain the extent of, and risk factors for, physical abuse among older urban American Indian/Alaska Natives (AI/ANs), we conducted a chart review of 550 urban AI/AN primary care patients >/=50 years old seen during 1 year. Mistreatment was documented in 10%. A logistic regression found younger age (P <.001), female gender (P <.001), current depression (P <.001), and dependence on others for food (P <.05) to be significant correlates of physical abuse. In only 31% of instances of definite abuse were the authorities notified. We conclude that providers should be alert to the possibility of physical mistreatment among older urban AI/ANs. Improvements in detection and management are sorely needed. [ABSTRACT FROM AUTHOR]

To determine how often housestaff notified primary care providers (PCPs) of admissions, whether notification prompted a visit, and whether PCP input impacted care, 210 medical inpatients were asked about their PCPs, and at discharge, housestaff completed a questionnaire on the patient's PCP, and whether he or she was contacted, came to the hospital, and influenced care. Of 105 patients with a PCP, 74 were contacted and 26 visited their patients. The PCPs spoken with personally more often made hospital visits than those contacted only by message (p < 0.0001). PCP input frequently contributed to patient care by providing continuity, clarifying history/diagnosis, managing chronic problems, and elucidating psychosocial/cultural factors. Having a PCP did not influence length of stay or readmission rates. [ABSTRACT FROM AUTHOR]