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Racial-ethnic minorities receive lower quality and intensity of health care compared with whites across a wide range of preventive, diagnostic, and therapeutic services and disease entities. These disparities in health care contribute to continuing racial-ethnic disparities in the burden of illness and death. Several national medical organizations and the Institute of Medicine have issued position papers and recommendations for the elimination of health care disparities. However, physicians in practice are often at a loss for how to translate these principles and recommendations into specific interventions in their own clinical practices. This paper serves as a blueprint for translating principles for the elimination of racial-ethnic disparities in health care into specific actions that are relevant for individual clinical practices. We describe what is known about reducing racial-ethnic disparities in clinical practice and make recommendations for how clinician leaders can apply this evidence to transform their own practices. [ABSTRACT FROM AUTHOR]

Increasingly, the mental health needs of populations are measured using large-sample surveys with standardized measures and methods. Such efforts, however, rarely include sufficient number of smaller, culturally defined populations to draw defensible conclusions about their needs. Furthermore, without some adaptation, the standardized methods and measures may yield invalid results in such populations. Using a recently completed psychiatric epidemiology and services study with American Indian populations as a case example, this paper outlines issues facing epidemiologists working in such culturally diverse contexts. The issues discussed include the following: (1) persuading the scientific community and potential sponsors that work with distinct or culturally defined populations is important; (2) framing research questions and activities to meet the needs of communities; (3) defining a population of inference; (4) balancing the needs for comparability and cultural specificity; (5) maximizing scientific validity in light of the challenges in sample acquisition; and (6) developing and implementing data collection methods that uphold scientific standards but are also realistic given the context. The authors draw on their experiences--most recently in the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP)--to illustrate these issues and suggest ways to address each. A goal of this paper is to challenge those invested in conducting culturally valid epidemiologic work in such populations to better articulate the nature of these efforts. [ABSTRACT FROM AUTHOR]

In this paper we report on the process of translating five mental health outcome measures into Spanish and adapting them to Latino culture. The instruments considered are the World Health Organization-Disability Assessment Scale, the Burden Assessment Scale, the Family Burden Scale, Lehman's Quality of Life Interview and the Continuity of Care in Mental Health Services Interview. A systematic process of translation and adaptation of the instruments was followed with the goal of achieving cultural equivalence between the English and Spanish versions of the instruments in five dimensions: semantic, content, technical, construct, and criterion equivalence. In this paper we present data about the semantic, content, and technical equivalence. Various steps were taken to achieve equivalence in these dimensions, including the use of a bilingual committee, a multi-national bilingual committee, back-translation, and focus groups with mental health patients and their relatives. [ABSTRACT FROM AUTHOR]

Tailored programs to diversify the pool of HIV/AIDS investigators and provide sufficient training and support for minority investigators to compete successfully are uncommon in the US and abroad. This paper encourages a shift in the HIV/AIDS training and research paradigm to effectively train and mentor Latino researchers in the US, Latin America and the Caribbean. We suggest three strategies to accomplish this: (1) coaching senior administrative and academic staff of HIV/AIDS training programs on the needs, values, and experiences unique to Latino investigators; (2) encouraging mentors to be receptive to a different set of research questions and approaches that Latino researchers offer due to their life experiences and perspectives; and (3) creating a virtual infrastructure to share resources and tackle challenges faced by minority researchers. Shifts in the research paradigm to include, retain, and promote Latino HIV/AIDS researchers will benefit the scientific process and the patients and communities who await the promise of HIV/AIDS research. [ABSTRACT FROM AUTHOR]

The issue of whether, how and how much to tell cancer patients about their diagnosis and prognosis is confronted in different ways in different countries. This paper reflects my direct experience as a medical oncologist both in the US and in Italy. It is an attempt to describe two different ways of dealing with truth-telling in oncology and to explore their reasons and consequences. [ABSTRACT FROM AUTHOR]

Uncertainty, fear, and distress have become prevalent in the lives of U.S. residents since the beginning of the COVID-19 pandemic. The unpredictable reality of social distancing, shutdowns, and isolation have affected daily routines and influenced well-being and health. Drawing on consumer culture theory, we conducted an exploratory study to examine the mediating role of consumer spirituality in the subjective well-being of religious Christians during COVID-19 and to discover links between well-being and health outcomes. Participants from the United States (n = 104) were recruited via a Qualtrics' online panel. Findings show that religiosity among Christians enhanced subjective well-being, demonstrating the positive effect of religious beliefs, especially during the COVID-19 pandemic. However, spiritual consumption mediated this relationship, suggesting the importance of possessions to religious expression and subjective well-being. Implications for messaging about health and well-being are discussed. [ABSTRACT FROM AUTHOR]

