The Medical clinics of North America
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Sarcoidosis is a disease found in most populations worldwide, although it has a proclivity for relatively young African-American women in the United States. Although the pathogenesis is unknown, there likely are social, environmental, and genetic factors that are involved. Sarcoidosis seems to be different between whites and African Americans, with the latter population experiencing more severe and chronic disease. Improving access to care and addressing other disparities in health care may help to bridge the gap in health outcomes observed between patients.
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Med. Clin. North Am. · Jul 2005
ReviewCorrectable sources of disparities in cancer among minority elders.
This article explores the hypothesis that medical policies and procedures represent immediately correctible causes of disparity in minority elders. Evidence of policies and procedures that have the unintended consequence of creating disparity is presented. ⋯ Specific prostate cancer issues with unintended effects include the prostate cancer screening controversy, access to diagnostic facilities in minority communities, and special needs of older adult cancer survivors. A summary of all recommendations and their implications across cancer sites is provided.
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HIV infection among racial and ethnic minorities is an ongoing health crisis. The disproportionate impact of HIV infection on racial and ethnic minorities has affected communities already struggling with many social and economic challenges, such as poverty, substance abuse, homelessness,unequal access to health care, and unequal treatment once in the health care system. Superimposed on these challenges is HIV infection, the transmission of which is facilitated by many of these factors. ⋯ Prevention of HIV infection remains essential, especially among those seeking care for HIV infection. Despite several published recommendations for the inclusion of HIV prevention in the clinical care setting, studies have documented how few providers actually achieve this goal, especially those who care for disadvantaged patients. Although there are many barriers to discussing HIV risk behaviors and prevention strategies in an office visit,including time constraints and potential provider discomfort in discussing these matters, clinical visits represent an important opportunity to reinforce HIV prevention and possibly decrease further HIV transmission.
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Med. Clin. North Am. · Jul 2005
Review Comparative StudyRheumatic diseases in minority populations.
Rheumatic diseases are expressed in all ethnic populations, but differ in prevalence, genetic associations, clinical features, and responses to interventions. Most data describing these differences do so in reference to and comparisons with white populations. These are sparse data that evaluate differences within minority populations where there is more homogeneity of external factors, such as social, cultural, and behavioral attitudes. This article reviews the features that are unique to various rheumatic diseases within minority populations.
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Med. Clin. North Am. · Jul 2005
ReviewRacial and ethnic disparities in breast cancer: a multilevel perspective.
Although the etiology of racial and ethnic disparities in breast cancer is complex, the studies reviewed here suggest many possible culprits. In the authors' model, outcomes at the cellular level reflect not only genetic constitution and the hormonal milieu but also the interactions of predictors at multiple levels. At the societal level, important predictors include toxin and hormone exposure, access to care, quality of care, and social support. ⋯ Increasing incidence of breast cancer among both men and women likely reflects important trends at the societal and individual levels. These trends may include increased toxin exposure, increased obesity, and changes in the timing and number of births. Efforts to reduce breast cancer incidence and disparities must consider societal and individual factors and the important effects these factors can have on normal cell function.