Despite a population of over two million Vietnamese people in the United States, very few domestic violence shelters employ Vietnamese-speaking staff or provide culturally responsive services. Research on the needs of Vietnamese intimate partner violence (IPV) survivors is also sparse, and very few studies have asked Vietnamese IPV survivors themselves about their service recommendations. To fill this gap in the literature, the current study conducted qualitative interviews and focus groups with 20 Vietnamese IPV survivors and 13 service providers about IPV services for Vietnamese survivors living in the United States. Analytic Induction was used to identify recommendations for culturally responsive services at the practitioner, intervention, and institutional levels. Participant recommendations were primarily at the intervention and institutional levels. At the institutional level, participants recommended more community outreach and education. At the intervention level, participants recommended more comprehensive and long-term services, more accessible services and locations, and incorporating cultural values and norms into services. At the practitioner level, participants recommended hiring bilingual/bicultural staff and providing culturally responsive and trauma-informed training. Much of the cultural competency literature focuses on practitioner skills and knowledge, but findings from the current study suggest that changes at the intervention and institutional level are just as important. Such changes include the development of non-Western service models, relationship-based methods of community engagement, and long-term services to meet survivors' needs. [ABSTRACT FROM AUTHOR]

People taking antipsychotic medications are at increased risk for obesity, diabetes, and early mortality. Few weight loss interventions have targeted this population. Thirty-six individuals were randomized to an evidence-based 12-week weight loss intervention (PREMIER with DASH diet, n = 18) or to usual care (n = 18) in this feasibility trial. Average attendance was 8.6 of 12 sessions. Intent-to-treat analyses of covariance, adjusted for baseline weight, showed significant changes in weight: Mean weight in intervention participants declined from 213.3 to 206.6 pounds, while control participants' weight was unchanged. It is possible to recruit, assess, intervene with, and retain participants taking antipsychotic medications in a dietary and exercise lifestyle change trial. Participants reported high levels of satisfaction with the intervention. [ABSTRACT FROM AUTHOR]

Background: The National Consortium for Multicultural Education for Health Professionals (Consortium) comprises educators representing 18 US medical schools, funded by the National Institutes of Health. Collective lessons learned from curriculum implementation by principal investigators (PIs) have the potential to guide similar educational endeavors.Objective: Describe Consortium PI's self-reported challenges with curricular development, solutions and their new curricular products.Methods: Information was collected from PIs over 2 months using a 53-question structured three-part questionnaire. The questionnaire addressed PI demographics, curriculum implementation challenges and solutions, and newly created curricular products. Study participants were 18 Consortium PIs. Descriptive analysis was used for quantitative data. Narrative responses were analyzed and interpreted using qualitative thematic coding.Results: Response rate was 100%. Common barriers and challenges identified by PIs were: finding administrative and leadership support, sustaining the momentum, continued funding, finding curricular space, accessing and engaging communities, and lack of education research methodology skills. Solutions identified included engaging stakeholders, project-sharing across schools, advocacy and active participation in committees and community, and seeking sustainable funding. All Consortium PIs reported new curricular products and extensive dissemination efforts outside their own institutions.Conclusion: The Consortium model has added benefits for curricular innovation and dissemination for cultural competence education to address health disparities. Lessons learned may be applicable to other educational innovation efforts. [ABSTRACT FROM AUTHOR]

This study investigated young adults' beliefs about their intra- and intergenerational communications in South Vietnam, North Vietnam, and the U.S.A. Respondents perceived their interactions with older people as simultaneously more problematic (e.g., older people seen as more nonaccommodative) and more pleasing (e.g., older adults seen as more accommodative) than their interactions with other young adults. Young adults also strongly felt more of an obligation to be respectful, and to a lesser degree avoidant, in their communication with older adults than to those in their peer age group. Large-scale linguistic, historical, political, and cultural differences notwithstanding, a similar intergenerational communication profile emerged among the North Vietnamese, South Vietnamese, and American respondents in their reports of their communication with people of different ages. Intergroup, cultural, identity, and modernity issues were invoked to account for these findings. [ABSTRACT FROM AUTHOR]

Ethnographic materials, including depth interviews and a video, are analyzed to better understand how expatriate retirees living in the Lake Chapala Riviera region of Jalisco, Mexico manage personal identities in retirement. Using concepts from narrative gerontology, this study demonstrates how expatriates' stories and descriptions of Mexicans and Mexican ways of life reflexively construct storytellers' identities and provide a logic for intercultural relationships. While the host population is characterized as happy, friendly, helpful, enterprising and polite, concurrent stories by the same narrators portray them also as untrustworthy, inaccessible, lazy and incompetent. A discourse analysis that extends Cavarero's narrative identity theory argues that these contrasting conceptions of the host culture and population are deployed so as to reflexively position expatriate retirees as interpersonally attractive, culturally tolerant and pragmatically adaptable. Implications for the subjective experience of international migrant retirees are drawn from the descriptive analysis. [ABSTRACT FROM AUTHOR]